Narrative Synthesis In Systematic Reviews Research Articles

Interventions for children who have experienced physical abuse: A systematic review narrative synthesis

AimPhysical abuse has been linked to poor mental and physical health in adulthood, more recently findings have suggested that these effects can be present in children as young as three. Though these effects are known, research exploring interventions specifically for children who have experienced physical abuse is scarce. The current systematic review uses a narrative synthesis approach to examine studies which reported on interventions for children who have experienced physical abuse. MethodA number of databases were searched, and studies were selected based on hierarchical criteria. This systematic review used a narrative synthesis approach to evaluate the interventions involved in the studies selected. Results: There were 17 studies included in this review, each of the studies reported improvements in at least one of the necessary outcome areas evaluated which included: behavioural, cognitive, and socio-emotional outcomes. ConclusionOverall efficacy of interventions was not able to be determined due to the heterogeneity of the studies, however theoretical underpinnings and successful components of interventions are discussed in this review. Limitations and recommendations for the future are also addressed.

Guided Imagery for Symptom Management of Patients with Life-Limiting Illnesses: A Systematic Review of Randomized Controlled Trials.

Background: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery (GI), a complementary and integrative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of articles was evaluated using the Cochrane Collaboration's Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 14 randomized controlled trials were included in this review. The quality assessment revealed that four studies had a high risk of bias, nine had some concerns, and one had a low risk of bias. Out of the 14 studies, 6 evaluated oncological diagnosis, while the remaining 8 focused on nononcological diagnoses across 6 different diseases. GI was found to be effective in managing symptoms in 10 out of the 14 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, sleep disturbances, and fatigue. Conclusion: GI therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses at different stages.

Coparenting After Divorce: An Approach to Typologies and Context of Intervention

Co-parenting after divorce is the relationship of mutual collaboration, support and communication between two parents no longer romantically linked to each other, who work together to raise and care for their children together. Over the past decade, research on co-parenting after divorce has increased. Therefore, the question arises as: what has been published in the last decade on co-parenting after divorce or separation? The aim of this study was to collect, review and synthesize articles published in scientific databases about co-parenting after divorce, to inform about the state of the art on this topic in the last decade to update professionals, academics and researchers who work in the family area, such as social workers, psychologists or lawyers. Thus, a systematic literature review was carried out in seventeen academic databases during August and September 2023. This systematic literature review followed the preferred reporting protocol for systematic reviews and meta-analyses (PRISMA-P) and it was registered in PROSPERO (ID=CRD42022306146). Twenty-nine articles met the inclusion criteria and the quality of each one of them was evaluated with the MMAT instrument. Data were analyzed following the guide for narrative synthesis in systematic reviews. The results show that most of the articles were published during the year 2017, mostly they were from the United States, the type of studies were investigation, with a quantitative design whose participants were fathers and mothers (not dyads). Three recurring themes were identified in the included studies. The three themes were named as: (1) co-parenting categories, (2) components, and (3) interventions. In addition, an integration of the study variables found in the included articles is included and they are organized into four dimensions: positive and negative co-parental relationships, and internal and external factors. It is recommended to regulate through public policies that divorced parents attend interventions or psychoeducational programs as a compulsory stage of the divorce process to promote good co-parenting and prevent conflictive co-parenting relationships.

Investigating the impact of terrorist attacks on the mental health of emergency responders: systematic review.

Terrorist attacks have strong psychological effects on rescue workers, and there is a demand for effective and targeted interventions. The present systematic review aims to examine the mental health outcomes of exposed emergency service personnel over time, and to identify risk and resilience factors. A literature search was carried out on PubMed and PubPsych until 27 August 2021. Only studies with a real reported incident were included. The evaluation of the study quality was based on the Quality Assessment Tool for Quantitative Studies, and the synthesis used the 'Guidance on the Conduct of Narrative Synthesis in Systematic Reviews'. Thirty-three articles including 159 621 individuals were identified, relating to five different incidents with a post-event time frame ranging from 2 weeks to 13 years. The post-traumatic stress disorder prevalence rates were between 1.3 and 16.5%, major depression rates were between 1.3 and 25.8%, and rates for specific anxiety disorders were between 0.7 and 14%. The highest prevalence rates were found after the World Trade Center attacks. Reported risk factors were gender, no emergency service training, peritraumatic dissociation, spatial proximity to the event and social isolation. The inconsistency of the prevalence rates may be attributable to the different severities of the incidents. Identified risk factors could be used to optimise training for emergency personnel before and after catastrophic events. Voluntary repetitive screening of rescue workers for mental health symptoms is recommended.

