Need For Good Quality Research Research Articles

Ketogenic diet in clinical populations-a narrative review.

Ketogenic diet (KD) is a high-fat, low-carbohydrate (CHO) diet, designed to induce a metabolic state of ketosis in which the body metabolizes primarily lipids for energy production. Various forms of KD are being promoted as promising treatments for numerous health conditions from chronic headaches to weight-loss and even different forms of cancer and are becoming increasingly more popular. KD appears to be an efficacious approach for weight-loss, and maintenance, improved glycemia, cognitive function and cancer prognosis. However, there is a controversy regarding the safety of KD, and the potential health risks that might be associated with long-term exposure to KD. There is a gap between the acceptance and utilization of KD in individuals with health conditions and the criticism and negative attitudes toward KD by some clinicians. Many individuals choose to follow KD and are encouraged by the positive results they experience. Although the medical establishment does not endorse KD as a first line of treatment, clinicians need to be informed about KD, and offer support and medical supervision for patients who self-select to follow KD. This can ensure that within the boundaries of KD, patients will make good and healthy dietary choices and prevent clinical disengagement in extreme cases. To that end, there is an urgent need for good quality research to address the issues of long-term safety of KD in different clinical populations and for standardization of KD both in research and in the clinic.

E kaua e hoki i te waewae tūtuki, ā, apā anō hei te ūpoko pakaru - a systematic review of neurosurgical disease and care for Māori in New Zealand.

The Royal Australasian College of Surgeons (RACS) Te Rautaki Māori cites the need for more research dedicated to health equity in surgery for Māori. However, the gaps in research for Māori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Māori at any point from referral through to the postoperative period. A systematic review of Māori neurosurgical disease and care for Māori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement assisted study selection and reporting. Kaupapa Māori (Māori-centred) research methodology and the Māori Framework were utilized to evaluate Māori research responsiveness. Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Māori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Māori. Studies assessing long-term outcomes from the management of neurosurgical disease for Māori and patient and whānau experiences of neurosurgical care are lacking. This study indicates the limited scope of research conducted for Māori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long-term outcomes from the management of neurosurgical disease for Māori.

The Prevalence of Comorbidities and Associated Factors among Patients with Dementia in the Indian Setting: Meta-analysis of Observational Studies.

Patients with dementia usually have multiple comorbidities. The presence of comorbidities may exacerbate the progression of dementia and decreases the patient's ability to participate in health maintenance activities. However, there is hardly any meta-analysis estimating the magnitude of comorbidities among patients with dementia in the Indian context. We searched PubMed, Scopus, and Google Scholar, and relevant studies conducted in India were included. The risk of bias was assessed and a random-effects meta-analysis model was used in which I2 statistics were calculated to measure heterogeneity among studies. Fourteen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Altogether, we found the coexistence of comorbid conditions such as hypertension (51.10%), diabetes (27.58%), stroke (15.99%), and factors like tobacco use (26.81 %) and alcohol use (9.19%) among patients with dementia in this setting. The level of heterogeneity was high due to differences in the methodologies in the included studies. Our study found hypertension as the most common comorbid condition among patients with dementia in India. The observed lacuna of methodological limitations in the studies included in the current meta-analysis provides the urgent need for good quality research to successfully meet the challenges ahead while devising appropriate strategies to treat the comorbidities among patients with dementia.

Effectiveness of psychological interventions to reduce alcohol consumption among pregnant and postpartum women: a systematic review.

