Unpublished Reviews Research Articles

Addressing alcohol health harms through non-health sector policies in English local government: a systematic overview, legal analysis, and case study

BackgroundMany key determinants of alcohol health harms lie outside the health sector and are affected by non-health sector policies. Public health practitioners tackling alcohol health harms need to work effectively with non-health sectors. Understanding how health can be addressed through non-health policies will improve the public health response to alcohol harms in England. We aimed to identify the barriers to and opportunities for implementation of population-level health interventions in English local government that effectively address alcohol health harms. MethodsWe used a three-stage research design. First, an overview of systematic reviews identified effective population-level interventions addressing alcohol-related health harms. 6775 articles were retrieved from Medline, Embase, Cochrane, Social Policy and Practice, DARE, Campbell, and NICE database searches, supplemented by screening of references of included reviews and contacting key experts to identify missed and unpublished reviews. 10% of articles were independently dual screened with the remainder screened individually after reconciling all classification disagreements. Systematic reviews were included if they were published since 2002, assessed the effectiveness of population-level interventions, and reported quantitative outcomes on alcohol use or related harm. Two reviewers independently assessed the included reviews' quality using the AMSTAR criteria. Second, a legal and policy analysis established the legislative framework governing English local authority alcohol control policies, identifying opportunities to enact effective policies to address alcohol health harms. Third, case studies were done in two local authorities to understand how local factors affected the choice and implementation of alcohol control policies. Data were obtained through non-audio recorded qualitative interviews with local government staff, work shadowing, documentary analysis of reports and external-facing communications, and quantitative analysis of administrative data. Findings52 systematic reviews were identified. The evidence base showed a pattern of support for regulatory or statutory enforcement interventions over local non-regulatory approaches. Interventions with proven effectiveness that are especially relevant to English local authority intervention include limiting alcohol outlet density and opening hours and increasing alcohol prices. By contrast, the legal and policy analysis showed that licensing decisions in England that might control local alcohol availability and affordability should be framed around non-health arguments. Licensing committees need data that relate to a specific premises or local geography, limiting how much aggregate population health indices can be used to justify policy choices. Nevertheless, alcohol health harms can be addressed by developing sufficiently detailed local health evidence; designing special policy areas to address cumulative effect; aligning local planning policy with licensing; and cross-sector collaborations—in particular with licensing, planning, the police, and community safety—such as joint needs assessments and strategies to tackle alcohol harms. The legal framework and local government operating practices do, however, make interventions that address the immediate harms associated with alcohol intoxication more feasible to implement in non-health sectors than those that tackle chronic overconsumption. Case study findings suggest that local government practitioners perceive that policy decisions relate to the priorities of a range of constituencies that might not align with health concerns. InterpretationOpportunities exist to address local health consequences of alcohol consumption through English local government policies. Public health practitioners wishing to engage with non-health sectors will benefit from understanding how other sectors define evidence in terms of relevance and validity, how legislation constrains and enables their practice and policy, and whose priorities shape policy choices. FundingNational Institute for Health Research (NIHR)'s School for Public Health Research (SPHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years’ follow-up in the MRC study long enough?

IntroductionTuberculosis of the spine is a still a common disease entity, not only in developing countries but is also returning in developed countries especially in the immune-compromised patients. Conservative treatment with chemotherapy is still the main stay of treatment. This article focuses on the clinical and radiological outcomes, and problems with conservative treatment.MethodThe available literature of anti-tuberculosis chemotherapy in managing spinal tuberculosis was reviewed. Data sources included relevant literature of the English language identified through Medline search from 1946 to 2011. Personal experience and unpublished reviews from the authors’ institution were also included.ResultsAlthough majority of patients respond well to anti-tuberculosis chemotherapy, about 15 % of them develop paradoxical response. The Medical Research Council (MRC) studies have shown that for patients without significant neurological deficits, operative and conservative treatment could produce the same clinical outcome at 15 years follow-up. Patients treated operatively with debridement and spinal fusion with strut graft had faster bony fusion and less kyphotic deformity. In contrast, those treated with drugs alone or with simple debridement without fusion may result in disease reactivation, severe kyphosis or late instability, which in turn may lead to late-onset Pott’s paraplegia, back pain, sagittal imbalance and compromised pulmonary function that are difficult or risky to treat.ConclusionRecognition of the clinical and radiologic features of these late sequels is important for the management. Prevention of deformity in the early disease has been added to the modern standard of treatment of TB spine.