Does Connected Health Technology Improve Health-Related Outcomes in Rural Cardiac Populations? Systematic Review Narrative Synthesis.

Individuals living in rural areas are more likely to experience cardiovascular diseases (CVD) and have increased barriers to regular physical activity in comparison to those in urban areas. This systematic review aimed to understand the types and effects of home-based connected health technologies, used by individuals living in rural areas with CVD. The inclusion criteria included technology deployed at the participant’s home and could be an mHealth (smart device, fitness tracker or app) or telehealth intervention. Nine electronic databases were searched across the date range January 1990–June 2021. A total of 207 full texts were screened, of which five studies were included, consisting of 603 participants. Of the five studies, four used a telehealth intervention and one used a form of wearable technology. All interventions which used a form of telehealth found a reduction in overall healthcare utilisation, and one study found improvements in CVD risk factors. Acceptability of the technologies was mixed, in some studies barriers and challenges were cited. Based on the findings, there is great potential for implementing connected health technologies, but due to the low number of studies which met the inclusion criteria, further research is required within rural areas for those living with cardiovascular disease.

Effectiveness of technology-enhanced simulation in teaching digital rectal examination: a systematic review narrative synthesis

BackgroundDigital rectal examination (DRE) is a challenging examination to learn.ObjectiveTo synthesise evidence regarding the effectiveness of technology-enhanced simulation (TES) for acquiring DRE skills.Study selectionEMBASE, Medline, CINAHL, Cochrane, Web of Knowledge...

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk.

BackgroundThe accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's ‘gut feeling’ or perception of risk correlates with patient outcomes and available risk scoring systems.MethodsA systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation‐specific morbidity and long‐term outcomes.ResultsTwenty‐seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC). Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre‐existing risk prediction models. Long‐term outcomes were poorly predicted by surgeons, with AUC values ranging from 0·51 to 0·75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery.ConclusionSurgeons consistently overestimate mortality risk and are outperformed by pre‐existing tools; prediction of longer‐term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision‐making.

Ayurvedic Interventions for Psoriasis

Background: Psoriasis produces significant adverse effects on the psychological and social aspects of the patient, mainly because of its visibility. World Health Organization's (WHO) recent Global Report on Psoriasis states that there are many unmet research gaps in psoriasis with respect to treatment and ways to improve healthcare services. Clinical Research on psoriasis should focus on options that can be applicable globally, on a large-scale. Plenty of studies individually proving efficacy of various Ayurvedic treatment modalities in subjective and objective improvement of psoriasis are published. Systematic reviews of complementary and alternative medicine (CAM) on psoriasis are available, but these studies do not include Ayurvedic interventions. Aim: Thorough review of published data of Ayurvedic interventions in the management of psoriasis to provide more precise estimates of safety and effectiveness of Ayurvedic interventions for psoriasis. Objective: Outlining the protocol to conduct a Systematic Review of published studies examining the effects of Ayurvedic interventions on psoriasis. Materials and methods: The preferred reporting items for systematic review and meta-analysis (PRISMA) protocols guidelines, The Cochrane Handbook for Systematic Reviews of Interventions, the consolidated standards of reporting trials guidelines, guidance on the conduct of narrative synthesis in systematic reviews provided the design to conduct and report the protocol, structure research question and search term selection and the data extraction form; though some adaptations may be made with regard to search terms, data synthesis, and evaluating the risk of bias. Trial registration number: PROSPERO 2018 CRD42018097298. Dissemination: The SR will be published in a peer-reviewed journal. The review will be updated to inform and guide healthcare practice and policy.

