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Chapter 7: Systematic Reviews of Etiology and Risk

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... This protocol follows the Methodological Expectations of Campbell Collaboration Intervention Reviews (MECCIR) conduct standards, as suggested by The Methods Group of the Campbell Collaboration (2017) (Supporting Information S1: I). The proposed review will be conducted following the JBI methodology for systematic reviews of etiology and risk, which aims to identify and synthesize the available evidence on the factors that are associated with a health outcome (Moola et al., 2020), and the NIRO-SR guidelines for the development of non-intervention, ...
... The guide to information retrieval for Campbell systematic reviews was consulted to organize the search for studies (Kugley et al., 2016). Within this framework, the search strategy was designed to identify studies published before May 2024, and the keywords selected will be agreed upon by all authors, following a three-step methodology (Moola et al., 2020). A professional librarian was consulted during all stages of the search strategy design. ...
... This review is expected to encompass primarily observational and analytical studies, given that these study designs are most frequently employed to assess the relationship between certain exposure variables and health outcomes (Moola et al., 2020). Additionally, some experimental and quasi-experimental studies are expected to be included. ...
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This is the protocol for a Campbell systematic review. The objectives are as follows. In order to understand the variables affecting breastfeeding in working women, this systematic review will aim to determine the factors associated with early breastfeeding cessation upon women's return to work within a Social‐Ecological framework. This will be achieved by answering the following questions: Which individual factors are associated with early discontinuation of breastfeeding upon returning to work?; Which interpersonal factors are associated with early discontinuation of breastfeeding upon returning to work?; Which community factors are associated with early discontinuation of breastfeeding upon returning to work?; Which institutional factors are associated with early discontinuation of breastfeeding upon returning to work?; Which public policies are associated with early discontinuation of breastfeeding upon returning to work?
... Per tutti gli studi che rispettavano i criteri di selezione è stata valutata la qualità sulla base di checklist esistenti (Moola et al., 2017). La qualità è stata definita come la precisione nella stima dell'effetto dell'abuso di apportare cambiamenti cerebrali, minimizzata sulla base del disegno di studio utilizzato e le appropriate analisi. ...
... La qualità è stata definita come la precisione nella stima dell'effetto dell'abuso di apportare cambiamenti cerebrali, minimizzata sulla base del disegno di studio utilizzato e le appropriate analisi. Due autori (AU & MM) hanno valutato in maniera indipendente tutti gli studi per qualità, utilizzando i criteri predeterminati e validati della checklist del Johanna Briggs Institute per studi cross-sectional e caso-controllo (Moola et al., 2017). I criteri di valutazione includevano la comparabilità e l'appropriatezza dei casi e dei controlli, misura dell'esposizione valida e affidabile, identificazione dei fattori confondenti e strategie utilizzate per l'implementazione di questi fattori, valutazione degli outcome valida e affidabile e appropriatezza delle analisi statistiche utilizzate. ...
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Riassunto La violenza di genere è un fenomeno che colpisce almeno il 35% delle donne in tutto il mondo e si configura ormai come un problema di salute pubblica a causa delle sue conseguenze a breve e a lungo termine nei suoi componenti bio-psico-sociali. L'Intimate Partner Violence (IPV) è la forma più insidiosa e difficile da rintracciare in quanto generalmente viene messa in atto all'interno delle mura domestiche, luogo che dovrebbe per definizione proteggere, accogliere, far sentire al sicuro. La portata traumatica di queste manifestazioni non può essere limitata ad un'episodio di vittimizzazione casuale, quanto piuttosto al ripetersi e al cronicizzarsi della violenza in maniera deliberata, in un contesto un tempo avvertito come sicuro. Se da un lato alcuni aspetti, studiati da tempo, risultano essere chiari, dall'altro è meno chiaro cosa si verifica nelle strutture cerebrali delle vittime al seguito della violenza. È stata quindi condotta una revisione sistematica della letteratura secondo il metodo PRISMA per fornire chiarimenti in merito. I risultati dei 13 studi inclusi saranno discussi nel presente articolo. Parole chiave: violenza, IPV, conseguenze anatomo-funzionali, revisioni sistematiche THE ANATOMICAL-FUNCTIONAL CORRELATES OF VIOLENCE: A SYSTEMATIC REVIEW Gender violence is a phenomenon that involves at least 35% of women worldwide, and it is a public health problem due to its short and long-term bio-psycho-social consequences. Intimate Partner Violence (IPV) is the most difficult and insidious form because it happens inside houses, places in which one feels protected, accepted, and safe. The traumatic extent can't be limited to an episode of casual victimization, but rather to the repeat and become chronic deliberate violence, in a safe context. If on the one hand some aspects, studied for a long time, are clear, on the other hand, it is not clear what happens to the brain of the victims after violence. Therefore, a systematic review was conducted according to the PRISMA method to provide clarification in this regard. The 13 included studies' results will be discussed in the present article.
... This study rejected data from (1) Clinician respondents, (2) irrelevant study aims, (3) a review study, and (4) a qualitative study. The quality of the final studies was assessed using the JBI (Joanna Briggs Institute) checklist for observational studies [19]. Key aspects of assessment include 8 points that are scored 1 or 0 (yes = 1), (no = 0), and (unclear or not applicable = 0) [20]. ...
... It is challenging to identify the confounding variables in WTP studies because the main objective of these studies is to assess people's monetary appraisal of a particular good or service. Thus, participant behaviors, attitudes, and lifestyle choices are critical to the assessment [19]. ...
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Colorectal cancer (CRC) screening is crucial to reduce the global economic burden related to CRC. The purpose of this study is to examine studies on assessing willingness to Pay (WTP) for CRC screening and to investigate any potential variables influencing WTP. A systematic review was conducted through databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The study included 10 English-language studies that evaluated WTP for CRC screening. The study assessed how much participants were willing to pay for the assumed test cost by calculating the proportion of their WTP value. All values were converted to 2023 USD using a consumer price indices calculator and US Treasury converter. This study showed that the WTP value for CRC screening varied from USD 11.07 to USD 658.65. The co-payment rate ranged from 0.15 to 83.73. The factors influencing WTP value includes sociodemographic factors and the screening test attributes. Our study revealed the variative relationship between sociodemographic parameters and test features in influencing individuals’ decisions about CRC screenings. Understanding the importance of both demographic factors and test attributes is crucial for future research to develop targeted strategies for improving CRC screening uptake. Additionally, insights into WTP value aid in shaping public policies for CRC screening programs.