This study aims to synthesise the available evidence on psychological interventions to reduce alcohol consumption among pregnant and postpartum women. Six electronic databases were searched to identify controlled studies targeting pregnant and postpartum women who drink or are at risk of drinking due to previous patterns of alcohol use. Controlled quantitative studies such as randomised controlled trials and quasi-experimental studies were included. The search was limited to peer-reviewed articles in English. The methodological quality of studies was assessed using the Cochrane risk of bias tool. A narrative synthesis of the findings was conducted. In total, 12,610 records were screened, and 11 studies were eligible for inclusion (9 with pregnant women, 2 with postpartum women). All studies were randomised controlled trials. Five studies had positive or partially positive primary outcomes of reductions in drinking or abstinence, and their interventions ranged from multi-session brief interventions to self-help manuals based on cognitive behavioural components. All studies showed considerable methodological limitations. Psychological interventions may be effective in promoting abstinence or reducing alcohol consumption among pregnant and postpartum women. Interventions that demonstrated some efficacy showed higher level of engagement with pregnant women compared to studies which delivered interventions in a single session. Paucity of evidence, inconsistency of outcomes, large heterogeneity in the interventions and methodological weaknesses limit the ability to make final conclusions about the overall effectiveness of these interventions. Findings highlight the need for better quality research on this topic.

Pharmacy practice research priorities during the COVID-19 pandemic: Recommendations of a panel of experts convened by FIP Pharmacy Practice Research Special Interest Group.

Across the globe, pharmacists on the frontline continue to fight COVID-19 and its continuously evolving physical, mental, and economic consequences armed by their knowledge, professionalism, and dedication. Their need for credible scientific evidence to inform their practice has never been more urgent. Despite the exponentially increasing number of publications since the start of the pandemic, questions remain unanswered, and more are created, than have been resolved by the increasing number of publications.A panel of leading journal editors was convened by the International Pharmaceutical Federation (FIP) Pharmacy Practice Research Special Interest Group to discuss the current status of COVID-19 related research, provide their recommendations, and identify focal points for pharmacy practice, social pharmacy, and education research moving forward.Key priorities identified spanned a wide range of topics, reflecting the need for good quality research to inform practice and education. The panel insisted that a foundation in theory and use of rigorous methods should continue forming the basis of inquiry and its resultant papers, regardless of topic area. From assessing the clinical and cost effectiveness of COVID-19 therapies and vaccines to assessing different models of pharmaceutical services and education delivery, these priorities will ensure that our practice is informed by the best quality scientific evidence at this very challenging time.

Outcome of Single Stage Revision ACL Reconstruction. Retrospective Study and Review of Literature.

Pragmatic review of outcomes for single stage revision ACL reconstruction performed in a single center and the reasons for failure in primary surgery. Retrospective study included 59 patients with revision ACL reconstruction done by one surgeon from 2007 to 2017.Clinical records, operative notes and x-rays were assessed to find the reasons of failure. The cause of failure was traumatic in 26 (44.1%) patients after primary reconstruction, incorrect tunnel position in 18(30.5%) and biological failure in 15 (25.4%). All ACL revisions were done using autografts; patellar tendon grafts in 33 patients (55.9%), ipsilateral hamstrings in 12 (20.3%), contralateral hamstrings in 9 (15.3%) and quadriceps tendons in 5 (8.5%). Twenty-one patients were contactable as regards postoperative functional outcome scores. There was an average 18 point improvement in Oxford knee score (OKS) post-operatively, 1.6 point improvement in Tegner scores and 30 point improvement in Lysholm scores. One patient (1.7%) developed septic arthritis, 4 (6.8%) had superficial infection, while 6 (10.2%) had residual instability after revision but did not have further surgery. There was lack of full extension in 4 (6.8%) patients. In BTB grafts, 2 (6.1%) patients sustained a post-traumatic patellar fracture. 1. Good outcomes of single stage revision ACL reconstruction surgery are achievable as de-monstrated in our cohort. 2. There is need for good quality research to identify whether BTB, hamstrings or quadriceps autografts are better for ACL Reconstruction.

