Systematic Review Synthesis Research Articles

Comorbidity of inflammatory bowel diseases and periodontal pathology

Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, are a global disease of the 21st century. Periodontitis is the sixth most common disease in the world (second among dental pathologies after caries) and the leading cause of tooth loss in adults. At the beginning of the 21st century, the concept of “periodontal medicine” was formed, within the framework of which the bidirectional connection of periodontal pathology with systemic diseases of the body is considered. Extraintestinal manifestations of inflammatory bowel disease are associated with the generalized nature of the inflammatory response. In clinical guidelines, only aphthous stomatitis is described as a systemic manifestation of Crohn’s disease and ulcerative colitis from the oral cavity. Periodontitis is considered a less representative non-specific oral manifestation of inflammatory bowel disease. We searched the Pubmed and Scopus information databases for articles published before 02/15/2024 that examined the relationship between inflammatory bowel disease and periodontal pathology. The results of clinical studies, their synthesis in systematic reviews and meta-analyses, indicate a bidirectional relationship between Crohn’s disease and ulcerative colitis with periodontal pathology. The most likely mechanism is associated with a change in the microbiocenosis of the oral cavity and a further change in the intestinal microbiome due to oral intake of periodontal organisms, which leads to impaired intestinal permeability and the development of immune reactions that play a key role in the development of periodontal diseases and inflammatory bowel diseases.

Nurse-Involved Policy, Systems, and Environmental School-Based Interventions for Supporting Healthy Nutrition and Obesity Prevention Among Children and Adolescents: A Systematic Review.

Overweight and obesity are common in school-age children. Policy, system, and environmental (PSE) approaches-which entail making upstream changes to a school's context-can be leveraged to reduce childhood obesity. Nurses can advance PSE approaches in schools to promote healthy living habits. This review examines the effect of nurse-involved PSE interventions globally to promote healthy nutrition and reduce obesity in schools. We conducted a literature search using multiple databases from 2010 to 2023 for nurse-involved studies that implemented interventions focused on PSE change related to promoting healthy nutrition or reducing obesity in school settings. Twenty interventions globally were included in the systematic review synthesis. Improvements in anthropometrics, health and nutrition knowledge, attitudes, and beliefs were observed. PSE interventions can be leveraged to promote healthy nutrition and reduce obesity in school settings. Nurses in varying roles are uniquely qualified to advocate for and implement school-based interventions focused on PSE change.

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.

Lead Exposure Survey Tool (LEST): A methodological approach to highlight the invisible lead poisoning

Lead is the most common heavy metal found in the Earth's crust. Lead has been widely dispersed and incorporated in the natural world since prehistoric times. In the majority of wealthy countries, the amount of lead entering the atmosphere has been significantly reduced. Acute lead exposure becomes relatively low, but chronic lead exposure remains a substantial public health hazard. Disadvantaged people, are developing and industrializing countries in the Middle East and North Africa (MENA). Between 1981 and 2018, a comprehensive literature search was undertaken in the PubMed and Scopus databases. All studies were evaluated equally based on predetermined inclusion and exclusion criteria. The Delphi method was used to identify numerous resources of lead pollutants. The Mixed Method Appraisal Tool (MMAT) was used to evaluate the quality of identified papers for inclusion in the systematic review synthesis. The studies and sources of lead toxicology were further evaluated using a scale of evidence to establish the degree of evidence based on SIGN & GRADE standards. There were 14 genres and 82 subgenres identified. Through a comprehensive analysis, our cohort developed an exposure survey tool that takes into account the local sociocultural aspects of MENA countries, which will serve as a resource forresearchers,medical toxicologists, and public health professionals in the MENA region to enhance early detection of potential subjects, conduct further studies and implement exposure prevention strategies.•There is no single tool available to detect the invisible lead poison. Lead poisoning is a serious public health problem that can have devastating consequences.•The tool, called the Lead Exposure Survey Tool (LEST), uses a combination of but not limited to data sources, including blood lead levels, environmental lead levels, and demographic information, to identify subjects who are at risk of lead poisoning. LEST is a powerful tool that can help to improve early detection and prevention of lead poisoning.•The development of LEST is a major breakthrough in the fight against lead poisoning. This tool has the potential to save lives and improve the health of high risk subjects around the world.

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.

Non-invasive respiratory support in the management of COVID-19: a synthesis of systematic reviews.

Hospitalised patients with COVID-19 often require oxygen because of the increased risk of hypoxia, and one of the main treatment goals is to avoid mechanical ventilation where possible. Non-invasive respiratory support such as high-flow nasal oxygen, bi-level positive airway pressure and continuous positive airway pressure appear to be clinical alternatives. However, further research is needed to assess the effectiveness of non-invasive respiratory support and its varying modes as a treatment for COVID-19 within a diverse population. This commentary aims to critically appraise three reviews concerning the use of non-invasive respiratory support in patients with COVID-19 and expand upon the findings with regards to clinical practice.