... A.A. and E.K. assessed the quality of the studies using the JBI's critical appraisal tools for case reports [16] and case series [17]. A third reviewer (M.H.) was involved in cases of inconsistencies. ...
... Quality appraisal was conducted for the five included case reports [18,19,[21][22][23] using the JBI checklist for case reports [16] and for the case series [20] using the JBI checklist for case series [17]. ...
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Background Pulsed‐field ablation (PFA) is a cutting‐edge technique that employs non‐thermal energy to cause cell death by inducing irreversible electroporation of cell membranes. This systematic review evaluates the PFA effectiveness as a potential alternative to radiofrequency and cryo‐ablation for treating ventricular tachycardia. Methods PubMed, Embase, Scopus, and Web of Science were systematically searched using keywords related to ventricular tachycardia and pulsed‐field ablation. Eligible Studies evaluating this therapeutic approach for ventricular tachycardia were included in the final analysis. Results We included six studies (five case reports and one case series) in our systematic review. Eight (88.8%) of procedures were successful with 100% long‐term efficacy. No procedural complications or ventricular tachycardia (VT) recurrence were observed in the cases. Conclusion The absence of complications, high effectiveness, and long‐term success rate make PFAs a good VT treatment option. However, PFA safety and efficacy studies for VT treatment are scarce. Thus, larger investigations on this topic are urgently needed.
... The checklist is intended to ensure comprehensive and systematic reporting, thereby enhancing the reliability and reproducibility of anatomical studies [14]. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool for casecontrol studies [15]. The JBI tool consists of 10 components, with each item being scored as No (not reported), Unclear (reported but inadequate), Yes (reported and adequate), or Not Applicable. ...
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Introduction > The dimensions and morphology of sella turcica (ST) are often altered in individuals with craniofacial anomalies, including those with cleft lip and palate (CLP). Therefore, the review aimed to identify the current evidence on the 3D morphological characteristics of the ST in patients with CLP. Methods > A systematic literature search was conducted using different databases without language or publication date restrictions. Studies were included comparing non-syndromic CLP patients to non-cleft controls using 3D imaging techniques for ST assessment. Critical appraisal of included studies was evaluated using the JBI case-control checklist and Anatomical Quality Assurance (AQUA) checklist. A random-effects meta-analysis was used for quantitative synthesis. Results > Out of 1187 identified articles, six studies met the inclusion criteria. Four studies were rated moderate quality, while two were considered low quality. Most studies reported larger overall ST dimensions in non-cleft controls, with significant differences in ST depth and diameter. The meta-analysis revealed reduced ST depth (MD = À0.95; 95% CI: À1.73, À0.17; P = 0.02) and diameter (MD = À1.00; 95% CI: À1.88, À0.11; P = 0.03) in CLP patients, while no significant difference was observed in ST length. CLP patients exhibited more irregular ST morphologies, such as flattening and irregular posterior walls. Conclusions > The review highlights an association between CLP and alterations in ST morphology and dimensions. However, variability in methodologies and the lack of standardized protocols
... The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies is recommended as the preferred tool for assessing the quality of analytical cross-sectional studies (Ma et al., 2020). The (JBI) Critical Appraisal Checklist is a domain-based tool that includes eight criteria: three referring to the study population, one criterion related to validity and reliability concerning the measurement of exposure, one criterion related to validity and reliability concerning the measurement of outcomes, and three criteria related to statistical analysis and adjustment for confounding factors (Moola et al., 2020). A criterion was rated Yes if enough information was available to determine the criterion was met, No if it was not met, Unclear if a decision could not be applied with the information provided, and Not applicable if the criterion did not apply. ...
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Extensive research has shown that spending time in natural greenspaces has a positive impact on health. However, there is limited evidence regarding potential factors that may influence these effects. This review aimed to assess the strength of the evidence and potential impact of exposure to green and bluespaces on dietary outcomes in adults. Inclusion criteria for the review were based on the PICO criteria. Following PRISMA guidelines, an initial search of five databases was conducted: CINAHL, GreenFILE, AMED, Medline, and PubMed, accessed on 14th June 2021 and augmented by an updated rerun in January 2024. All studies used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross‐Sectional Studies for quality assessment. Due to heterogeneity, a narrative synthesis was conducted to evaluate the relationships between the included studies. Four observational studies that reported diet‐related outcomes were included in the review, and participants within the studies ranged from 554 to >350,000 participants. Other health outcomes, including physical activity and obesity, were also reported. Two studies found that dietary patterns were not correlated with exposure to greenspace. Due to the small number of articles retrieved and the paucity of evidence, the findings must be interpreted cautiously. In conclusion, further research is essential to clarify the intricate mechanisms involved in greenspace‐related health benefits. Additionally, investigating the specific greenspace attributes influencing adult dietary intake and food choices is warranted. When devising public health interventions, it is crucial to account for the substantial health advantages associated with various socioeconomic groups.
... The null hypothesis model was utilized for the effect size comparison. Statistical analyses were conducted using Comprehensive Meta-Analysis Software version 3.0 (Biostat, Englewood, New Jersey, USA) [21]. ...
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The COVID-19 pandemic has significantly impacted mental health worldwide, leading to increased rates of suicidal behavior. This systematic review and meta-regression aim to investigate the global prevalence and risk factors associated with suicidal behaviors in the general population during the pandemic. The study included 202 articles from January 1, 2019, to October 31, 2023, sourced from databases such as Embase, MEDLINE, CINAHL, Web of Science, and Cochrane Library. The meta-analysis revealed a prevalence of 13.5% for suicidal ideation, 10.4% for suicide attempts, and a death rate of 0.5%, translating to 4.52 per 100,000 person-years. Significant risk factors identified include being transgender, young adults (18–44 years), unmarried status, low education, retirement, living alone, low social support, a history of suicide attempts, substance use, depression, anxiety, PTSD, sleep problems, poor perceived physical health, loneliness, quarantine, and residing in the Americas or multiple regions. The findings underscore the urgent need for targeted mental health interventions during pandemics, focusing on high-risk groups such as young adults, transgender individuals, those with low social support, and people with mental health issues. This comprehensive analysis provides valuable insights for policymakers and healthcare providers to develop effective strategies to mitigate the heightened risk of suicide during global health crises.
