Systematic Reviews Of Such Studies Research Articles

Nutrition users’ guides: systematic reviews part 1 – structured guide for methodological assessment, interpretation and application of systematic reviews and meta-analyses of non-randomised nutritional epidemiology studies

Due to the challenges of conducting randomised controlled trials (randomised trials) of dietary interventions, evidence in nutrition often comes from non-randomised (observational) studies of nutritional exposures—called nutritional epidemiology studies. When...

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review.

BackgroundLevels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention.ObjectiveThe objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored.MethodsA systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies.ResultsOverall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds.ConclusionsThe findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being.Trial RegistrationPROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz

Understanding Digital Work and its Use in Organizations from a Literature Review

Background: Digital work is becoming increasingly popular due to its benefits and the continuous surge of the COVID-19 pandemic. Despite numerous studies in attempting at understanding the adoption of digital work and its impact from various perspectives, there is lack of a systematic review of such studies. As a result, a systematic review of this nature is becoming critical as such a review can summarize what has been done and provide a solid foundation for future research. Method: A comprehensive review of existing studies of digital work and its use in organizations is conducted in a systematic manner. This leads to the identification of 87 papers published between 2010 and 2020 in major journals from the mostly popular databases including ProQuest, Emerald, ScienceDirect and Web of Science. Such papers then have been critically analyzed and synthesized. Results: The review of the related literature leads to the formulation of a working definition for digital work, the identification of the characteristics of digital work, and the emerging issues that influence the adoption of digital work in organizations. An integrated framework is proposed for better understanding the adoption of digital work from the perspectives of individuals, organizations, and society. Conclusion: This study proposes an integrated framework for better understanding the adoption of digital work in organizations. Such a framework can be tested and validated in various contexts. The study contributes to existing research from both theoretical and practical perspectives. Theoretically, this study identifies the characteristics of digital work and the emerging issues for affecting the adoption of digital work through reviewing the related literature in a holistic manner. Practically, this study provides organizations with useful information on how to address the emerging issues in the adoption of digital work.

A systematic review of artificial intelligence techniques for collaborative learning over the past two decades

This systematic review focuses on publications related to studies of the use of artificial intelligence (AI) for collaborative learning. The use of AI for collaborative learning is a recent phenomenon and a systematic review of such studies is lacking. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, 41 journal articles were shortlisted. These articles were analysed in terms of the contexts of study (year, group size, platforms of interaction, and types of learners). Using a thematic approach, two broad foci and five sub-categories of use of AI for collaborative learning were identified: (1) learning outcomes – (a) collective performances, and (b) content of learning; (2) social interactions and processes – (c) sentiments and emotions, (d) discourse patterns and talk moves, and (e) learner characteristic and behaviours. The AI techniques were coded according to three broad purposes (discovering, learning and reasoning) and nine techniques: clustering, ensemble, regression algorithms, deep learning, decision trees, natural language processing, instance-based, fuzzy logic, and agents. A Sankey diagram was used to depict the relationships among the nine AI techniques to the five sub-categories of how AI was used to support collaborative learning. The gaps in the selected articles and limitations of the current review were discussed to suggest future areas of study.

Sorption characteristics in coal and shale: A review for enhanced methane recovery

The exploration and exploitation of hydrocarbon resources within coal and shale reservoirs is an engineering challenge. Well-developed internal micro-pore structures, complex sorption mechanism as well as numerous influencing factors affecting the gas flow are generally not well-accounted in the commercial life-cycle of shale gas and coalbed methane wells. Although large number of studies have been conducted to propose improved sorption models and study the influencing factors on adsorption and desorption characteristics of methane and CO2 in coal and shale reservoirs, a systematic review of such studies for efficient understanding of the accumulated literature is missing, especially with a focus towards coal and shale reservoirs. In that context, this study presents a review of sorption characteristics of methane in coal and shale. Firstly, theoretical mechanisms for methane sorption are introduced, followed by description of sorption models. Further, three factors influencing the sorption of gas in coal and shale are described: total organic carbon and clays, pore structures, and reservoir conditions. Finally, the preferential sorption characteristics of hydrocarbons and carbon dioxide are described, and the methods to promote methane desorption for enhanced recovery are discussed, which include technologies such as gas injection, microwave heating, and hydraulic fracturing. Cited as: Qin, X., Harpreet, S., Cai, J. Sorption characteristics in coal and shale: A review for enhanced methane recovery. Capillarity, 2022, 5(1): 1-11. https://doi.org/10.46690/capi.2022.01.01

