Narrative Synthesis Of Quantitative Data Research Articles

Feeding difficulties in children with food allergies: An EAACI Task Force Report.

The term "feeding difficulties" refers to a spectrum of phenotypes characterized by suboptimal intake of food and/or lack of age-appropriate eating habits. While it is evident that feeding difficulties are prevalent within healthy children, no consensus has been reached for those with food allergies. The aim of this study was to systematically review all the available literature reporting the prevalence of feeding difficulties within food allergic children. We searched eight international electronic databases for all published studies until June 2022. International experts in the field were also contacted for unpublished and ongoing studies. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so narrative synthesis of quantitative data was performed. A total of 2059 abstracts were assessed, out of which 21 underwent full-text screening and 10 studies met the study criteria. In these, 12 different terms to define feeding difficulties and 11 diagnostic tools were used. Five papers included data of feeding difficulty prevalence in children with food allergies, ranging from 13.6% to 40%. Higher prevalence was associated with multiple food allergies. The current literature suggests that feeding difficulties are prevalent within food allergic children, particularly those with multiple food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging. Consensus guidelines for the diagnosis and management of feeding difficulties within food allergic children and further research on the development and perpetuation of feeding difficulties are needed to appropriately manage such patients.

Early Intervention With a Curative Intent Through an Intensive Therapy Versus Immunologic Disease Control Using a Minimal Intensity Approach in the Management of High-risk Smoldering Multiple Myeloma: A Systematic Review of Evidence From Clinical Trials.

A subset of individuals with smoldering myeloma (SMM) are at a high risk of progression to symptomatic myeloma. Current efforts are focused on identifying this high-risk group and intercepting the disease process before its progression. There is no consensus on what the goal of an intervention should be, whether to aim for a cure through a high-intensity intervention or pursue immunologic disease control using the least intense approach. This systematic review summarized current evidence in support of the optimum approach. A database search of Medline/PubMed, Scopus, EMBASE, Web of Science, CINAHL, Wiley Cochrane Library, clinicaltrials.gov, and conference proceedings of ASH, EHA, ASCO, ESMO was performed. Results were presented using narrative synthesis of quantitative data. Of the 2088 identified records, a total of 10 eligible studies made up of 6 minimal-intensity clinical trials, 3 moderate-intensity trials, and 1 high-intensity trial were included in this review with a total demographic population of 588 high-risk SMM patients. Minimal intensity lenalidomide-based regimen demonstrated clinical effectiveness in delaying disease progression and improving overall survival in high-risk SMM. The single-agent monoclonal antibodies did not have any major impact on improving overall survival, although the studies were not powered to do so. There is a marked increase in the depth of response as the intensity of treatment increases without a proportional improvement in overall survival. Moderate- and high-intensity interventions yielded similar minimal residual disease negativity rates and overall survival. The minimal, moderate, and high-intensity approaches all demonstrated clinical benefits in delaying disease progression and improving overall survival in patients with high-risk SMM and increasing intensity of intervention does not necessarily translate to improved overall survival.

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

BackgroundGlobal consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease. ObjectiveTo inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers. MethodsPubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure). ResultsOf 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty). ConclusionsNo definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.

Strengthening the clinical academic pathway: a systematic review of interventions to support clinical academic careers for doctors and dentists

ObjectiveEvaluate existing evidence on interventions intended to increase recruitment, retention and career progression within clinical academic (CA) careers, including a focus on addressing inequalities.DesignSystematic review.Data sourcesMedline, Embase, Cochrane Controlled Register...

Guilt, shame, and postpartum infant feeding outcomes: A systematic review.

Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: ‘underprepared and ineffectively supported’, ‘morality and perceived judgement’ (breastfeeding), ‘frustration with infant feeding care’ and ‘failures, fears and forbidden practice’ (formula feeding). Both guilt and shame were associated with self‐perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided.

Physicians perspectives about medical sources of information: protocol for an overview of systematic reviews.

Despite the growing availability of evidence and sources of information, it is not clear what are the physicians preferences for filling gaps in their medical knowledge. To summarize the available evidence about physicians preferences and perceived barriers and facilitators about sources of information. We will undertake an overview of systematic reviews according to PRISMA guidelines. We will search Epistemonikos from inception until March 2019. We will also search PROSPERO, and we will perform a forward citation search in Scopus. Inclusion criteria will consider systematic reviews (qualitative, quantitative, or mixed methods) focusing on physicians preferences about sources of information, as well as perceived barriers and facilitators. Two authors will independently screen and select records for inclusion. We will appraise the quality of included systematic reviews using the Joanna Briggs Institute checklist, and the overlap of primary studies according to the corrected covered area formula. We will conduct a narrative synthesis of quantitative data and a thematic analysis of qualitative findings. We expect that our findings will contribute to improving the evidence-based general practice by identifying physicians perspectives about different sources of medical information.

A systematic review of the impact of person-centred care interventions on the behaviour of staff working in dementia care.