... The risk of bias was assessed independently by two reviewers (J.R.T. and B.A.B.A.) using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for Observational Studies (Cross-sectional). 21 For cross-sectional studies, all eight items were applied. Each criterion was categorized as "Y" (yes), "N" (no), or "U" (unclear) for risk of bias. ...
... The quality of the studies was evaluated by the Joanna Briggs Institute (JBI) critical appraisal tool [31]. This tool assesses various aspects of study design, conduct, and reporting to gauge the reliability and validity of findings. ...
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Investigating sport persistence can make a significant contribution to a thorough examination and understanding of the factors underlying an athlete’s activity, integrating physical activity, sports motivation and commitment. This systematic review aimed to detect the papers focusing on the factors influencing sport persistence following the levels of Bronfenbrenner’s and Bauman’s ecological models. Following the PRISMA guidelines, by the EBSCO Discovery Service Search Engine, 512 records were detected, of which 21 met the criteria. Factors influencing sport persistence show a huge variety. Individual factors and micro-system level were overrepresented. Meso- and macro-level factors are underrepresented and measured only with other (individual or micro-system level) factors. Most factors detected at the individual (e.g. gender, age, career-related variables and positive psychological factors), micro- (e.g. family, peers and coaches), meso- (e.g. climate), and macro-level (cultural, societal, and institutional influences) were positively correlated with sport persistence, i.e. supporting the persistent behaviour of the athletes regarding participating in one’s sporting activity. In conclusion, there is still room for further research concerning sport persistence. Including variables belonging to the meso- and macro-system and conducting longitudinal research should be considered which would allow us to better understand the nature of sport persistence.
... The Johanna Briggs Institute (JBI) checklist of related items, sampling, eligibility protocols, description of study subject and setting, appropriate statistical analysis, case definition, confounder identification, valid and reliable result measurement, bias minimization, comparability among study participants, and generalizability of the study were checked independently. The scoring system was No (not done), Yes (done), UC (unclear), and NA (not applicable), and the judgments of the score range for cross-sectional studies were 0 (lowest quality) to 8 (highest quality) and for quasi-experimental studies, 0 (lowest quality) to 9 (highest quality) [32,33]. Articles with an average methodological score of �50% for each item were included in this review (S3 Table). ...
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Background Lean methodology, originally developed in the manufacturing sector, is a process management philosophy focused on maximizing value by eliminating waste. Its application in laboratory settings, particularly concerning laboratory turnaround times (TAT), involves a systematic approach to identifying inefficiencies and optimizing processes to enhance value for end customers. Methods This systematic review was registered in PROSPERO with identification number (CRD42024552350) and reported based on the 2020 PRISMA checklist. An extensive search strategy was performed using PubMed, Scopus, and Embase databases and gray literatures. Advanced searching was used using Boolean operators (AND & OR). After articles were exported to endnote x8, duplications were removed and articles were selected based on titles, abstracts, and full texts. The illegibility of the articles was independently assessed by the three authors (NC, DMB, and BBT), and the disagreements were settled through scientific consensus. Methodological quality was assessed using JBI critical appraisal checklist. Discussion In this review, electronic databases search yielded 1261 articles, of which 7 met the inclusion criteria. The review demonstrated, implementation of lean principle into the routine laboratory testing had an overall impact 76.1% on reducing laboratory TAT. Transportation, manual data processing, inefficient workflow, and the heavy workload were identified as the main wasteful procedures. To eliminate these non-value-added steps, several intervention techniques were implemented, including the use of a barcoding system, process redesign, workflow optimization, hiring additional staff, and relocating the sample collection room closer to the result distribution center. Lean implementation is crucial in the medical laboratory industry for optimizing processes, reducing TAT, and ultimately enhancing customer satisfaction. As a result, all clinical laboratories should adopt and implement lean principles in their routine testing processes. The medical laboratory industry should also proactively look for and apply lean tools, provide ongoing training, and foster awareness among laboratory staffs.
... We used the Joanna Briggs Institute Critical Appraisal Checklist for analytical studies to assess the risk of bias [36]. Studies addressing ≥75% of checklist items were considered as having a low risk of bias. ...
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There is increasing interest in the pathophysiological role of arginine metabolism in schizophrenia, particularly in relation to the modulation of the endogenous messenger nitric oxide (NO). The assessment of specific arginine metabolites that, unlike NO, are stable can provide useful insights into NO regulatory enzymes such as isoform 1 of dimethylarginine dimethylaminohydrolase (DDAH1) and arginase. We investigated the role of arginine metabolomics in schizophrenia by conducting a systematic review and meta-analysis of the circulating concentrations of arginine metabolites associated with DDAH1, arginase, and NO synthesis [arginine, citrulline, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), dimethylamine, and ornithine] in this patient group. We searched PubMed, Scopus, and Web of Science from inception to the 31 st of May 2023 for studies investigating arginine metabolites in patients with schizophrenia and healthy controls. The JBI Critical Appraisal Checklist for analytical studies and GRADE were used to assess the risk of bias and the certainty of evidence, respectively (PROSPERO registration number: CRD42023433000). Twenty-one studies were identified for analysis. There were no significant between-group differences in arginine, citrulline, and SDMA. By contrast, patients with schizophrenia had significantly higher ADMA (DDAH1 substrate, standard mean difference, SMD = 1.23, 95% CI 0.86-1.61, p < 0.001; moderate certainty of evidence), dimethylamine (DDAH1 product, SMD = 0.47, 95% CI 0.24-0.70, p < 0.001; very low certainty of evidence), and ornithine concentrations (arginase product, SMD = 0.32, 95% CI 0.16-0.49, p < 0.001; low certainty of evidence). In subgroup analysis, the pooled SMD for ornithine was significantly different in studies of untreated, but not treated, patients. Our study suggests that DDAH1 and arginase are dysregulated in schizophrenia. Further studies are warranted to investigate the expression/activity of these enzymes in the brain of patients with schizophrenia and the effects of targeted treatments.