Impact of findings from grey literature on the outcomes of systematic reviews on interventions to prevent obesity among children: a systematic review

Impact of findings from grey literature on the outcomes of systematic reviews on interventions to prevent obesity among children: a systematic review

How can we improve the interpretation of systematic reviews?

A study conducted by Lai and colleagues, published this week in BMC Medicine, suggests that more guidance might be required for interpreting systematic review (SR) results. In the study by Lai and colleagues, positive (or favorable) results were influential in changing participants' prior beliefs about the interventions presented in the systematic review. Other studies have examined the relationship between favorable systematic review results and the publication of systematic reviews. An international registry may decrease the number of unpublished systematic reviews and will hopefully decrease redundancy, increase transparency, and increase collaboration within the SR community. In addition, using guidance from the Preferred Items for Systematic Reviews and Meta-analyses (PRISMA: http://www.prisma-statement.org/) Statement and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE: http://www.gradeworkinggroup.org/) approach can also be used to improve the interpretation of systematic reviews. In this commentary, we highlight important methodological issues related to the conduct and reporting of systematic reviews and also present our own guidance on interpreting systematic reviews.Please see Research article: http://www.biomedcentral.com/1741-7015/9/30/.

Methodology in conducting a systematic review of systematic reviews of healthcare interventions.

BackgroundHundreds of studies of maternity care interventions have been published, too many for most people involved in providing maternity care to identify and consider when making decisions. It became apparent that systematic reviews of individual studies were required to appraise, summarise and bring together existing studies in a single place. However, decision makers are increasingly faced by a plethora of such reviews and these are likely to be of variable quality and scope, with more than one review of important topics. Systematic reviews (or overviews) of reviews are a logical and appropriate next step, allowing the findings of separate reviews to be compared and contrasted, providing clinical decision makers with the evidence they need.MethodsThe methods used to identify and appraise published and unpublished reviews systematically, drawing on our experiences and good practice in the conduct and reporting of systematic reviews are described. The process of identifying and appraising all published reviews allows researchers to describe the quality of this evidence base, summarise and compare the review's conclusions and discuss the strength of these conclusions.ResultsMethodological challenges and possible solutions are described within the context of (i) sources, (ii) study selection, (iii) quality assessment (i.e. the extent of searching undertaken for the reviews, description of study selection and inclusion criteria, comparability of included studies, assessment of publication bias and assessment of heterogeneity), (iv) presentation of results, and (v) implications for practice and research.ConclusionConducting a systematic review of reviews highlights the usefulness of bringing together a summary of reviews in one place, where there is more than one review on an important topic. The methods described here should help clinicians to review and appraise published reviews systematically, and aid evidence-based clinical decision-making.

An international survey indicated that unpublished systematic reviews exist

Objective To determine the frequency of unpublished systematic reviews (SRs) and explore factors contributing to their occurrence. Study Design and Setting First or corresponding authors from a sample of SRs published in 2005 were asked to participate in a 26-item survey administered through the Internet, facsimile, and postal mail. Outcomes included median and range of published and unpublished SRs, and barriers, facilitators, and reasons for not publishing SRs. Descriptive analyses were performed. Results 55.7% (348 of 625) of those invited participated, half of which were from Europe and 22.7% were from the United States. Participants reported 1,405 published (median: 2.0, range: 1–150) and 199 unpublished (median: 2.0, range: 1–33) SRs. Lack of time and lack of funding and organizational support were barriers, whereas time availability and self-motivation were facilitators to publishing reviews. For most recent unpublished SRs ( n = 52), the reasons for not publishing included lack of time (12 of 52, 23.0%), the manuscript being rejected (10 of 52, 19.0%), and operational issues (six of 52, 11.5%). Conclusion Unpublished SRs do exist. Lack of time, funding, and organizational support were consistent reasons for not publishing SRs. Statistical significance of SR results was not reported as being a major barrier or reason for not publishing. Further research on unpublished SRs is warranted.

