Narrative Synthesis Of Evidence Research Articles

How Electronic Cigarette Affects the Vascular System.

The popularity of the electronic cigarette has soared in the last decades. However, the health effect of smoking electronic cigarettes on the vascular system is unclear. This systematic review examines the electronic cigarettes' effect on the vascular system from recent evidence. A systematic search was conducted in MEDLINE (PubMed) database from January 2016 to August 2021 for studies assessing the vascular effect of chronic use of electronic cigarettes on human and animal. The Cochrane Risk of Bias 2, NIH Quality Assessment for Cross-Sectional Study, and SYRCLE's Risk of Bias were used to assess the risk of bias in interventional, observational, and animal study, respectively. A narrative synthesis of evidence is provided to describe results. From 101 retrieved studies related to electronic cigarettes effect on the vascular system, a total of 16 studies are included in this review. The overall results indicated that electronic cigarette use is associated with adverse events in the vascular, including the incident of elevated oxidative stress, endothelial dysfunction, inflammation, arterial stiffness, and the development of atherosclerotic lesion. Further studies should broaden perspectives and reveal more about the mechanism of how electronic cigarettes impact on vascular system.

Telehealth interventions for mobility after lower limb loss: A systematic review and meta-analysis of randomized controlled trials.

Mobility is a crucial component for healthy aging after lower limb loss (LLL). Telehealth technologies, for example, smart devices, are novel approaches for health programs delivery regardless of geographical boundaries. To assess the effect of telehealth interventions on mobility, quality of life, and antecedents of health behavior compared with a control condition (usual care or simpler telehealth interventions with fewer number of behavior change techniques [BCTs]) for community-dwelling adults (>50 years) with an LLL and the effect of mode of delivery and BCTs used in telehealth interventions on health outcomes. Systematic review and meta-analysis. We systematically searched MEDLINE, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PsycINFO, and SPORTDiscus on January 28, 2021, to identify relevant randomized controlled trials. Two authors independently screened records and assessed risk of bias. We conducted a narrative synthesis of evidence and, when appropriate, used the standardized mean difference (SMD) and mean difference for meta-analyses and the Grading Recommendations Assessment, Development, and Evaluation approach for practice recommendations. We identified six randomized controlled trials. Telephone was the most common delivery mode (n = 3), and "instructions for performing behaviors" was the most common BCT (n = 5). Very low certainty evidence showed no changes in mobility (six studies: SMD = 0.33 [95% confidence interval [CI] = -0.08, 0.75]), quality of life (two studies: mean difference = -0.08 [95% CI = -0.30, 0.15]), and antecedents of behavior (five studies: SMD = 0.04 [95% CI = -0.28, 0.36]). Our review highlights a knowledge gap for the effect of telehealth interventions for people with LLL. Although no promising effect was shown for telehealth interventions, very low certainty evidence precludes making a definitive clinical recommendation.

Can Digital Health Interventions Improve Adherence to Antiretroviral (ART) for Patients Living with HIV/AIDS in Sub-Saharan Africa? Systematic Review

BACKGROUND: Human Immunodeficiency Virus (HIV) infection is one of the most devastating human pandemics in Sub-Saharan Africa (SSA) and this is the region most hit by pandemic. Adherence to Antiretroviral Therapy (ART remains challenging and varies between 27% and 80% compared to the required level of 95%. Lack of adherence is of one the major causes of treatment failures. Given the increase in the use of mobile phones in Africa, text messaging is seen as a potential strategy to improve medication adherence although there is little evidence to support this argument. The aim of this review is to evaluate the efficacy of text messaging interventions to improve adherence to antiretroviral treatment.
 
 METHODS: The Effective Public Health Practice Project (APHPP) tool was used to ensure that included Randomized Controlled Trials (RCT) studies follow vigorous methodological standards including selection bias, study design, confounders, blinding, data collection methods, and withdrawal and dropout. Selected bibliographic databases MEDLINE, Web of Science, and CINAHL Plus were searched for relevant articles published in English and dated between 2005 and 2018. Six trials met the inclusion criteria as set out in the protocol. Due to the inconsistency and the likely observed heterogeneity, narrative synthesis of evidence was carried out.
 