... The quality of the included studies [22,[43][44][45][47][48][49][50][51][53][54][55][58][59][60][61] was assessed using the Joanna Briggs Institute (JBI) checklist tool [62] (Table 3). This tool, developed by the University of Adelaide's Joanna Briggs Institute, is a validated and reliable instrument specifically designed for systematic reviews. ...
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Background/Objectives: Job satisfaction is crucial for healthcare professionals, and understanding its influencing factors is essential for fostering a positive work environment, reducing turnover rates, and improving the overall quality of patient care. This systematic review examined the factors linked to nurse job satisfaction in psychiatric hospitals and diverse psychiatric settings, analyzing the findings through the lens of Herzberg’s theory. Despite existing evidence, gaps remain in understanding the differences in factors affecting job satisfaction across various settings. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a comprehensive systematic review by searching six databases, namely PubMed, CINAHL, Cochrane Library, PsycINFO, Scopus, and APA PsycNet. Our search yielded an initial 567 studies published between January 2014 and February 2024, which were subsequently screened and evaluated based on predetermined inclusion criteria. Following this process, a total of 16 studies were deemed eligible for final analysis. Each of these selected studies underwent an independent review by two authors, utilizing the Joanna Briggs Institute checklist tool to ensure rigorous assessment. Results: The findings revealed that interpersonal relationships, working conditions, and recognition were the most frequently reported factors associated with nurse job satisfaction, along with various extrinsic, intrinsic, personal, emotional, and psychosocial factors. Notably, psychiatric hospitals showed a mix of personal, extrinsic, intrinsic, and psychosocial factors influencing job satisfaction, with demographic factors being the most frequently examined. In contrast, diverse psychiatric settings focused more on external aspects impacting job satisfaction. Conclusions: The review highlights the importance of both intrinsic and extrinsic factors and suggests that future research should employ more robust methods and consider psychiatric hospitals and other mental health contexts. Herzberg’s theory provides a valuable framework for understanding the factors associated with nurse job satisfaction.
... The following information was extracted from each article: (1) author; (2) year; (3) country; (4) sample size; (5) measurement tool used; and (6) outcomes found. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools (Moola et al., 2020). This tool consists of a standardized checklist that follows a set of criteria, developed in a series of variable items according to the type of study analyzed. ...
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Background Emotional intelligence (EI) enables the regulation of emotions and facilitates interpersonal relationships. This is essential for managing emotionally charged situations and developing skills to provide quality care. Method A systematic review was conducted according to PRISMA recommendations in Web of Science, Scopus, CINAHL, and PubMed databases to describe the levels of EI, identify differences according to gender, and determine the relationship of EI with health, academic, and clinical performance in nursing students. Results Average levels of EI were found; in five of the studies, the levels were higher among females. An association between high levels of EI and improved academic and clinical performance and health also was found. Conclusion Future research on EI education programs for nursing students is essential for the development of skills and abilities that improve well-being, academic performance, and quality of health care. [ J Nurs Educ . 2024;63(10):686–692.]
... For each study, the authors appraised the level of evidence in accordance with the 2011 Oxford Center for Evidence-Based Medicine guidelines and evaluated the risk of bias using the Joanna Briggs Institute checklist for case series. [15,21] Following the preliminary evaluation of titles and abstracts in addition to subsequent full-text assessment, 27 case studies were finally included [1][2][3][4][5][6][7][8][9][10][12][13][14]19,20,22,[24][25][26][27][28][30][31][32][33][34][35] [ Table 1]. Quality assessment resulted in a low risk of bias for all included articles [Supplementary File 1]. ...
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Background The presigmoid approach represents the standard route to reach the petrous area anterior to the sigmoid sinus. Several lateral skull base approaches have been integrated into this approach for the purpose of widening the window, leading to variable combined approaches and variable terminology. Herein, the authors conducted a systematic review of the literature to simplify understanding of the potential combination of different approaches and their complications. Methods PubMed, EMBASE and Web of Science databases were searched on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include studies describing modifications of the presigmoid approach. Results We included 27 studies comprising 545 patients. Five combination types applied to the presigmoid approach were identified: Anterior petrosal (Kawase’s) approach (Type-1), Supra-tentorial approach (Type-2), Infratemporal fossa approach (Type-3), retrosigmoid approach (Type-4), and Far-lateral suboccipital approach (Type-5). Type-1 combined approach was the commonest type ( n = 204, 37.5%), followed by type-2 ( n = 197, 36%), type-4 ( n = 54, 9.9%), type-5 ( n = 51, 9.4%), and type-3 ( n = 39, 7.2%). Meningioma was the typical target lesion in all types except type 3, where it is solely used for paraganglioma. The petroclival region was the prevalent access location in all the types of combined presigmoid approaches (type-1, 92%; type-2, 95%; type-3, 100%; type-4, 59%; and type-5, 64%). The intraoperative lateral patient position was dominantly utilized in type-1, type-3, and type-5 approaches (65%, 100%, and 100%, respectively), while park-bench was the most common position in type-2 (36%) and type-4 (100%) approaches. Overall, all types exhibited good outcomes in the form of gross total resection of the lesion and the absence of surgical complications in the follow-up. Conclusion Presigmoid approaches are becoming increasingly complex with the application and integration of the lateral skull base approaches, resulting in broadening the surgical field and easy access to the targeted lesions. The importance of designing a comprehensive nomenclature of the combined presigmoid approaches may add distinctive contributions to the growing knowledge of neurosurgery.
... All included studies were treated as non-randomized trials. Therefore, the Risk of bias in cohort studies (JBI Critical Appraisal Checklist for cohort studies) tool was used for assessing the quality of studies (15). This tool assesses the methodological quality of cohort studies across 11 key domains. ...