Status, Trends and Significance of Single Phase, Single and Coupled Natural Circulation Loops in Sustainable Energy Technologies – A comprehensive review

Researchers have made continuous efforts to understand the behavior of the natural circulation systems, their application, and the challenges involved in implementation. A large number of numerical, analytical, and experimental studies during recent years reflect the importance of the passive technology. However, there is a dearth of systematic review of such studies based on geometry, loop fluid, and the intended application. Hence, the present review extensively focuses on thermal-hydraulic parameters in single-phase single and coupled loop natural circulation systems. Performance aspects like steady-state, transient, and stability criteria, including instability restraining techniques have been discussed. Even the importance of validating the numerical codes is highlighted. Since the coupled natural circulation loop finds major application in nuclear reactors as passive cooling systems, various configurations and fluid combinations intended are illustrated. As there is a dearth of experimental studies in the coupled loop, preliminary analysis was done, which showed the efficacy of such a system. The review further revealed the scope for experimental studies along with numerical analysis of the single and coupled system, which can be linked to sustainable and renewable energy applications.

Efficacy of phage therapy in pigs: systematic review and meta-analysis.

Limits on the use and efficacy of various antibiotics coupled with negative consumer perception of the practice have together spurred substantial research into compounds that could reduce the use antibiotics to control bacterial diseases in pigs. Bacteriophages are often among such potential compounds, and various groups have examined the efficacy of bacteriophages or bacteriophage products in limiting transmission or colonization of targeted bacteria. The study presented here provides a systematic review of such studies followed by a meta-analysis of aggregated data produced by each study. The data set was limited to inputs (n = 19; 576 total observations) from studies where: 1) live pigs were inoculated with a known quantity of challenge bacteria; 2) challenged animals were treated with a known quantity of phages; 3) concentrations of the challenge bacteria were measured in different tissues/fluids following phage treatment; and 4) SD (or SE to allow calculation of SD) was reported. Concentrations of challenge bacteria were significantly lower in phage-treated pigs versus challenged but untreated pigs (P < 0.0001; effect size = −1.06 1log10 colony-forming units [CFU]/g). The effect size of phage treatment was significantly greater (P < 0.05) in samples collected 48 to 96 h following phage treatment versus those collected ≤ 24 h following phage treatment. Likewise, effect size of phage treatment was significantly greater in piglets versus market-weight pigs. Across observations, phage treatment effect sizes were greatest (P < 0.01) in fecal samples versus ileal or cecal samples. Taken together, these data indicate that phage treatment can significantly reduce the concentrations of targeted bacteria in pigs; scenarios exist, however, where phage treatment could predictably be more or less effective.

Characteristics and quality of systematic reviews and meta-analyses of observational nutritional epidemiology: a cross-sectional study

Dietary recommendations and policies should be guided by rigorous systematic reviews. Reviews that are of poor methodological quality may be ineffective or misleading. Most of the evidence in nutrition comes from nonrandomized studies of nutritional exposures (usually referred to as nutritional epidemiology studies), but to date methodological evaluations of the quality of systematic reviews of such studies have been sparse and inconsistent. We aimed to investigate the quality of recently published systematic reviews and meta-analyses of nutritional epidemiology studies and to propose guidance addressing major limitations. We searched MEDLINE (January 2018-August 2019), EMBASE (January 2018-August 2019), and the Cochrane Database of Systematic Reviews (January 2018-February 2019) for systematic reviews of nutritional epidemiology studies. We included a random sample of 150 reviews. Most reviews were published by authors from Asia (n=49; 32.7%) or Europe (n=43; 28.7%) and investigated foods or beverages (n=60; 40.0%) and cancer morbidity and mortality (n=54; 36%). Reviews often had important limitations: less than one-quarter (n=30; 20.0%) reported preregistration of a protocol and almost one-third (n=42; 28.0%) did not report a replicable search strategy. Suboptimal practices and errors in the synthesis of results were common: one-quarter of meta-analyses (n=30; 26.1%) selected the meta-analytic model based on statistical indicators of heterogeneity and almost half of meta-analyses (n=50; 43.5%) did not consider dose-response associations even when it was appropriate to do so. Only 16 (10.7%) reviews used an established system to evaluate the certainty of evidence. Systematic reviews of nutritional epidemiology studies often have serious limitations. Authors can improve future reviews by involving statisticians, methodologists, and researchers with substantive knowledge in the specific area of nutrition being studied and using a rigorous and transparent system to evaluate the certainty of evidence.