To examine the content, focus, and effectiveness of person-centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia. Systematic search and narrative synthesis of quantitative data. PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA, and BNI were searched from inception to 5 November 2016. All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP). A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour. The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. In future, more rigorously controlled research comparing the relative effectiveness of these interventions will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC. This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.

Lack of transparency in reporting narrative synthesis of quantitative data: a methodological assessment of systematic reviews

ObjectiveTo assess the adequacy of reporting and conduct of narrative synthesis of quantitative data (NS) in reviews evaluating the effectiveness of public health interventions. Study Design and SettingA retrospective comparison of a 20% (n = 474/2,372) random sample of public health systematic reviews from the McMaster Health Evidence database (January 2010–October 2015) to establish the proportion of reviews using NS. From those reviews using NS, 30% (n = 75/251) were randomly selected and data were extracted for detailed assessment of: reporting NS methods, management and investigation of heterogeneity, transparency of data presentation, and assessment of robustness of the synthesis. ResultsMost reviews used NS (56%, n = 251/446); meta-analysis was the primary method of synthesis for 44%. In the detailed assessment of NS, 95% (n = 71/75) did not describe NS methods; 43% (n = 32) did not provide transparent links between the synthesis data and the synthesis reported in the text; of 14 reviews that identified heterogeneity in direction of effect, only one investigated the heterogeneity; and 36% (n = 27) did not reflect on limitations of the synthesis. ConclusionNS methods are rarely reported in systematic reviews of public health interventions and many NS reviews lack transparency in how the data are presented and the conclusions are reached. This threatens the validity of much of the evidence synthesis used to support public health. Improved guidance on reporting and conduct of NS will contribute to improved utility of NS systematic reviews.

Review article: A scoping review of physiotherapists in the adult emergency department.

To provide an overview of the literature that considers physiotherapists working in the ED in relation to their roles, training levels, patient profile, safety, effectiveness, efficiency, cost-effectiveness and the provision of low-value care. We performed a scoping review of the literature. Four databases (PubMed, EMBASE, CINAHL and Cochrane CENTRAL) were searched from their inception to December 2016 and we updated searches on PubMed in September 2017. Two reviewers independently screened studies for eligibility. We performed a narrative synthesis of quantitative data. We included 27 studies: five randomised controlled trials (n = 1434), 12 prospective observational studies (n = 153 767), six retrospective studies (n = 9968), two survey studies (n = 61), one case report (n = 3) and one qualitative study (n = 11). Physiotherapists primarily managed patients with low urgency musculoskeletal conditions. Physiotherapists appeared to have similar clinical effectiveness and costs compared to other health providers (four randomised controlled trials). Physiotherapists were associated with increased efficiency (eight observational studies) and reduced low-value care (one observational study). Three observational studies reported very low adverse event rates. However, none of the studies followed participants to measure adverse events that became apparent after the ED visit, nor did they consider unsafe discharge decisions or suboptimal follow-up care. The available evidence suggests that physiotherapists may be as effective as other health providers in managing low urgency musculoskeletal conditions in the ED. There is uncertainty about appropriate training and a lack of robust studies investigating the efficiency, safety and cost-effectiveness of this model of care.

Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence.

Smoking prevalence remains high in some vulnerable groups, including those who misuse substances, have a mental illness, are homeless, or are involved with the criminal justice system. E-cigarette use is increasing and may support smoking cessation/reduction. Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups. Databases searched were MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, ProQuest Dissertations and Theses, and Open Grey. Narrative synthesis of quantitative data and thematic synthesis of qualitative data. 2628 records and 46 full texts were screened; 9 studies were identified for inclusion. Due to low quality of evidence, it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable populations. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy. Four studies suggested significant smoking reduction; however, three were uncontrolled and had sample sizes below 30. A prospective cohort study found no differences between e-cigarette users and nonusers. No significant adverse events and minimal side effects were identified. Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceptions of effectiveness for cessation/reduction; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity. Further research is needed to identify the most appropriate device types for practicality and safety, level of support required in e-cigarette interventions, and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups. Smoking prevalence among people with mental illness, substance misuse, homelessness, or criminal justice system involvement remains high. E-cigarettes could support cessation. This systematic review found limited quantitative evidence assessing effectiveness. No serious adverse events were identified. Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B (capability, opportunity, motivation, and behavior) model, including practical barriers; perceived effectiveness; design features contributing to automatic and reflective motivation; smoking bans facilitating practical opportunity; and social connectedness increasing social opportunity. Further research should consider appropriate devices for practicality and safety, concurrent support, and comparison with best practice smoking cessation support.

Improving Conduct and Reporting of Narrative Synthesis of Quantitative Data (ICONS-Quant): protocol for a mixed methods study to develop a reporting guideline

IntroductionReliable evidence syntheses, based on rigorous systematic reviews, provide essential support for evidence-informed clinical practice and health policy. Systematic reviews should use reproducible and transparent methods to draw conclusions from...