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In this meta-analysis and systematic review, 7785 patients from 33 original studies reporting outcomes of therapy- related myeloid neoplasms (t-MN) including therapy-related acute myeloid leukemia (t-AML) and therapy-related myelodysplastic syndrome (t-MDS) were included. The survival data were retrieved from Kaplan-Meier (KM) curves to calculate the overall survival (OS) and disease-free survival (DFS) probabilities. 67.3% (n = 5241) of the patients had t-AML. 26.5% (n = 2076) had t-MDS, and 6% had a mixed presentation (n = 468). The age of the patients ranged from 2 to 89 years and 61.7% were females. The pooled median OS was 16.9 months (95% CI: 13.7–21.1) and the estimated mean OS was 46.0 months (95% CI: 42.1–49.6). The pooled median DFS was 8.8 months (95% CI: 7.4–11.2) and mean DFS was 37.8 months (95% CI: 33.4–41.9). The pooled proportion of acute graft versus host disease (aGvHD) was 34% (95% CI: 0.35–0.45, I ² : 91.71%, p < 0.0001). Relapse of the myeloid neoplasm was the most common cause of mortality, followed by infections, relapse of the underlying disease, and GvHD. Despite complications, allo-HCT is still the curative treatment option with better outcomes compared to conventional chemotherapy in t-MN. Timely transplants in carefully selected patients with post-HCT interventions could improve outcomes.
... Author, YAA, assessed the quality of studies using the standardized quality assessment checklist developed by the Joanna Briggs Institute (JBI) (16). The critical analysis checklist consists of eight parameters, each with the options Yes, No, Unclear, and Not applicable. ...
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Introduction Internet addiction refers to the excessive and uncontrolled utilization of the Internet, which disrupts one's daily activities. The current state of knowledge regarding internet addiction in Ethiopia is limited. Consequently, the objective of this study is to ascertain the combined prevalence of Internet addiction and its correlated factors among university students in Ethiopia. Methods To identify potential research findings, an extensive literature search was conducted using electronic databases such as PubMed/MEDLINE, Web of Science, and Google Scholar. The presence of heterogeneity between studies was assessed using Cochrane Q test statistics and I2 test statistics, while the effects of small studies were examined using Eggers statistical tests at a 5% significance level. Additionally, a sensitivity analysis was carried out. A random effects model was used to estimate the pooled prevalence and associated factors of Internet addiction among students. The primary focus of this research was to determine the prevalence of Internet addiction, while the secondary aim was to identify the factors associated with Internet addiction. Results To determine the overall prevalence of Internet addiction among university students in Ethiopia, a comprehensive analysis of 11 studies was conducted. The results of this study show that the pooled prevalence of Internet addiction was 43.42% (95% CI: 28.54, 58.31). The results also suggest that certain factors such as online gaming, depression, and current khat chewing are significantly associated with internet addiction among university students. Conclusions In Ethiopia, about one-third of university students suffer from internet addiction. The prevalence of Internet addiction among Ethiopian students is associated with online gaming, depression, and concurrent khat consumption. Therefore, we strongly recommend that health planners and policymakers prioritize monitoring and addressing Internet use and addiction in the Ethiopian context.
... A customized risk of bias tool was used for assessment of internal validity / reporting quality of each individual study independently and in duplicate by two investigators (DT and AKP). This tool was tailored to the scope of this review's eligible studies and based on items from The Joanna Briggs Institute's critical appraisal checklists for cross-sectional studies and the Appraisal tool for Cross-Sectional Studies (AXIS) [34,35]. The specific domains / questions of the customized tool can be seen in Supplementary Table 4. ...
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Background The anatomic characteristics of the masticatory muscles differ across craniofacial skeletal patterns. Objective To identify differences in the anatomic characteristics of masticatory muscles across different sagittal and vertical craniofacial skeletal patterns. Eligibility criteria Studies measuring the thickness, width, cross-sectional area (CSA), volume and orientation of masticatory muscles in healthy patients of different sagittal (Class I, Class II, and Class III) and/or vertical (normodivergent, hypodivergent, and hyperdivergent) patterns. Information sources Unrestricted literature searches in 8 electronic databases/registers until December 2023. Risk of bias and synthesis of results Study selection, data extraction, and risk of bias assessment with a customised tool were performed independently in duplicate. Random-effects meta-analysis and assessment of the certainty of clinical recommendations with the GRADE approach were conducted. Results 34 studies (37 publications) were selected with a total of 2047 participants and data from 16 studies were pulled in the meta-analysis. Masseter muscle thickness in relaxation was significantly greater by 1.14 mm (95% CI 0.74–1.53 mm) in hypodivergent compared to normodivergent patients while it was significantly decreased in hyperdivergent patients by − 1.14 mm (95% CI − 1.56 to − 0.73 mm) and − 2.28 mm (95% CI − 2.71 to − 1.85 mm) compared to normodivergent and hypodivergent patients respectively. Similar significant differences were seen between these groups in masseter muscle thickness during contraction as well as masseter muscle CSA and volume. Meta-analyses could not be performed for sagittal categorizations due to insufficient number of studies. Conclusions Considerable differences in masseter muscle thickness, CSA and volume were found across vertical skeletal configurations being significantly reduced in hyperdivergent patients; however, results should be interpreted with caution due to the high risk of bias of the included studies. These variations in the anatomic characteristics of masticatory muscles among different craniofacial patterns could be part of the orthodontic diagnosis and treatment planning process. Registration : PROSPERO CRD42022371187 .
... and A.S.) using the Joanna Briggs Institute (JBI) tools for case-control studies. Specific checklist items used from the JBI tools are detailed in [9]. Discrepancies were resolved through consensus. ...
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The rising incidence and mortality of early-onset colorectal cancer (EOCRC) emphasize the urgent need for effective non-invasive screening. Circulating microRNAs (miRNAs) have emerged as promising biomarkers for cancer detection. This systematic review aims to evaluate the diagnostic performance of circulating miRNAs in detecting colorectal cancer (CRC). A literature search was conducted in PubMed and Scopus. Studies that report sensitivity, specificity, or area under the curve (AUC) for CRC detection by miRNA were included. The miRNA miR-21 was the most frequently studied biomarker, with a varying range of AUC from 0.55 to 0.973 attributed to differences in study populations and methodologies. The miRNAs miR-210 and miR-1246 showed potential diagnostic capacity with miR-1246 achieving an AUC of 0.924, 100% sensitivity, and 80% specificity. The miRNA panels offer improved diagnostic performance compared to individual miRNA. The best performing panel for CRC patients below 50 is miR-211 + miR-25 + TGF-β1 with AUC 0.99 and 100 specificity and 97 sensitivity. Circulating miRNAs hold significant promise as non-invasive biomarkers for CRC screening. However, the variability in diagnostic performance highlights the need for a standardized method and robust validation studies. Future research should focus on large-scale, ethnically diverse cohorts to establish clinically relevant miRNA biomarkers for CRC, particularly in younger populations.