Resistance training and modulation of cardiac autonomic control in animal models: a systematic review

The purpose of the present review is to systematically evaluate the existing literature on the effects of resistance training (RT) on cardiac autonomic control in animal models. Electronic search was conducted in Pubmed, PEDro and Scopus databases from inception till June 2018. Randomised controlled trials and quasi-experimental trials which investigated the effects of RT (for at least 4 weeks) on cardiac autonomic control (assessed either by heart rate variability, baroreflex sensitivity or post-exercise heart rate recovery) in animal models were included. Out of the total 3,442 studies retrieved by the electronic search, 9 were found to be suitable as per the eligibility criteria and were included in this review. The majority of these studies (6 out of 9) demonstrated improvement in cardiovascular autonomic control after RT in animals; however, three studies did not illustrate any significant change. Standardised mean differences (SMD) showed a significant effect of RT on root mean square of successive differences between adjacent inter-beat (R-R) intervals (RMSSD) [SMD (confidence interval (CI)) = 4.56 (2.89, 6.23); P<0.0001] and bradycardic response to change in arterial blood pressure [SMD (CI)=-2.27 (-4.50, -0.03; P=0.05)] whereas no significant change was observed for other variables of cardiac autonomic control post-RT. The present systematic review do not give a clear conclusion regarding the effect of RT on cardiac autonomic control in animal models and thus highlight the need for good quality research in future.

Review of Virtual Reality Treatment in Psychiatry: Evidence Versus Current Diffusion and Use.

This review provides an overview of the current evidence base for and clinical applications of the use of virtual reality (VR) in psychiatric practice, in context of recent technological developments. The use of VR in psychiatric practice shows promise with much of the research demonstrating clinical effectiveness for conditions including post-traumatic stress disorder, anxiety and phobias, chronic pain, rehabilitation, and addictions. However, more research is needed before the use of VR is considered a clinical standard of practice in some areas. The recent release of first generation consumer VR products signals a change in the viability of further developing VR systems and applications. As applications increase so will the need for good quality research to best understand what makes VR effective, and when VR is not appropriate for clinical services. As the field progresses, it is hopeful that the flexibility afforded by this technology will yield superior outcomes and a better understanding of the underlying mechanisms impacting those outcomes.

A Systematic Review Of The Socio-Ethical Aspects Of Massive Online Open Courses

English Abstract Massive open online courses (MOOCs) offer learners across the globe unprecedented access to education. Through sophisticated e-learning technologies and web approaches, MOOCs attract massive scale participation and global interest. Some commercial ventures place social equality at the heart of their missions, claiming to empower communities by making education accessible and affordable. In reality, the socio-ethical impact of MOOCs has not been investigated fully, so it is not clear whether they meet these aspirations. The aim of this study was to conduct a systematic literature review to examine the socio-ethical dimensions of MOOCs. The results showed a paucity of literature specifically addressing the subject in question, although there was evidence of many innovative approaches underway to examine new paradigms within learning analytics and online study behaviour that are emerging because of MOOCs. A small number of papers explored new pedagogic approaches such as conducting peer assessment on a massive scale, and how learning groups connect and establish on the open web. To conclude, this paper begins to provide a framework on which to consider the socio-ethical dimensions of MOOCs. There is a need for good quality research to provide an evidence-base to ensure MOOCs deliver a socially equitable learning experience.

Desmopressin to Prevent Rapid Sodium Correction in Severe Hyponatremia: A Systematic Review

BackgroundHyponatremia is common among inpatients and is associated with severe adverse outcomes such as osmotic demyelination syndrome. Current guidelines recommend serum sodium concentration correction targets of no more than 8 mEq/L per day in patients at high risk of osmotic demyelination syndrome. Desmopressin is recommended to control high rates of serum sodium concentration correction in severe hyponatremia. However, recommendations are based on limited data. The objective of this study is to review current strategies for DDAVP use in severe hyponatremia. MethodsSystematic literature search of 4 databases of peer-reviewed studies was performed and study quality was appraised. ResultsThe literature search identified 17 observational studies with 80 patients. We found 3 strategies for desmopressin administration in hyponatremia: 1) proactive, where desmopressin is administered early based on initial serum sodium concentration; 2) reactive, where desmopressin is administered based on changes in serum sodium concentration or urine output; 3) rescue, where desmopressin is administered after serum sodium correction targets are exceeded or when osmotic demyelination appears imminent. A proactive strategy of desmopressin administration with hypertonic saline was associated with lower incidence of exceeding serum sodium concentration correction targets, although this evidence is derived from a small case series. ConclusionsThree distinct strategies for desmopressin administration are described in the literature. Limitations in study design and sample size prevent definitive conclusions about the optimal strategy for desmopressin administration to correct hyponatremia. There is a pressing need for better quality research to guide clinicians in managing severe hyponatremia.

Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the International Urogynecological Association (IUGA).

Synthetic midurethral slings (MUS) have gained popularity in the management of stress urinary incontinence (SUI), due to their efficacy and minimally invasive nature. As there are no robust data to guide management of persistent or recurrent SUI after failed MUS, the aim of this study was to evaluate the management of these cases among IUGA members. A pretested, web-based survey designed to explore assessment, surgical management and views about future research was sent to IUGA members. A total of 385 participants opened the survey and 331 eligible responses were obtained. Conventional laboratory urodynamics were the most commonly used investigation (72.6 %). The type of previous surgery, urodynamic findings and surgeon's preference/experience were considered to be the most important factors in choosing the type of surgical management. Retropubic sling (RPS) was the preferred surgical option in most of the clinical scenarios with urethral bulking agents (UBA) being more popular in the absence of urethral hypermobility after a failed RPS. While the vast majority of the respondents (93.0 %) recognized the urgent need for good quality research, they were less willing to participate in randomized controlled trials (RCT) comparing redo MUS with autologous fascial sling or colposuspension. Members of IUGA prefer RPS in most patients and UBA in patients with absent urethral hypermobility and intrinsic sphincter deficiency. There is a recognized need for good quality research, but IUGA members are reluctant to participate in RCTs comparing minimally invasive to conventional surgical techniques.

Bring more rigour to GM research

The latest furore over GM food highlights the need for good-quality research on highly sensitive topics, says Francois Houllier.

Spinal metastasis in head and neck cancer

BackgroundThe incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year survival rate for head and neck cancer has stagnated and remains at 50–55%. This is due, in large part, to both regional and distant disease spread, including spinal metastasis. Spinal metastasis from head and neck cancer is rare, has a poor prognosis and can significantly impede end-stage quality of life; normally only palliative care is given.This study aims to conduct a systematic review of the evidence available on management of spinal metastasis from head and neck cancer and to use such evidence to draw up guiding principles in the management of the distant spread.MethodsSystematic review of the electronic literature was conducted regarding the management of spinal metastasis of head and neck malignancies.ResultsDue to the exceptional rarity of head and neck cancers metastasizing to the spine, there is a paucity of good randomized controlled trials into the management of spinal metastasis. This review produced only 12 case studies/reports and 2 small retrospective cohort studies that lacked appropriate controls.ConclusionManagement should aim to improve end-stage quality of life and maintain neurological function. This review has found that radiotherapy +/− medical adjuvant is considered the principle treatment of spinal metastasis of head and neck cancers.There is an absence of a definitive treatment protocol for head and neck cancer spinal metastasis. Our failure to find and cite high-quality scientific evidence only serves to stress the need for good quality research in this area.