Following 411 Cochrane Protocols to Completion: A Retrospective Cohort Study

BackgroundCochrane reviews are regarded as being scientifically rigorous and are increasingly used by a variety of stakeholders. However, factors predicting the publication of Cochrane reviews have never been reported. This is important because if a higher proportion of Cochrane protocols with certain characteristics (e.g., funding) are being published, this may lead to inaccurate decisions. We examined the frequency of published and unpublished Cochrane reviews and protocol factors that predict the publication of Cochrane reviews.Methodology/Principal FindingsRetrospective cohort study of Cochrane protocols published in 2000 (Issues 2 to 4) and 2001 (Issue 1). The publication status of these reviews was followed up to Issue 1, 2008 in The Cochrane Library. Survival analysis of the time from protocol publication to the first review publication and protocol factors predicting the time to publication was conducted. There were 411 new Cochrane protocols in the cohort. After excluding 39; 71/372 (19.1%) were unpublished and 301/372 (80.9%) were published as full Cochrane reviews at the time of study analysis (January 2008). The median time to publication was 2.4 years (range: 0.15 to 8.96). Multivariate analyses revealed that shorter time to publication was associated with the review subsequently being updated (hazard ratio, HR: 1.80 [95% confidence interval, CI: 1.39 to 2.33 years]) and longer time to publication was associated with the review having two published protocols, indicating changes to the review plan (HR: 0.33 [95% CI: 0.12 to 0.90 years]).Conclusions/SignificanceOnly about 80% Cochrane protocols were published as full reviews after over 8 years of follow-up. The median time to publication was 2.4 years and some reviews took much longer. Strategies to decrease time to publication should be considered, such as streamlining the review process, increased support for authors when protocol amendments occur, and better infrastructure for updating Cochrane reviews.

Evidence-Based Clinical Recommendations for the Use of Pit-and-Fissure Sealants: A Report of the American Dental Association Council on Scientific Affairs

This article presents evidence-based clinical recommendations for use of pit-and-fissure sealants developed by an expert panel convened by the American Dental Association Council on Scientific Affairs. The panel addressed the following clinical questions: Under what circumstances should sealants be placed to prevent caries? Does placing sealants over early (noncavitated) lesions prevent progression of the lesion? Are there conditions that favor the placement of resin-based versus. glass ionomer cement sealants in terms of retention or caries prevention? Are there any techniques that could improve sealants' retention and effectiveness in caries prevention? Staff of the ADA Division of Science conducted a MEDLINE search to identify systematic reviews and clinical studies published after the identified systematic reviews. At the panel's request, the ADA Division of Science staff conducted additional searches for clinical studies related to specific topics. The Centers for Disease Control and Prevention also provided unpublished systematic reviews that since have been accepted for publication. The expert panel developed clinical recommendations for each clinical question. The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. The evidence indicates that sealants can be used effectively to prevent the initiation and progression of dental caries.

Recommendations on the Use of 18F-FDG PET in Oncology

The rationale was to develop recommendations on the use of (18)F-FDG PET in breast, colorectal, esophageal, head and neck, lung, pancreatic, and thyroid cancer; lymphoma, melanoma, and sarcoma; and unknown primary tumor. Outcomes of interest included the use of (18)F-FDG PET for diagnosing, staging, and detecting the recurrence or progression of cancer. A search was performed to identify all published randomized controlled trials and systematic reviews in the literature. An additional search was performed to identify relevant unpublished systematic reviews. These publications comprised both retrospective and prospective studies of varied methodologic quality. The anticipated consequences of false-positive and false-negative tests when evaluating clinical usefulness, and the impact of (18)F-FDG PET on the management of cancer patients, were also reviewed. (18)F-FDG PET should be used as an imaging tool additional to conventional radiologic methods such as CT or MRI; any positive finding that could lead to a clinically significant change in patient management should be confirmed by subsequent histopathologic examination because of the risk of false-positive results. (18)F-FDG PET should be used in the appropriate clinical setting for the diagnosis of head and neck, lung, or pancreatic cancer and for unknown primary tumor. PET is also indicated for staging of breast, colon, esophageal, head and neck, and lung cancer and of lymphoma and melanoma. In addition, (18)F-FDG PET should be used to detect recurrence of breast, colorectal, head and neck, or thyroid cancer and of lymphoma.

Provider arrangements for mental health services in 'The New NHS'

Mental health services in England, in common with many other European countries, have been the subject of sustained government attention during the 1990s. Since the election of the Labour administration in Britain in May 1997, mental health services have been discussed in most Department of Health documents on health and social care policy, and mental health services in England have a new national strategy. At the same time, the local provision of mental health services within NHS Trusts has been undergoing organisational change. This paper sets out the policy context and evidence base for the reorganisation of provider arrangements for mental health services. In addition, the results of a documentary analysis of unpublished reviews of provider arrangements in 10 localities are presented. The review identified three major themes: firstly, the reconfiguration of NHS Trusts is based around Specialist Mental Health Trusts and Community and Mental Health Trusts; secondly, the joint provision of services and/or the integration of services between health and social services is starting to appear and; thirdly, the delegation of responsibility to localities based on Primary Care Group/Social Services boundaries is being discussed. The paper discerns a number of trends and points to the need for further research, in particular into the relationship between organisational arrangements and effective service delivery.