... The Joanna Briggs Institute Appraisal tools for cross-sectional studies were used for the studies' quality appraisal. The checklist consisted of eight items [30]. Each item was rated as Yes, No, Unclear or Not Applicable. ...
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Objective This study was conducted to determine the effect of the mode of delivery on maternal postpartum comfort level and breastfeeding self-efficacy. Methods The study was conducted as a systematic review and a meta-analysis. Searching was performed from March to July 2022, on PubMed, National Thesis Center, Dergi Park, Google Scholar, Web of Science, and EBSCO search engines and we included studies from the last 10 years. The Joanna Briggs Institute Critical Appraisal tools used in cross-sectional studies were employed to appraise the methodological quality and performed meta-analyses using a random-effects model for all outcomes. Study data consisted of continuous variables calculated by Mean Difference. Results From 3732 records received, 21 cross-sectional studies involving 5266 participants were determined to be eligible. Meta-analysis results showed that cesarean section reduced postpartum comfort, albeit not statistically significant (MD: -0.87 95%: -1.98–0.24, Z = 1.53, p = 0.44), whereas the combined results of breastfeeding self-efficacy showed that delivery type did not affect breastfeeding self-efficacy. Conclusion The results of this review have clinical implications for postpartum caregivers, as the effects of mode of delivery on postpartum comfort and breastfeeding self-efficacy have been well documented in previous studies. The authors recommend caregivers plan maternal care to increase their comfort, taking into account the factors that may affect postpartum comfort in the light of evidence-based practices.
... In addition, the quality of the case reports was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports, which consists of eight yes/no/unclear questions. [8] Of the 16 case reports included in this review, 14 met with an affirmative response to each of the eight checklist questions. Only the articles by Stavrinou et al. (2008) [9] and Takei et al. (2009) [10] had a single negative response each, in relation to the description of adverse effects and the post-intervention clinical condition, respectively, but even so, they were eligible and included. ...
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Subependymal giant cell astrocytoma (SEGA), a circumscribed grade I glioma, is typically associated with tuberous sclerosis complex (TSC). However, “solitary SEGA” has been described. We performed a systematic review of available case reports and case series of solitary SEGA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used with the following MeSH terms: “Subependymal giant cell astrocytoma,” “Sporadic,” “Absence,” “Non-associated,” “Solitary,” and “Tuberous Sclerosis.” Data sources included PubMed, Google Scholar, Web of Science, and Cochrane from 1979 to June 29, 2023. Of the 546 studies, 20 met the inclusion criteria. Fifty-nine cases were analyzed. The mean age was 19 years (range 4–75), with 29 women (49.1%). Tumor ranged in size from 0.8 to 5.8 cm. Headache was the most frequent initial symptom (75.6%). The lateral ventricles near the foramen of Monro were the most common location (66.10%). Tumors expressed neuroglial (n = 19) or only glial (n = 20) markers. In nine of 59 cases, genetic studies ruled out germinal TSC1/2 mutations; in 13 cases (22.03%), somatic mutations in those genes were identified. “Solitary SEGAs” included tumors with neuroglial profile and classic morphological pattern, and tumors with only glial markers. It is necessary to confirm in SEGA-like tumors, the dual nature with at least glial fibrillary acidic protein (GFAP), neurofilaments, and synaptophysin antibodies. Screening for TSC1/2 mutations, and probably of the NF type 1 gene, is recommended for both germline and somatic mutations. Long-term clinical follow-up is necessary to analyze biological behavior and compare it with genetic and molecular profiles.
... The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for analytical studies (53). The certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group system (54). ...
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Introduction Patients with systemic sclerosis (SSc) have an increased risk of endothelial dysfunction, atherosclerosis, and cardiovascular events compared to the general population. Therefore, the availability of robust circulating biomarkers of endothelial dysfunction and atherogenesis may facilitate early recognition and management of cardiovascular risk in SSc. We sought to address this issue by conducting a systematic review and meta-analysis of studies investigating various types of circulating cell adhesion molecules involved in endothelial dysfunction and atherogenesis (i.e., immunoglobulin-like vascular cell, VCAM-1, intercellular, ICAM-1, platelet endothelial cell, PECAM-1, neural cell, NCAM, Down syndrome cell, DSCAM, and endothelial cell-selective, ESAM, adhesion molecules, E-, L-, and P-selectin, integrins, and cadherins) in SSc patients and healthy controls. Methods We searched PubMed, Scopus, and Web of Science from inception to 1 May 2024. Risk of bias and certainty of evidence were assessed using validated tools. Results In 43 eligible studies, compared to controls, patients with SSc had significantly higher plasma or serum concentrations of ICAM-1 (standard mean difference, SMD=1.16, 95% CI 0.88 to 1.44, p<0.001; moderate certainty), VCAM-1 (SMD=1.09, 95% CI 0.72 to 1.46, p<0.001; moderate certainty), PECAM-1 (SMD=1.65, 95% CI 0.33 to 2.98, p=0.014; very low certainty), E-selectin (SMD=1.17, 95% CI 0.72 to 1.62, p<0.001; moderate certainty), and P-selectin (SMD=1.10, 95% CI 0.31 to 1.90, p=0.007; low certainty). There were no significant between-group differences in L-selectin concentrations (SMD=-0.35, 95% CI -1.03 to 0.32, p=0.31; very low certainty), whereas minimal/no evidence was available for cadherins, NCAM, DSCAM, ESAM, or integrins. Overall, no significant associations were observed between the effect size and various patient and study characteristics in meta-regression and subgroup analyses. Discussion The results of this systematic review and meta-analysis suggest that specific circulating cell adhesion molecules, i.e., ICAM-1, VCAM-1, PECAM-1, E-selectin, and P-selectin, can be helpful as biomarkers of endothelial dysfunction and atherogenesis in the assessment of cardiovascular risk in SSc patients. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024549710.
... Pre-clinical animal-based studies were analyzed using the SYRCLE Risk of Bias tool [20]. Case-control studies were evaluated with the tool of the Joanna Briggs Institute (JBI) [21], while the studies of randomized clinical trials (RCT) were evaluated with the Cochrane risk of bias tool for randomized trials (RoB 2) [22]. ...