Alterations in PGC1\u03b1 expression levels are involved in colorectal cancer risk: a qualitative systematic review

BackgroundColorectal cancer (CRC) is a major global public health problem and the second leading cause of cancer-related death. Mitochondrial dysfunction has long been suspected to be involved in this type of tumorigenesis, as supported by an accumulating body of research evidence. However, little is known about how mitochondrial alterations contribute to tumorigenesis. Mitochondrial biogenesis is a fundamental cellular process required to maintain functional mitochondria and as an adaptive mechanism in response to changing energy requirements. Mitochondrial biogenesis is regulated by peroxisome proliferator-activated receptor gamma coactivator 1-α (PPARGC1A or PGC1α). In this paper, we report a systematic review to summarize current evidence on the role of PGC1α in the initiation and progression of CRC. The aim is to provide a basis for more comprehensive research.MethodsThe literature search, data extraction and quality assessment were performed according to the document Guidance on the Conduct of Narrative Synthesis in Systematic Reviews and the PRISMA declaration.ResultsThe studies included in this review aimed to evaluate whether increased or decreased PGC1α expression affects the development of CRC. Each article proposes a possible molecular mechanism of action and we create two concept maps.ConclusionOur systematic review indicates that altered expression of PGC1α modifies CRC risk. Most studies showed that overexpression of this gene increases CRC risk, while some studies indicated that lower than normal expression levels could increase CRC risk. Thus, various authors propose PGC1α as a good candidate molecular target for cancer therapy. Reducing expression of this gene could help to reduce risk or progression of CRC.

Adherence to self-care behaviours and associated barriers in type 2 diabetes patients of low-and middle-income countries: a systematic review protocol

BackgroundDiabetes has become a global health emergency affecting high-, middle- and low-income countries. Previous systematic reviews have either focused on patients’ adherence to diabetes self-care behaviours only or barriers to diabetes care (including self-care) only in the published literature and have not also analysed data separately for low- and middle-income countries (LMICs). Thus, none have focused on adherence with, and barriers to, self-care behaviours from the perspectives of both patient and providers in low- and middle-income countries (LMICs). This systematic review will evaluate the published literature on adherence to five diabetes self-care behaviours (i.e., diet, exercise, self-monitoring of blood glucose, medication taking and foot care) and associated barriers in type 2 diabetes patients in LMICs. Healthcare providers’ barriers to the provision of diabetes self-care support will also be reviewed.MethodsThis narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, MEDLINE, EMBASE, CINAHL, SCOPUS, PsycINFO, Cochrane Library and the British Nursing Index will be searched. Qualitative and quantitative studies reporting on type 2 diabetes patients’ adherence to self-care behaviours and associated barriers in LMICs will be included. Studies also reporting on barriers encountered by providers in LMICs providing diabetes care and supporting patients to adhere to self-care behaviours will also be included. Cross-sectional studies, observational cohort studies, baseline data of randomised controlled trials and qualitative studies will be eligible. Two independent reviewers will screen articles for inclusion, undertake quality assessment of included studies and execute data extraction using standardised forms. Discrepancies will be discussed to reach consensus, and another reviewer will adjudicate if the need arises. The Guidance of Narrative Synthesis in Systematic Reviews will be employed to explore relationships within and between included studies.DiscussionThis review will provide evidence on adherence to self-care behaviours by type 2 diabetes patients in LMICs. Barriers experienced by patients in LMICs to adhere to recommended self-care behaviours will also be identified. Barriers experienced by healthcare providers in LMICs in providing self-care support patients will also be determined.Systematic review registrationPROSPERO CRD42016035406

Reporting of narrative synthesis in systematic reviews of public health interventions: a methodological assessment