Commentary on Smith GD (2011) Editorial: Evaluation of CAM interventions. Journal of Clinical Nursing 20, 921–922

I was stimulated by the recent editorial by Smith (2011) on the need for good quality research on complementary and alternative medicine (CAM) for nurses. The piece also highlighted the role of clinical nurses in actively conducting valid research into the effectiveness of CAM and advocating methodologies including ‘complex interventions’. Smith’s discussion and review of CAM research methods are a useful contribution. It will help to make practitioners and researchers aware of the inherent problems. Whether the problems are different where the research is being carried out by clinical nurses is debatable – it is the methods and conclusions that matter. There is, however, an important body of CAM research – not discussed in the editorial – that has emerged from the Peninsula College of Medicine and Dentistry led by Edzard Ernst, Professor of Complementary Medicine. Ernst et al. (2006) have used the rigorous method of systematic review (arguably still at the pinnacle of the evidence hierarchy) and a dedicated commitment to evidence-based practice, to produce, among other outputs, their handbook. This is intended to guide healthcare practitioners through the solid research evidence to assessment of the value of various CAM therapies. Searchable by therapy and disease/condition, the handbook offers nurses a substantial access to the research on CAM that has already been conducted. This and other work are important for any nurse to be aware of before undertaking original research including the complex interventions advocated in Smiths editorial (Smith 2011). It is also crucial to appreciate that the contribution to this field by the Peninsula Medical School comes from the inside of conventional mainstream medicine rather than from the media or alternative practitioners. Ernst’s approach is that of scientific medicine and ‘science’ having credibility and integrity (usually), a view strongly promoted again from the inside of orthodox healthcare (Goldacre 2009). For practitioners, an evidence-base of reliable assessment and recommendation is crucial. If reflexology and homoeopathy are demonstrated to be no more than placebo and chiropractic to be potentially dangerous, nurses need to be sure of the strength of the evidence. For the patient who comes with a printout from the internet recommending Therapy X, the nurse is offering an evidence-based review and needs to be confident. This case has been argued most persuasively by Gray (2008) when considering the position of 21st century clinicians in the face of the information explosion as it applies to health. Gray was then Chief Knowledge Officer to the NHS. CAM remains a key test-bed for the evidence-based approach. The author has no conflict of interest to declare.

A systematic literature review of psychological factors and the development of late whiplash syndrome

This systematic literature review aims to assess the prognostic value of psychological factors in the development of late whiplash syndrome (LWS). We included prospective cohort studies that provided a baseline measure of at least one psychological variable and used outcome measures relating to LWS (i.e. pain or disability persisting 6 months post injury). A search of electronic databases (Pubmed, Medline, Cinahl, Embase and Psychinfo) up to August 2006 was done using a predetermined search strategy. Methodological quality was assessed independently by two assessors. Data extraction were carried out using a standardised data extraction form. Twenty-five articles representing data from 17 cohorts were included. Fourteen articles were rated as low quality with 11 rated as adequate quality. Meta-analysis was not undertaken due to the heterogeneity of prognostic factors, outcome measures and methods used. Results were tabulated and predefined criterion applied to rate the overall strength of evidence for associations between psychological factors and LWS. Data on 21 possible psychological risk factors were included. The majority of findings were inconclusive. Limited evidence was found to support an association between lower self-efficacy and greater post-traumatic stress with the development of LWS. No association was found between the development of LWS and personality traits, general psychological distress, wellbeing, social support, life control and psychosocial work factors. The lack of conclusive findings and poor methodological quality of the studies reviewed highlights the need for better quality research. Self-efficacy and post-traumatic distress may be associated with the development of LWS but this needs further investigation.

Speech and language therapy for dysarthria due to non-progressive brain damage.

Dysarthria is a common sequel of non-progressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population. To determine the efficacy of speech and language therapy interventions for adults with dysarthria following non-progressive brain damage. This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials (see Review Group Details for more information). We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and Linguistics and Language Behavior Abstracts were electronically searched. Hand-searching of The International Journal of Language and Communication Disorders and of reference lists from relevant articles and conference proceedings was also undertaken. Colleagues were approached to identify other possible published and unpublished studies. Date of most recent searches: May 2000. Unconfounded randomised controlled trials. One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review. No trials of the required standard were identified. There is no evidence of the quality required by this review to support or refute the effectiveness of Speech and Language Therapy interventions for dysarthria following non-progressive brain damage. There is an urgent need for good quality research in this area.