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Purpose The aim of the present systematic review was to collect and synthesize the literature concerning the effects of photobiomodulation (PBM) with light-emitting diode (LED) on the prevention and treatment of oral mucositis (OM). Methods A systematic review was conducted based on PRISMA 2020 statement. The searches were undertaken in four electronic databases and gray literature, according to the following question: “Is LED-based PBM effective as a preventive and therapeutic treatment for oral mucositis induced by anticancer treatments?”. Inclusion criteria were preclinical studies or clinical trials of LED therapy for subjects with OM induced by antineoplastic treatment. Results Eleven studies published between 2002 and 2022 were analyzed. The findings indicate that LED proved to be feasible and safe (3 clinical trials); effective in reducing inflammation (1 pre-clinical), severity (4 pre-clinical and 2 clinical trials), and analgesic and anti-inflammatory prescription requirements (1 clinical trial); in accelerating wound healing (2 pre-clinical and 1 clinical trial); preventing OM (1 pre-clinical and 2 clinical trials); and controlling pain (5 clinical trials). In addition, LED proved to have similar effects to low level laser therapy (LLLT) (2 pre-clinical studies and 2 clinical trials). Conclusions The current study adds to our understanding of how PBM with LED could play a significant role in the management of OM and reports promising results of this resource for managing a debilitating complication of cancer therapy.
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Nasal polyp (NP) is a pathological benign mass that affects the nasal cavity and paranasal sinuses. This lesion is occasionally associated with chronic rhinosinusitis (CRS), which is named chronic rhinosinusitis with nasal polyps (CRSwNP). Proliferating cell nuclear antigen (PCNA) indicates abnormal cell proliferation which may help assess the nasopharyngeal lesions and upper airway cancers. This study aimed to examine the PCNA expression in NP tissue. This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A thorough search using relevant keywords was performed on the electronic database to identify studies examining the PCNA expression in NP. Meta-analysis on pooled single group proportion and means of PCNA expression was conducted by the metamean and metaprop functions in R software (version 4.4.0). Quality assessment was done according to the Joanna Briggs Institute (JBI) checklist. Ten articles were included in this study. The PCNA expression in NP was higher than in normal nasal mucosa (NNM), while its expression in NP was lower than in inverted papilloma (IP). The mean percentage of PCNA expression in NP was 15.73% (95%-CI[2.87–28.58]) with considerable heterogeneity (I2 = 97%[96-98%],p-value < 0.01). Based on a cutoff staining (> 5%), 64% of NP samples were PCNA-positive (95%-CI[42-81%]) with high heterogeneity (I2 = 76%[47-89%], p-value < 0.01). NP tissue has a relatively high expression of the PCNA oncoprotein based on the immunohistochemistry (IHC) staining. Although more than half of NP samples were positive for PCNA, still the mean expression of this marker in NP was lower than in IP tissue.
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Background Infection prevention and control work environments are highly complex in nature and have long been associated with crisis events including serious infectious disease outbreaks. The role of infection control practitioners shifted exponentially during the COVID-19 pandemic and with this rapid and nebulous change came anxiety, emotional exhaustion and ultimately burnout. Burnout at work generally occurs as a response to chronic and prolonged exposure to emotionally challenging events, causing emotional exhaustion, feelings of cynicism, and lack of accomplishment at work. This systematic review aims to investigate burnout in infection control practitioners during public health crisis events (major outbreaks, epidemics, and pandemics) in upper-middle and high-income countries on a global scale. Methods A mixed-methods systematic review will be carried out and will include qualitative, quantitative and primary mixed-methods studies that investigate the different elements of burnout, during public health crisis events. After an initial scoping literature search, up to six databases will be searched for studies on burnout in relation to infection prevention practitioners. Study quality will be checked using standardised JBI critical appraisal tools. The proposed review will follow the JBI convergent integrated approach for mixed methods systematic reviews. Following data extraction, quantitative data will then be converted into ‘qualitized data’ in the form of textual descriptions. Discussion It is well documented that adverse conditions during public health crisis events can lead to burnout. This systematic review will investigate of burnout in infection control practitioners in upper-middle and high-income countries during public health crisis events. The findings will inform healthcare professionals, senior policy makers and researchers and will help contribute to a richer understanding of burnout and associated factors in infection control practitioners. Protocol registration number PROSPERO 2024 CRD42024508996.
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Purpose There is an imbalance between demand for and availability of stem cell donors worldwide. The purpose of this systematic review is to provide the first comprehensive understanding of facilitators and barriers influencing unrelated stem cell donation (USCD) in adults, through a data synthesis of qualitative and quantitative evidence. Identification of the facilitators and barriers associated with stem cell donation intention and behaviour is essential to inform the development of behaviour change interventions to meet the current demand. Methods Four databases were searched (Embase, PsycINFO, MEDLINE and CINAHL) and the last search was in February 2021. The search was limited to studies written in English and published from 1980 to present. Screening, quality assessment, data extraction and data synthesis incorporating the COM‐B model were undertaken in line with the Joanna Briggs Institute methodology for an integrated mixed‐methods review. Results Fifty studies were included in the review, analysis and mapping produced four integrated findings. Donation‐related knowledge was a facilitator and conversely, lack of knowledge was a barrier to donation related behaviours. Perceived convenience, positive social influences, religious beliefs and the accessibility of positive donation‐related social norms promoted positive donation related behaviours. Altruism and sense of duty were the most commonly cited motives for donation related behaviours.Through mapping to the COM‐B model, Communication/Marketing, and Service Provision are the primary policy categories that can be used to change donation related behaviours. Conclusion Future interventions should focus on targeted education regarding unrelated stem cell donation and creating recruitment campaigns that emphasise the life‐saving potential of donation.
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There is a large and rapidly growing body of literature investigating the therapeutic effects of classic psychedelics in affective and anxiety disorders, but very few studies have examined the inverse of this, that is, the potential for psychedelics to inflict anxiety and affective symptoms. A systematic literature search was performed and 39 papers were included in the final review to qualitatively synthesize the current literature on anxiety and affective disorders related to the use of classic psychedelics. Persisting disorders were less frequent but generally occurred in individuals who presented with several risk factors (overdose, polydrug use, unstructured recreational setting, psychosocial stress, personal/familial psychiatric histories). When psychedelics were administered in clinical studies under the framework of psychedelic-assisted therapy, the incidence of enduring anxiety and affective symptoms was low. In most cases, acute transient anxiety emerged and resolved during the dosing session without the need for additional treatment interventions. The nuance of such cases is discussed, shedding light on the role of emotional catharsis in the therapeutic process. Several suggestions are proposed to enhance patient safety including strengthening the therapeutic alliance, ensuring adequate mental preparation, acclimating to high doses and providing on-going therapeutic support.