Research progress on the application of feed additives in ruminal methane emission reduction: a review.

BackgroundRuminal methane (CH4) emissions from ruminants not only pollute the environment and exacerbate the greenhouse effect, but also cause animal energy losses and low production efficiency. Consequently, it is necessary to find ways of reducing methane emissions in ruminants. Studies have reported that feed additives such as nitrogen-containing compounds, probiotics, prebiotics, and plant extracts significantly reduce ruminant methane; however, systematic reviews of such studies are lacking. The present article summarizes research over the past five years on the effects of nitrogen-containing compounds, probiotics, probiotics, and plant extracts on methane emissions in ruminants. The paper could provide theoretical support and guide future research in animal production and global warming mitigation.MethodsThis review uses the Web of Science database to search keywords related to ruminants and methane reduction in the past five years, and uses Sci-Hub, PubMed, etc. as auxiliary searchers. Read, filter, list, and summarize all the retrieved documents, and finally complete this article.ResultsMost of the extracts can not only significantly reduce CH4 greenhouse gas emissions, but they will not cause negative effects on animal and human health either. Therefore, this article reviews the mechanisms of CH4 production in ruminants and the application and effects of N-containing compounds, probiotics, prebiotics, and plant extracts on CH4 emission reduction in ruminants based on published studies over the past 5 years.ConclusionOur review provides a theoretical basis for future research and the application of feed additives in ruminant CH4 emission reduction activities.

Diagnostic and therapeutic approach to meniscal ossification: a systematic review.

The purpose of this study was to systematically review case reports and case series about meniscal ossicle, to summarize existing evidence. Specifically, to identify the etiology, demographic characteristics, localization, clinical features, diagnostic procedures and treatment options of this rare entity. Although, case reports/ series are of low level of evidence, a systematic review of such studies can provide and help us to gain a better understanding and awareness of meniscal ossicle. Two authors searched three online databases (MEDLINE, SCOPUS and GOOGLE SCHOLAR) from inception until March 2020 for the literature on meniscal ossicle. Inclusion criteria included case series, case reports and case-based reviews, available in full-text version, in English and that concern humans. Reports published in languages other than English were excluded, as well as articles with no electronic full text availability. Case reports using the term "meniscal ossicle" to describe an acute avulsion fracture of the tibial root of the meniscus, were also excluded. Of 453 initial studies, 38 studies satisfied inclusion criteria. In total 169 patients were included of whom 107 (63%) were males and 62 (37%) were females. Mean age was 44years (range 12-87). According to Magnetic resonance imaging findings, in 144 knees (86%) the ossicle was localized at the posterior root or horn of the medial meniscus. 60% of the patients had a history of trauma. The predominant symptom in 87% of patients was knee pain. In all patients was detected an intra-articular density structure in computed radiography. 76% had associated meniscal tear, 61% had intraarticular cartilage loss, 34% meniscal extrusion and 28% anterior cruciate ligament injury. Treatment modalities included conservative regimen in 40 patients, while 59 patients underwent surgical excision. The most possible etiology of meniscal ossicle is posttraumatic heterotopic ossification and small occult bony avulsion fracture. It is commonly observed in individuals complaining about knee pain with history of antecedent trauma. The presence of a meniscal ossicle should alert the physician to the high likelihood of the patient having an associated meniscal tear, articular cartilage loss, ACL injury or meniscal extrusion. Along with the meniscal ossicle, the associated meniscal tear should be treated as well.

Parent Empowerment in Pediatric Healthcare Settings: A Systematic Review of Observational Studies.