The impact of cancer on the severity of disease in patients affected with COVID-19: an umbrella review and meta-meta-analysis of systematic reviews and meta-analyses involving 1,064,476 participants.

During the COVID-19 pandemic, cancer patients were among the most vulnerable patient groups to the SARS-CoV-2 infection effects. This paper aimed to conduct an umbrella review and meta-meta-analysis to determine the severity of disease in cancer patients affected by COVID-19. The umbrella review and meta-meta-analysis were undertaken according to the PRISMA and MOOSE guidelines. The PubMed/Medline, Web of Science, and Scopus databases were searched for published papers from the start of the pandemic through July 18, 2022. The pooled effect sizes (ES) and odds ratios (ORs) were calculated using a random effect model in the 95% confidence interval (CI) for ICU (Intensive Care Unit) admissions and mortality in cancer patients infected with SARS-CoV-2. Egger's linear regression test, schematic illustrations of funnel plots, and Begg and Mazumdar’s rank correlation tests were used to quantify the possibility of publication bias. The pooled ES was calculated based on 1,031,783 participants, and mortality was significantly increased in cancer patients affected by COVID-19 (OR = 2.02, %95 CI: 1.74–2.35, p < 0.001). The pooled ES for ICU admission was also significantly increased in cancer patients infected with SARS-CoV-2 (OR = 1.84, %95 CI: 1.44–2.34, p < 0.001). As a result, this synthesis of systematic reviews and meta-analyses by the meta-meta-analysis method revealed that disease severity is higher in cancer patients affected by COVID-19. Since cancer patients are a more sensitive and specific patient group, they should be evaluated more carefully, especially during the COVID-19 pandemic and other pandemics that may occur in the future.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10238-022-00911-3.

A Review of COVID-19 Response Challenges in Ethiopia.

Background: The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia. Methodology: Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis. Results: Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services. Conclusions: The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.

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.

Preferred Methods of Measuring Work Participation: An International Survey Among Trialists and Cochrane Systematic Reviewers

Purpose Heterogeneity in work participation (WP) outcomes measurements hampers large scale evidence synthesis in systematic reviews of trials. In this survey we explore authors’ reasons for choosing specific WP outcomes and their measurement methods, including employment status, absence from work, at-work productivity loss, and employability. Methods We contacted authors of 260 trials and 69 systematic reviews and asked closed and open-ended questions about previously used WP outcomes and measurement methods as well as their opinion on the best way to measure WP. Results In total, 91 authors from a wide range of professional backgrounds completed the survey. The majority of authors (86%) chose WP outcomes based on their use in previous similar studies. In most studies (88%), patients had not been involved in the process of selecting the WP outcome. Authors judged feasibility to be an important factor for choosing a measurement instrument (67%). Additionally, valid measurement tools should be available, easy to administer and not too time consuming. Although authors preferred registry data for long term follow-up, the availability and validity of registries was seen as a barrier. Most of the reviewers (72%) struggled to pool data because of variation in follow-up times and cut off points and varying definitions of work outcomes. Almost all (92%) respondents support the use of a Core Outcome Set for Work. Conclusions There is strong support from authors of trials and systematic reviews to develop a core outcome set on work participation outcomes for the evaluation of interventions.

The effect of Ebola virus disease on maternal health service utilisation and perinatal outcomes in West Africa: a systematic review

BackgroundEbola outbreaks pose a major threat to global public health, especially in Sub-Saharan Africa. These outbreaks disrupt the already fragile maternal health services in West Africa. The aims of this study is to assess the effect of Ebola virus disease (EVD) on maternal health service utilisation and perinatal outcomes.MethodsThis systematic review was conducted in West Africa, and the databases used were Medline, PubMed, CINAHL, Scopus, EMBASE and African journals online. Studies that reported the effect of the Ebola outbreak on maternal health services in West Africa were eligible for this systematic review. The search was limited to articles written in the English language only and published between 2013 and 2020. Three authors independently appraised the articles, and the data were extracted using a standardised data extraction format. The findings were synthesised using a narrative summary, tables, and figures.ResultsTwelve studies met the inclusion criteria and were used for this systematic review synthesis. The results showed that antenatal care significantly decreased during Ebola virus disease and strove to recover post-Ebola virus disease. Women were less likely to have institutional childbirth during Ebola virus disease and struggled to recover post-Ebola virus disease. In addition, this review revealed a substantially higher rate of maternal mortality post EVD than those observed before or during the outbreak.ConclusionBased on our findings, antenatal care, institutional childbirth, and postnatal care are attempting to recover post-Ebola virus disease. We recommended that responsible bodies and stakeholders need to prepare locally tailored interventions to increase the number of women attending ANC, institutional childbirth, and PNC services post-EVD and future outbreaks including COVID-19. In order to build trust, creating community networks between health care providers and trusted community leaders may increase the number of women attending antenatal care (ANC), institutional childbirth and postnatal care (PNC) post-EVD and during future outbreaks. Further studies are needed to examine health centre and hospital availability and accessibility, and capacity to deliver maternal health services post-Ebola virus disease and future outbreaks.