 RESULTS: The results from 2/3 of included studies provided evidence that text messages reminders improve adherence to antiretroviral treatment whereas 1/3 produced contradictory results. Nevertheless, weekly Short Messaging Service (SMS) reminders were more effective than daily (SMS) in achieving 95% self-reported adherence to antiretroviral treatment and in reducing the frequency of treatment interruptions. The results indicated that patients receiving text messages had their plasma HIV viral load suppressed, median CD4+ cell counts increased and were on 100% on time picking up monthly ART refills compared to the control.
 
 CONCLUSION: Included studies in this review provided evidence that simple SMS reminders were important in improving and sustaining optimal ART adherences. Text messaging is seen as potential strategy to improve medication adherence. Therefore, it should be included in health systems strategies to help improve sustainable development goals. The results suggest that preventing treatment failure can be achieved by SMS reminders in a resource limited setting.

A Multidisciplinary Perspective of Ultra-Processed Foods and Associated Food Processing Technologies: A View of the Sustainable Road Ahead.

Ultra-processed foods (UPFs) are negatively perceived by part of the scientific community, the public, and policymakers alike, to the extent they are sometimes referred to as not “real food”. Many observational surveys have linked consumption of UPFs to adverse health outcomes. This narrative synthesis and scientific reappraisal of available evidence aims to: (i) critically evaluate UPF-related scientific literature on diet and disease and identify possible research gaps or biases in the interpretation of data; (ii) emphasize the innovative potential of various processing technologies that can lead to modifications of the food matrix with beneficial health effects; (iii) highlight the possible links between processing, sustainability and circular economy through the valorisation of by-products; and (iv) delineate the conceptual parameters of new paradigms in food evaluation and classification systems. Although greater consumption of UPFs has been associated with obesity, unfavorable cardiometabolic risk factor profiles, and increased risk for non-communicable diseases, whether specific food processing techniques leading to ultra-processed formulations are responsible for the observed links between UPFs and various health outcomes remains elusive and far from being understood. Evolving technologies can be used in the context of sustainable valorisation of food processing by-products to create novel, low-cost UPFs with improved nutritional value and health potential. New paradigms of food evaluation and assessment should be funded and developed on several novel pillars—enginomics, signalling, and precision nutrition—taking advantage of available digital technologies and artificial intelligence. Research is needed to generate required scientific knowledge to either expand the current or create new food evaluation and classification systems, incorporating processing aspects that may have a significant impact on health and wellness, together with factors related to the personalization of foods and diets, while not neglecting recycling and sustainability aspects. The complexity and the predicted immense size of these tasks calls for open innovation mentality and a new mindset promoting multidisciplinary collaborations and partnerships between academia and industry.

Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review

IntroductionThe Global Polio Eradication Initiative uses polio supplementary immunisation activities (SIAs) as a strategy to increase vaccine coverage and cease poliovirus transmission. Impact of polio SIAs on immunisation systems is...

Telemedicine experiences and perspectives of healthcare providers in long-term care: A scoping review

Objective To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. Methods A scoping review was conducted. A systematic search for articles published in 2000–2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included ‘telemedicine’, ‘telehealth’ and ‘nursing homes’. Results Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. Conclusion and implications Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers’ perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.

Scoping future outbreaks: a scoping review on the outbreak prediction of the WHO Blueprint list of priority diseases

BackgroundThe WHO’s Research and Development Blueprint priority list designates emerging diseases with the potential to generate public health emergencies for which insufficient preventive solutions exist. The list aims to reduce...

A systematic review into healthcare professionals' attitudes towards self-harm in children and young people and its impact on care provision.

Self-harming behaviours in children and young people are an alarming reality, with provision of effective treatment historically compromised. The present systematic literature review highlights attitudes displayed by healthcare professionals towards this health problem, providing valuable insight by analysing how these attitudes can impact patient care. Ten studies were included, allowing creation of a narrative synthesis of qualitative, quantitative and mixed-methods evidence. Six themes emerged: negativity, positivity, worry or fear, the emotional impact of working with these patients, professional roles and ward-dependent concerns. Overall, professional negativity towards this patient group, in the form of apprehensiveness, was accentuated by fear of worsening their symptoms. The attitude aforementioned impacts on treatment by hindering creation of meaningful therapeutic relationships. Educational opportunities that increase healthcare professionals' knowledge of self-harm have the potential to provide invaluable power by promoting positive attitudes.

Glenoid failure after total shoulder arthroplasty with cemented all-polyethylene versus metal-backed implants: a systematic review protocol

IntroductionAnatomical total shoulder arthroplasty (TSA) is an effective treatment adopted for patients with glenohumeral osteoarthritis (OA). The glenoid component failure is the main risk that occurs in this therapeutic choice;...

Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review

ObjectiveTo consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.DesignUmbrella review.Data sourcesMedline, Embase, and...

Misuse of the sign test in narrative synthesis of evidence.

In narrative synthesis of evidence, it can be the case that the only quantitative measures available concerning the efficacy of an intervention is the direction of the effect, that is, whether it is positive or negative. In such situations, the sign test has been proposed in the literature and in recent Cochrane guidelines as a way to test whether the proportion of positive effects is favorable. I argue that the sign test is inappropriate in this context as the data are not generated according to the binomial distribution it employs. I demonstrate possible consequences for both hypothesis testing and estimation via hypothetical examples.

Economic evaluation of manual therapy for musculoskeletal diseases: a systematic review and narrative synthesis of evidence

Economic evaluation of manual therapy for musculoskeletal diseases: a systematic review and narrative synthesis of evidence

How effective are self-management interventions in promoting health-related quality of life in people after primary treatment for breast cancer? A critical evidence synthesis.

Self-management interventions (SMIs) are designed to empower people living beyond breast cancer and help them adjust to a new normal. This structured review aimed to critically appraise and synthesise up-to-date evidence on the effectiveness of SMIs to promote health-related quality of life (HRQoL) in people with breast cancer in the post-treatment period. According to PRISMA statement guidelines, MEDLINE, EMBASE and CINAHL were searched for peer-reviewed publications of randomised controlled trials of SMIs. Pre-specified selection criteria were applied to all retrieved records. Methodological quality and risk of bias were evaluated by using the Caldwell framework and Cochrane Collaboration Risk of Bias tool, respectively. Findings were integrated into a narrative critical evidence synthesis. Nine eligible trials were identified that tested nine SMIs. Five SMIs were based on cognitive behaviour therapy (CBT). Eight SMIs targeted recipients' decision-making and taking-action skills. Across trials, gains in one to four domains of HRQoL were reported. SMIs predominantly promoted recipients' physical and functional well-being, regardless of methodological quality or self-management skills applied, but effect sizes were consistently small. SMIs were mainly prescribed for 12 weeks, but optimal dosage cannot be confirmed currently. SMIs informed by CBT and/or offered through recipient education were marginally more effective. Evidence derived from moderate-to-good quality trials. SMIs are potentially effective after primary treatment for breast cancer, although effect sizes are small and inconsistent across HRQoL domains. More rigorous development and testing is required, while co-production from the early development stages or at the refinement phase is recommended.

Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review

BackgroundWe systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain.MethodsWe searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety.ResultsWe included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety – two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies.ConclusionPoor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.

Can feedback approaches reduce unwarranted clinical variation? A systematic rapid evidence synthesis

BackgroundAssessment of clinical variation has attracted increasing interest in health systems internationally due to growing awareness about better value and appropriate health care as a mechanism for enhancing efficient, effective and timely care. Feedback using administrative databases to provide benchmarking data has been utilised in several countries to explore clinical care variation and to enhance guideline adherent care. Whilst methods for detecting variation are well-established, methods for determining variation that is unwarranted and addressing this are strongly debated. This study aimed to synthesize published evidence of the use of feedback approaches to address unwarranted clinical variation (UCV).MethodsA rapid review and narrative evidence synthesis was undertaken as a policy-focused review to understand how feedback approaches have been applied to address UCV specifically. Key words, synonyms and subject headings were used to search the major electronic databases Medline and PubMed between 2000 and 2018. Titles and abstracts of publications were screened by two reviewers and independently checked by a third reviewer. Full text articles were screened against the eligibility criteria. Key findings were extracted and integrated in a narrative synthesis.ResultsFeedback approaches that occurred over a duration of 1 month to 9 years to address clinical variation emerged from 27 publications with quantitative (20), theoretical/conceptual/descriptive work (4) and mixed or multi-method studies (3). Approaches ranged from presenting evidence to individuals, teams and organisations, to providing facilitated tailored feedback supported by a process of ongoing dialogue to enable change. Feedback approaches identified primarily focused on changing clinician decision-making and behaviour. Providing feedback to clinicians was identified, in a range of a settings, as associated with changes in variation such as reducing overuse of tests and treatments, reducing variations in optimal patient clinical outcomes and increasing guideline or protocol adherence.ConclusionsThe review findings suggest value in the use of feedback approaches to respond to clinical variation and understand when action is warranted. Evaluation of the effectiveness of particular feedback approaches is now required to determine if there is an optimal approach to create change where needed.