Parent empowerment is often an expressed goal in clinical pediatrics and in pediatric research, but the antecedents and consequences of parent empowerment are not well established. The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings. The inclusion criteria were (1) studies with results about parent empowerment in the context of children's healthcare or healthcare providers; and (2) qualitative studies, observational studies, and systematic reviews of such studies. We searched the databases of PubMed, Web of Science, and Google Scholar (2006-2017) and reference lists. Forty-four articles met the inclusion criteria. We identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships, processes of care, experiences with medical care, experiences with community services, receiving informational/emotional support, and building personal capacity and narrative. We synthesized these findings into a conceptual model to guide future intervention development and evaluation. Non-English articles were excluded. Parent empowerment may enhance parent involvement in daily care and care decisions, improve child symptoms, enhance informational needs and skills, and increase advocacy and altruistic behaviors. Parent empowerment may be promoted by the parent-provider relationship and care processes, finding the right fit of medical and community services, and attention to the cognitive and emotional needs of parents. PROSPERO 2017:CRD42017059478.

Functional Ability in the Changing Demographic Landscape: Evidence and Opportunities for Occupational Therapy.

The growing number of older adults is changing the demographic landscape. Occupational therapy can better serve the older adult population by helping them maintain their functional ability, which is the ability to engage in occupations. This special issue includes both studies of interventions to evaluate and support functional ability in community-dwelling older adults and systematic reviews of such studies. This editorial highlights the six systematic reviews, which were completed in collaboration with the American Occupational Therapy Association's Evidence-Based Practice Project. These reviews compile evidence for the effectiveness of interventions within the scope of occupational therapy practice to promote occupational performance in community-dwelling older adults. The distinct value of occupational therapy in supporting the functional ability of community-dwelling older adults with stable or declining health is discussed using the World Health Organization's framework for healthy aging.

Applying GRADE-CERQual to qualitative evidence synthesis findings\u2013paper 7: understanding the potential impacts of dissemination bias

BackgroundThe GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation.CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on a probable fifth component, dissemination bias. Given its exploratory nature, we are not yet able to provide guidance on applying this potential component of the CERQual approach. Instead, we focus on how dissemination bias might be conceptualised in the context of qualitative research and the potential impact dissemination bias might have on an overall assessment of confidence in a review finding. We also set out a proposed research agenda in this area.MethodsWe developed this paper by gathering feedback from relevant research communities, searching MEDLINE and Web of Science to identify and characterise the existing literature discussing or assessing dissemination bias in qualitative research and its wider implications, developing consensus through project group meetings, and conducting an online survey of the extent, awareness and perceptions of dissemination bias in qualitative research.ResultsWe have defined dissemination bias in qualitative research as a systematic distortion of the phenomenon of interest due to selective dissemination of studies or individual study findings. Dissemination bias is important for qualitative evidence syntheses as the selective dissemination of qualitative studies and/or study findings may distort our understanding of the phenomena that these syntheses aim to explore and thereby undermine our confidence in these findings.Dissemination bias has been extensively examined in the context of randomised controlled trials and systematic reviews of such studies. The effects of potential dissemination bias are formally considered, as publication bias, within the GRADE approach. However, the issue has received almost no attention in the context of qualitative research. Because of very limited understanding of dissemination bias and its potential impact on review findings in the context of qualitative evidence syntheses, this component is currently not included in the GRADE-CERQual approach.ConclusionsFurther research is needed to establish the extent and impacts of dissemination bias in qualitative research and the extent to which dissemination bias needs to be taken into account when we assess how much confidence we have in findings from qualitative evidence syntheses.

Hemoglobin E in Northeast India: A review on its origin, distribution, migration and health implication

A systematic review of the studies on hemoglobin E in Northeast India has been carried out to understand the magnitude of research undertaken on this aspect during the last seven decades. Owing to the high prevalence of hemoglobin E in this part of India different authors have studied this hemoglobin from different perspectives and found conflicting results. However a systematic review of such studies is lacking from a holistic point of view. Most of the epidemiological, in vitro as well as in vivo studies show signatures of selection with this hemoglobin locus. However, how this polymorphism is maintained at different rates at different geographical region is still a matter of contention. This review will fill the gap from all perspectives starting from the frequency distribution of hemoglobin E and its spread in different parts of Northeast India, its relationship with malaria hypothesis, the population migration, population affinity and most importantly the health implication arising out of it. A probable origin of hemoglobin E among an Austroasiatic population of Northeast India has been postulated with the help of advance molecular anthropological knowledge like the deep rooted markers of mt DNA and Y-chromosome haplotypes.