The automation of relevant trial registration screening for systematic review updates: an evaluation study on a large dataset of ClinicalTrials.gov registrations

BackgroundClinical trial registries can be used as sources of clinical evidence for systematic review synthesis and updating. Our aim was to evaluate methods for identifying clinical trial registrations that should be screened for inclusion in updates of published systematic reviews.MethodsA set of 4644 clinical trial registrations (ClinicalTrials.gov) included in 1089 systematic reviews (PubMed) were used to evaluate two methods (document similarity and hierarchical clustering) and representations (L2-normalised TF-IDF, Latent Dirichlet Allocation, and Doc2Vec) for ranking 163,501 completed clinical trials by relevance. Clinical trial registrations were ranked for each systematic review using seeding clinical trials, simulating how new relevant clinical trials could be automatically identified for an update. Performance was measured by the number of clinical trials that need to be screened to identify all relevant clinical trials.ResultsUsing the document similarity method with TF-IDF feature representation and Euclidean distance metric, all relevant clinical trials for half of the systematic reviews were identified after screening 99 trials (IQR 19 to 491). The best-performing hierarchical clustering was using Ward agglomerative clustering (with TF-IDF representation and Euclidean distance) and needed to screen 501 clinical trials (IQR 43 to 4363) to achieve the same result.ConclusionAn evaluation using a large set of mined links between published systematic reviews and clinical trial registrations showed that document similarity outperformed hierarchical clustering for identifying relevant clinical trials to include in systematic review updates.

A Framework for Using Epidemiology in Animal Welfare Science

ABSTRACT The potential advantages of using epidemiology in animal welfare research are substantial and are used with increased frequency. Collaboration between scientists of different fields, with different specific expertise is advantageous in the advancement of science. In this review, a framework to use epidemiology in animal welfare science is established. The different epidemiological study designs and analytical procedures are explored and put in an animal welfare scientific context. It is argued and demonstrated that epidemiology is used with advantage: in the identification of risk factors behind the development of maladaptation and abnormal behaviors; in the introduction of standardized procedures in research allowing comparisons between studies and facilitating the integration for evidence synthesis in systematic reviews and meta-analysis; by allowing animal welfare scientists to analyze complex settings such as farms or zoos. Mathematical modeling can also be used with advantage in risk assessment.

Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review.

This systematic review aims to summarize the body of available literature on pediatric extracorporeal cardiopulmonary resuscitation in order to delineate current utilization, practices, and outcomes, while highlighting gaps in current knowledge. PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov databases. We searched for peer-reviewed original research publications on pediatric extracorporeal cardiopulmonary resuscitation (patients < 18 yr old) and were inclusive of all publication years. Our systematic review used the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Our initial literature search was performed on February 11, 2019, with an updated search performed on August 28, 2019. Three physician reviewers independently assessed the retrieved studies to determine inclusion in the systematic review synthesis. Using selected search terms, a total of 4,095 publications were retrieved, of which 96 were included in the final synthesis. Risk of bias in included studies was assessed using the Risk of Bias in Non-Randomized Studies of Interventions-I tool. There were no randomized controlled trials of extracorporeal cardiopulmonary resuscitation use in pediatrics. A vast majority of pediatric extracorporeal cardiopulmonary resuscitation publications were single-center retrospective studies reporting outcomes after in-hospital cardiac arrest. Most pediatric extracorporeal cardiopulmonary resuscitation use in published literature is in cardiac patients. Survival to hospital discharge after extracorporeal cardiopulmonary resuscitation for pediatric in-hospital cardiac arrest ranged from 8% to 80% in included studies, and there was an association with improved outcomes in cardiac patients. Thirty-one studies reported neurologic outcomes after extracorporeal cardiopulmonary resuscitation, of which only six were prospective follow-up studies. We summarize the available literature on: determination of candidacy, timing of activation of extracorporeal cardiopulmonary resuscitation, staffing/logistics, cannulation strategies, outcomes, and the use of simulation for training. This review highlights gaps in our understanding of best practices for pediatric extracorporeal cardiopulmonary resuscitation. We summarize current studies available and provide a framework for the development of future studies.