BackgroundThe value of systematic reviews for decision making is their transparency, reproducibility, and robust approach to assessing the evidence base. For reviews of public health interventions, quantitative data are often narratively synthesised. Narrative synthesis has been criticised for its lack of transparency, raising concerns about potential bias in many systematic reviews used in public health, and threatening their value for decision making. We systematically assessed the reporting and conduct of narrative synthesis in reviews assessing public health interventions. MethodsWe screened a 20% (474/2372) random sample of systematic reviews published between Jan 1, 2010, and Oct 31, 2015, from the McMaster Health Evidence database (a comprehensive database of systematic reviews of public health interventions), to identify reviews that had synthesised quantitative data narratively. From these reviews we investigated a 30% (n=75) random sample in greater detail. Informed by key guidance on narrative synthesis methods, we extracted data about the description of narrative synthesis methods, presentation of data, and management of heterogeneity by review authors. These data were used to assess the adequacy of reporting of narrative synthesis. FindingsNarrative synthesis was used in 251 (53%) of the 474 reviews sampled. Reporting of narrative synthesis methods and data were limited in most reviews: 58 (77%) of the 75 reviews assessed in more detail provided no rationale for or description of the narrative synthesis process, with 36 (48%) simply stating that meta-analysis was not possible. Presentation of data was often incomplete (40%, n=30), with investigation and management of heterogeneity unclear. Of the 51 reviews in which data were grouped, 22 (43%) tabulated data differently from how the data were grouped in the text. InterpretationNarrative synthesis of quantitative data in public health reviews is often inadequate. Reporting of methods is limited, and available guidance is rarely referred to. Links between the data and the narrative summary are often unclear. This lack of transparency prevents assessment of the reliability of review findings, and threatens the credibility of systematic reviews that use narrative synthesis. For many public health questions, narrative synthesis will continue to be a necessary synthesis method. Updated guidance is therefore required, and review authors need to be transparent in their reporting of narrative synthesis, thereby improving reliability. FundingMC and HT were funded by the UK Medical Research Council Chief Scientist Office Informing Healthy Public Policy programme (MC_UU_12017-15). SVK is supported by a NHS Research Scotland Scottish senior clinical fellowship (SCAF/15/02).

A Systematic Review Protocol to Assess the Effects of Physical Activity on Health and Quality of Life Outcomes in Adolescent Cancer Survivors.

BackgroundThe benefits of physical activity for child and adult cancer survivors have been summarized in previous systematic reviews. However, no review has summarized the evidence for adolescent cancer survivors.ObjectiveThis paper describes the design of a protocol to conduct a systematic review of published studies examining the effects of physical activity on health and quality of life outcomes for adolescent cancer survivors. MethodsSeveral guidelines informed the development of this protocol. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines provided the structure by which to conduct and report the protocol; though some adaptations were made with regards to search terms, data synthesis, and evaluating the risk of bias. The Cochrane Handbook for Systematic Reviews of Interventions was used to guide research question development, search term selection, and the data extraction form. The Consolidated Standards of Reporting Trials guidelines helped inform the data extraction form. Lastly, the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews informed the data synthesis. Ten electronic databases were identified and a search strategy was developed using a combination of Medical Subject Headings terms and keywords that were developed by the authors and peer reviewed by a university librarian. Both authors independently screened eligible studies for final inclusion, and data were abstracted using a form developed by the research team. A decision was made to synthesize all data narratively.ResultsThe review has now been completed, peer-reviewed, and accepted for publication in a forthcoming issue of JMIR Cancer. ConclusionsAs this will be the first systematic review on this topic, outlining the protocol ensures transparency for the completed review. Further, this protocol illustrates how elements from several guidelines were incorporated to answer the research question (ie, what is the effect of physical activity on health and quality of life outcomes in adolescent cancer survivors). This flexible approach was necessary as a function of the paucity of available research on this topic.

Testing Methodological Guidance on the Conduct of Narrative Synthesis in Systematic Reviews

The objective was to assess the impact of new guidance on the conduct of narrative synthesis in systematic reviews of effectiveness, by means of a blinded comparison of guidance-led narrative synthesis against a meta-analysis of the same study data.The conclusions of the two syntheses were broadly similar. However, differences between the approaches meant that conclusions about the impact of moderators of effect appeared stronger when derived from the meta-analysis, whereas implications for future research appeared more extensive when derived from the narrative synthesis. These findings emphasize that a rigorously conducted narrative synthesis can add meaning and value to the findings of meta-analysis.The guidance framework provided a useful vehicle for structuring a narrative synthesis and increasing transparency and rigour of the process.While there may be risks with overinterpretation of study data, the framework, tools and techniques described in the guidance appear to increase the transparency and reproducibility of narrative synthesis.