Protocol for a systematic review of the efficacy of epidermal grafting for wound healing

BackgroundAutologous skin grafting is an important modality for wound coverage; however, it can result in donor site morbidity. Epidermal grafting is an emerging option to overcome this challenge. Furthermore, it can be done in an outpatient setting with minimal or no pain. To date, the evidence on the efficacy of this technique for wound healing has yet to be outlined. We aim to synthesise the current evidence on epidermal grafting for wound healing to establish the efficacy of this technique.Methods/designWe will conduct a comprehensive search in the MEDLINE, EMBASE, and CENTRAL databases (up to May 2016) to identify studies on epidermal grafting for wound healing. We will include any primary studies (excluding case reports or case series lesser than three patients) or systematic reviews of such studies to assess the outcome of epidermal grafting for wound healing either on its own or compared to other methods. The expected primary outcome measures are the efficacy of epidermal grafting for wound healing (measured by the proportion of wounds healed at 6 weeks) and the mean wound-healing time (time for complete re-epithelialisation). Secondary outcome measures are the mean donor site-healing time, need for anaesthesia, costs associated with resource use, health-related quality of life, and proportion of patients with adverse event. Subgroup analysis will be performed for the proportions of wounds healed based on wound aetiology.DiscussionThis is a timely systematic review, and the finding of this systematic review is expected to guide research and clinical practice aimed at improving wound care.Systematic review registrationPROSPERO CRD42016033051Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0268-7) contains supplementary material, which is available to authorized users.

Diagnostic errors in older patients: a systematic review of incidence and potential causes in seven prevalent diseases.

BackgroundMisdiagnosis, either over- or underdiagnosis, exposes older patients to increased risk of inappropriate or omitted investigations and treatments, psychological distress, and financial burden.ObjectiveTo evaluate the frequency and nature of diagnostic errors in 16 conditions prevalent in older patients by undertaking a systematic literature review.Data sources and study selectionCohort studies, cross-sectional studies, or systematic reviews of such studies published in Medline between September 1993 and May 2014 were searched using key search terms of “diagnostic error”, “misdiagnosis”, “accuracy”, “validity”, or “diagnosis” and terms relating to each disease.Data synthesisA total of 938 articles were retrieved. Diagnostic error rates of >10% for both over- and underdiagnosis were seen in chronic obstructive pulmonary disease, dementia, Parkinson’s disease, heart failure, stroke/transient ischemic attack, and acute myocardial infarction. Diabetes was overdiagnosed in <5% of cases.ConclusionOver- and underdiagnosis are common in older patients. Explanations for over-diagnosis include subjective diagnostic criteria and the use of criteria not validated in older patients. Underdiagnosis was associated with long preclinical phases of disease or lack of sensitive diagnostic criteria. Factors that predispose to misdiagnosis in older patients must be emphasized in education and clinical guidelines.

The experience and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence protocol

The experience and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence protocol