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.

What are the factors affecting resilience in health professionals? A synthesis of systematic reviews

Introduction: Health professionals often have cumbersome responsibilities, performing their roles in complex environments under stressful circumstances. Resilience has been recognized as an enabler of thriving in such adversity and remains vague in the health profession literature.Aims: This paper aims to provide a synthesis of existing literature reviews of the evidence for resilience in health professionals, thematically integrating factors affecting resilience in health professionals.Methods: Electronic databases were searched systematically using inclusion and exclusion criteria to include literature reviews that explored resilience in health care professionals using purposive sampling of primary research studies.Results: Nine studies were identified. The definition of resilience varied across the studies. Four main themes of factors affecting resilience were found: (1) the influence of individual factors (e.g. individual traits, having a higher purpose, being self-determined), (2) environmental and organizational factors (e.g. workplace culture), (3) approaches that an individual takes when interacting with her/his professional circumstances (e.g. professional shielding and self-reflection), and (4) effective educational interventions (e.g. resilience workshops).Conclusions: Resilience is multidimensional and can be affected by multiple factors. Interventions to improve resilience should consider context and focus on improvement of adaptive abilities of health professionals in adversity. A more uniformed definition and measurement of resilience can further research in this field.

Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews.

Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.

Towards greater understanding of implementation during systematic reviews of complex healthcare interventions: the framework for implementation transferability applicability reporting (FITAR)

BackgroundThere have been calls for greater consideration of applicability and transferability in systematic reviews, to improve their usefulness in informing policy and practice. Understanding how evidence is, or is not applicable and transferable to varying local situations and contexts, is a key challenge for systematic review synthesis in healthcare. Assessing applicability and transferability in systematic reviews is reported to be difficult, particularly in reviews of complex interventions. There is a need for exploration of factors perceived to be important by policy-makers, and for further guidance on which items should be reported. In this paper we focus on the process of development of a framework that can be used by systematic reviewers to identify and report data across studies relating to applicability and transferability.MethodsThe framework was developed by scrutinising existing literature on applicability and transferability, examining data during a systematic review of highly complex changes to health service delivery, and was informed by stakeholder engagement. The items of the framework were thus grounded in both data identified during a real review, and stakeholder input. The paper describes examples of data identified using the framework during a review of integrated care interventions, and outlines how it informed analysis and reporting of the review findings.ResultsThe Framework for Implementation Transferability Applicability Reporting (FITAR) comprises 44 items which can be used to structure analysis and reporting across studies during systematic reviews of complex interventions. The framework prompts detailed consideration of contextual data during extraction and reporting, within areas of: patient type and populations; type of organisations and systems; financial and commissioning processes; systems leadership elements; features of services; features of the workforce; and finally elements of the interventions/initiatives.ConclusionsUse of the framework during our review of complex healthcare interventions helped the review team to surface contextual data, which may not be commonly extracted, analysed and reported. Further exploration and evaluation of systems for identifying and reporting these factors during reviews is required.

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.

Supporting parenting to address social inequalities in health: a synthesis of systematic reviews

BackgroundIn 2009, the World Health Organization’s Commission on Social Determinants of Health set out its recommendations for action, which included establishing equity from early childhood onwards by enabling all children and their mothers to benefit from a comprehensive package of quality programmes. In order to address social inequalities in health, it is recommended that action be taken from early childhood, and actions providing support for parenting are an effective lever in this respect.The aim of this review of systematic reviews is to analyse, on the one hand, the components and characteristics of effective interventions in parenting support and, on the other, the extent to which the reviews took into account social inequalities in health.MethodsA total of 796 reviews were selected from peer-reviewed journals published between 2009 and 2016 in French or English. Of these, 21 reviews responding to the AMSTAR and selected ROBIS criteria were retained. These were analysed in relation to the consideration they gave to social inequalities in health according to PRISMA-equity.ResultsThe reviews confirmed that parenting support programmes improved infants’ sleep, increased mothers’ self-esteem and reduced mothers’ anger, anxiety and stress levels. The mainly authors noted that the contexts in which the interventions had taken place were described either scantly or not at all, making it difficult to evaluate them.Only half of the reviews had addressed the question of social inequalities in health. In particular, there had been little research conducted on the relational aspect and the social link.ConclusionIn terms of addressing social inequalities in perinatal health, the approach remains both modest and reductive. Understanding how, for whom and in what conditions interventions operate is one way of optimising their results. Further research is needed to study the interactions between the interventions and their contexts.