Speech and language therapy for dysarthria due to nonprogressive brain damage: a systematic Cochrane review.

Dysarthria is a common sequel of nonprogressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population. To determine the efficacy of speech and language therapy interventions for adults with dysarthria following nonprogressive brain damage. Systematic review. This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and Linguistics and Language Behavior Abstracts were electronically searched. Hand-searching of the International Journal of Language and Communication Disorders and of reference lists from relevant articles and conference proceedings was also undertaken. Colleagues were approached to identify other possible published and unpublished studies. Unconfounded randomized controlled trials. One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review. No trials of the required standard were identified. There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following nonprogressive brain damage. There is an urgent need for good quality research in this area.

Choice of analgesia in labour on neonatal outcomes, delivery and maternal satisfaction with pain relief

Aim: to examine the use of pethidine, epidural or no analgesia during labour on neonatal outcomes, delivery and maternal satisfaction with pain relief.Design: a prospective cohort study was undertaken in one maternity unit in the East Midlands. Four hundred and seventy-one consecutive women assessed as low risk were recruited to one of three groups depending on their choice of analgesia: pethidine only, epidural only or no analgesia.Outcome measures: neonatal Apgar score at 1 and 5 minutes, base excess/arterial pH, type of delivery and maternal satisfaction with pain relief during labour.Results: results indicated that type of analgesia appeared to have no significant adverse effects on neonatal outcomes, at least in the short term, with the exception of a slight reduction in arterial pH for babies in the pethidine group. Babies born of women who had epidural block had significantly lower Apgar scores at 1 minute compared with babies of mothers who had no analgesia. However, these differences did not persist for Apgar scores at 5 minutes. Women receiving epidural analgesia were significantly more satisfied with their level of pain relief during labour than women in either the pethidine or no analgesia groups. A large proportion of women requested an epidural because of dissatisfaction with the level of pain relief pethidine provided. Women who had epidural block were more likely to need oxytocin augmentation to progress labour, tended to have longer time in labour and were more likely to have instrumental delivery or caesarean section than women in either the pethidine or no analgesia groups.Conclusion: we conclude from our study that while epidural analgesia is an effective method of pain relief, for most women during labour who choose it, it is not without possible side effects on the progress of labour and the delivery. There is a need for good-quality research to investigate the long-term effects of epidural analgesia on mother and infant, as well as research into the relative effectiveness and side effects of opioids that might be used as alternatives to pethidine in the relief of labour pain. In the light of current knowledge, women need to be made aware of the benefits and possible side effects of epidural analgesia and pethidine that might be considered for use during labour.

A basic introduction to medical research. Part I: What is research and why do it?

Our beliefs about health come from many sources, most of which come down to personal experience. This is often an unreliable way of finding out about health as it can be affected by the individual practitioner's own biases and beliefs. Moreover, changes observed in patients cannot always be ascribed to any treatments given. Research attempts to generate more reliable beliefs by carefully controlling for those factors likely to influence us incorrectly. Good research always starts by focusing on a question: what is the question which the researcher wants to answer? Questions enable the development of research designs. There is a particularly pressing need for good quality research in the complementary therapies typically used by nurses and midwives. We need to know: do the complementary therapies have specific effects on health? How should the therapies be used so that their effects are optimised? How should the therapies be used in health service settings? Unless these questions are answered, the use of complementary therapies by nurses and midwives is likely to remain sub-optimal.

Rejoinder To: Is the St. Louis Redevelopment Program Fiscally Beneficial?

There is a critical need for good quality research to add to what is known about the impact of tax abatement on development decisions. Unfortunately, Dr. McGuire's article does not meet this need. The author is clearly out of touch with his subject and with the realities of central city redevelopment. As we will demonstrate, the sources and methods he uses to calculate the “real” effects of tax abatement on development are out of date, biased, and inappropriate. As such, his article cannot be considered to be a serious contribution to the literature in this critically underresearched field.