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

A systematic review of the prevalence and risk factors of smoking among Saudi adolescents.

Objectives:To systemically review the evidence concerning the prevalence and reported risk factors of smoking among adolescents in Saudi Arabia.Methods:Following the PRISMA guidelines, studies that examined the prevalence and risk factors of smoking among adolescents in Saudi Arabia were identified through a computerized literature search using the following databases up to March 2018: PubMed, SCOPUS, Web of Science, and BIOSIS. The following search terms were used: smoking OR smok* OR tobacco OR cigar* OR shisha OR shesha OR sheesha AND Saudi Arabia OR KSA. Peer-reviewed articles published within the period from 2007 to 2018 were selected. Studies that reported prevalence data, patterns, and risk factors of smoking among adolescents were included. Extracted data from each study were tabulated, and data were narratively synthesized.Results:Thirty-two studies that reported the prevalence of smoking in the adolescent age group were included in the narrative evidence synthesis. These studies were conducted on secondary school students (n=11), college students (n=14), and an adolescent age group without educational specifications (n=7). According to published reports between 2007 and 2018, the prevalence of tobacco smoking among adolescents in Saudi Arabia ranged from 2.4% to 39.6%. Influence of friends, and family negligence were the most commonly reported risk factors for smoking.Conclusion:The prevalence of smoking is relatively high among adolescents in Saudi Arabia. The social influence of friends, teachers or parents, low academic performance, having spare time, living away from home, and the desire to relieve stress were the most commonly reported risk factors for smoking.PROSPERO REG. NO: CRD: 42018108053

Weight Management in Young Adults: Systematic Review of Electronic Health Intervention Components and Outcomes.

BackgroundYoung adulthood is a vulnerable period for unhealthy lifestyle adoption and excess weight gain. Scant attention has been focused on developing and evaluating effective weight gain prevention strategies for this age group. Electronic health (eHealth) offers potential as a cost-effective means of delivering convenient, individually-tailored, and contextually-meaningful interventions at scale.ObjectiveThe primary aim of this systematic review was to locate and synthesize the evidence on eHealth weight management interventions targeting young adults, with a particular focus on (eHealth) intervention components and outcomes.MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was executed across the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EBSCO, EMBASE, Emerald, Education Resources Information Center, Medical Literature Analysis and Retrieval System Online, Ovid, ProQuest, PsycINFO, PubMed, Science Direct, Scopus, and Web of Science. Furthermore, 2 reviewers independently assessed records for eligibility: peer-reviewed, published in English, and report evaluations of eHealth weight management interventions targeting healthy young adults (aged 18-35 years). Data were then extracted from studies that met the criteria for inclusion. The methodological quality of studies was independently assessed by 2 reviewers using the Effective Public Health Practice Project’s (EPHPP) quality assessment tool. A comprehensive narrative evidence synthesis was then completed.ResultsOut of the 1301 studies assessed for eligibility, 24 met the criteria for inclusion. According to the EPHPP quality assessment tool, overall, 19 studies were as rated weak, 5 as moderate, and none as strong. The narrative synthesis of intervention outcomes found 8 studies reported positive weight-related outcomes, 4 reported mixed outcomes, and 12 did not report any significant changes in weight-related outcomes. The narrative synthesis of (eHealth) intervention components led to 3 levels of classification. A total of 14 studies were classified as Web-based, 3 as mobile-based, and 7 as multicomponent interventions. Following the narrative synthesis, 5 key strategies were thematically identified: self-regulation (goal setting and self-monitoring), tailored or personalized feedback, contact with an interventionist, social support, and behavioral prompts (nudges and reminders) and booster messages.ConclusionsFindings highlight the limited evidence base for eHealth weight management interventions targeting young adults. The complex nature of weight management presents an ongoing challenge for interventionists to identify what works, for whom, how, and when. The quality of the evidence in this review was generally assessed as weak; however, assessment tools such as the EPHPP are principally concerned with what should be and this is seldom equivalent to what works. Thus, while sampling, study design and retention rates will remain key determining factors of reliability and validity, further research attention directed toward the development of guiding tools for community trials is warranted.

Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months After Total Knee Arthroplasty: A Systematic Review.

One-third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. Information on study design, patient characteristics, analysis, and results was extracted using pilot-tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.

Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes iN oncologY (EPIPHANY): a systematic review protocol

IntroductionWhile there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these...