Patient Preferences for the Treatment of Type 2 Diabetes: A Scoping Review

As more studies report on patient preferences, techniques are needed to identify, assess and, eventually, synthesize results from a diverse set of methodologies. Data on patient preferences are valuable to decision makers in a variety of ways. Preferences for outcomes can be used to inform decision and cost-effectiveness models, while preferences for treatments can inform patient-centered outcomes research (PCOR) and patient-centered care. This project sought to identify and assess the literature reporting on the treatment preferences of adult patients with type 2 diabetes. In addition to cataloging the preference elicitation methods used, we developed and assessed a novel quality assessment checklist for preference-based studies. PubMed, EMBASE, CINAHL, and EconLit databases were searched to identify studies examining patient preferences for medications for type 2 diabetes studies published since inception of each database. The review protocol specified inclusion of studies reporting diabetes-treatment preferences among adults with type 2 diabetes, using a range of preference measurement methods. Studies were excluded if participants were not patients with type 2 diabetes and if treatments were not pharmacological therapies targeting glycemic control, or if no primary preference information was collected. Two investigators independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved by consensus. Data on study country, year, number of respondents, preference elicitation method, number of attributes, subgroup analyses, and funding source were abstracted into standardized tables. A novel checklist (PREFS) was used to assess the data quality and validity across different types of preference studies by assessing the following: purpose of the study; respondent sampling; explanation of preference assessment methods; findings reported for total sample; and significance testing. Each item was scored, and an aggregate score was then calculated (ranging from 0 to 5). Of the 2,100 unique citations, 61 met the inclusion criteria. The studies used conjoint analysis (n=10), time trade-off (n=6), standard gamble (n=2), contingent valuation (n=1), other stated preference methods (n=39), and revealed preferences (n=5). Sample sizes ranged from 27 to 14,033, with an average of 562 respondents, and two-thirds included a subgroup analysis. Most studies were conducted in one country, predominantly the USA (n=27), UK (n=14), Canada (n=10), and Germany (n=7), while 14 were conducted in multiple (2-18) countries across two or more countries. There was an increase in the annual rate of studies published over time from the time of the first publication in 1985 (p=<0.01). Most (n=52) studies were funded by pharmaceutical or device companies, with government, academic, association, and hospital sources also funding studies. One study met all five of the PREFS criteria and 12 met four; yet four studies met none of the criteria. The average was 27. Currently, preferences reviews are limited by the mixed quality in the reporting of studies, the publication bias inherent in the literature, a lack of guidelines to conduct various methods, and the difficulty of synthesizing results from different studies. Our study is also limited by its focus on English language articles. This study provides the first systematic evaluation of the methods used in the broad existing body of research into patient preferences for type 2 diabetes medications and can serve as a primary source of information for decision makers. Future work is necessary to assess the utility of the results of reviews of preference information and to develop best-practice guidelines for the reporting of, and methods of conducting, preference studies and systematic reviews of such studies. This systematic review was registered with PROSPERO (registration number CRD42012002285).

Knowledge, attitudes and practices of private sector providers of tuberculosis care: a scoping review [Review article

The past decade has seen a significant increase in private sector provision of tuberculosis (TB)care. While patients often seek and select treatment from private providers at significant out-of-pocket expense,treatment outcomes remain largely unknown. To investigate the knowledge, attitudes and practices of private sector TB care providers in high burden countries. Medline, PubMed, Embase, International Pharmaceutical Abstracts and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched using Medical Subject Headings terms,Emtree terms and key words. Searches were limited to the English language and published between 1998 and week 2 of November 2009. Studies were included if they reported the knowledge, attitudes or practice behaviours of private health care providers working in one of 22 high-TB-burden countries. Each included study was critically assessed using a structured data extraction tool. Data extracted included the study setting, objective, design, sample, response rate, outcomes and limitations. The 34 studies that met review inclusion criteriaen compassed diverse study methods and designs.All categories of TB care providers lacked comprehensive knowledge of national treatment guidelines. Procedures for referral, treatment monitoring, record keeping and case holding were not systematically implemented.However, there was a high degree of willingness to collaborate with national TB programmes. Research using standardised data collection methods may assist in identifying gaps in knowledge and practice among all providers of TB care. Further studies in developing and evaluating needs-based interventions should be undertaken; systematic reviews of such studies may then assist in strategic decision making in public-private mix DOTS expansion.

Evidence-Based Medicine Must Be ...

Proponents of evidence-based medicine (EBM) provide the "hierarchy of evidence" as a criterion for judging the reliability of therapeutic decisions. EBM's hierarchy places randomized interventional studies (and systematic reviews of such studies) higher in the hierarchy than observational studies, unsystematic clinical experience, and basic science. Recent philosophical work has questioned whether EBM's special emphasis on evidence from randomized interventional studies can be justified. Following the critical literature, and in particular the work of John Worrall, I agree that many of the arguments put forward by advocates of EBM do not justify the ambitious claims that are often made on behalf of randomization. However, in contrast to the recent philosophical work, I argue that a justification for EBM's hierarchy of evidence can be provided. The hierarchy should be viewed as a hierarchy of comparative internal validity. Although this justification is defensible, the claims that EBM's hierarchy substantiates when viewed in this way are considerably more circumscribed than some claims found in the EBM literature.