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A biomarker is defined as a characteristic that is measured as an indicator of a normal biological or pathological process, a response to an exposure or intervention. Biomarkers with a diagnostic approach must identify not only the presence but also the absence of the disease with high precision, so having the biological source of the said marker is of vital importance to ensure precision and accuracy; the aim was to carry out a review of its diagnostic potential. The search strategy was carried out in three databases: PubMed, ScienceDirect, and Scopus. The keywords that were used were as follows: “gingival crevicular fluid”, “Biomarker”, and “Diagnosis”, using the Boolean operator “AND”. The filter was used at 10 years. Within the type of molecules most studied, the cytokine family was the most abundant with 25.42% of the studies, followed by metalloproteinases and proteins with 16.9% each one. Studies that included RNA-type genetic material were less frequently found. As has been demonstrated, the use of GCF as a source of biomolecules for diagnostic use has been increasing, both for oral diseases, which reflects the local conditions of the disease; it also has the ability to reflect the development of distant diseases; and this is because GCF is a blood ultrafiltrate.
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Healthcare workers (HCWs) are trusted sources of information for vaccination and their attitude toward vaccination is thus critical. We aimed to synthesize existing literature on healthcare workers’ HPV vaccine confidence and their practices of recommending this vaccine. We conducted a systematic literature review and meta-analysis, with the search conducted last in March 2024. For the inclusion criteria, the studies needed to include healthcare worker practices or behaviors on recommending the HPV vaccination. Seventy-three articles were included. The proportions of HCWs recommending varied considerably by region and gender of the recipient, but there was no statistically significant difference in income level or pre- or post-HPV vaccine introduction into the national vaccination program. The main barriers to recommending HPV vaccination were concerns around safety and efficacy, cost, parental concerns, and systemic barriers. The results illustrate the importance of contextually adapted approaches to improving vaccine acceptance and recommendation.
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Among youths, pathological irritability is highly prevalent and severely disabling. As a frequent symptom, it often leads to referrals to child and adolescent mental health services. Self-regulatory control (SRC) processes are a set of socio-psycho-physiological processes that allow individuals to adapt to their ever-changing environments. This conceptual framework may enhance the current understanding of the cognitive, emotional, behavioural and social dysregulations underlying irritability. The present systematic review (PROSPERO registration: #CRD42022370390) aims to synthesize existing studies that examine irritability through the lens of SRC processes among youths (< 18 years of age). We conducted a comprehensive literature search among six bibliographic databases: Embase.com, Medline ALL Ovid, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley and ProQuest Dissertations & Theses A&I. Additional searches were performed using citation tracing strategies. The retrieved reports totalled 2612, of which we included 82 (i.e., articles) from 74 studies. More than 85% of reports were published during the last 6 years, highlighting the topicality of this work. The studies sampled n = 26,764 participants (n = 12,384 girls and n = 12,905 boys, n = 1475 no information) with an average age of 8.08 years (SD = 5.26). The included reports suggest that irritability has an association with lower effortful control, lower cognitive control and delay intolerance. Further, evidence indicates both cross-sectional and longitudinal associations between irritability and a lack of regulation skills for positive and negative emotions, particularly anger. Physiological regulation seems to moderate the association between irritability and psychopathology. Finally, the mutual influence between a child’s irritability and parenting practice has been established in several studies. This review uses the lens of SRC to illustrate the current understanding of irritability in psychopathology, discusses important gaps in the literature, and highlights new avenues for further research.
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Background Despite substantial investments in maternity care, the United States continues to experience higher maternal mortality rates than most high-income countries. Rural regions lack adequate prenatal care services, a contributing factor to disparate maternal health outcomes. Methods This integrative review on patient, nurse, midwife, physician, and community perspectives on accessing prenatal care in rural areas of the United States follows Whittemore and Knafl's integrative review framework, including a systematic literature search in various databases from January 1, 2010, to May 1, 2024. Eligible articles were published in English, peer-reviewed, and focused on subjective accounts of accessing prenatal care in rural areas of the United States. Seven articles met inclusion criteria and were assessed for quality using the Joanna Briggs Institute checklists. Results Three major categories influencing access to prenatal care in rural areas were developed. Individual factors included transportation, family support, motivation, and work commitments. Socioeconomic factors encompass health insurance, rurality, income, and housing. System factors involved the qualities of nurses, midwives, physicians, the clinic environment, and collaboration within the health care system. The findings emphasized the complexity of rural prenatal care access. Conclusions Understanding patient and care giver perspectives on accessing prenatal care in rural areas is crucial for addressing the factors influencing maternal outcomes. Rural pregnant women face unique challenges, contributing to an increased risk of maternal morbidity and mortality. Further research is needed to explore their experiences and develop interventions to improve access and outcomes in rural areas.
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Context Despite increased youth and adolescent participation in fast-pitch softball and the reporting of upper extremity injuries, there remains a relative paucity of research examining shoulder and elbow injuries in high school and collegiate softball athletes. Objective To evaluate the reported incidence, setting, and positional factors associated with shoulder and elbow injuries in high school and collegiate fast-pitch softball players. Data Sources PubMed, Ovid, Medline, EMBASE, Scopus, Cochrane Central, and Clinicaltrials.gov. Study Selection English-language articles reporting the incidence of shoulder and/or elbow injuries occurring in high school or collegiate fast-pitch softball players were included. Biomechanical studies, review articles, abstract only texts, previous systematic reviews, and meta-analyses were excluded. Study Design Systematic review. Level of Evidence Level 4. Data Extraction Two reviewers independently evaluated studies. Data related to the reported incidence of shoulder and elbow injuries, injury setting, position, and rate of return to play after injury were recorded. Results A total of 22 studies were identified. In high school athletes, shoulder injury rates ranged from 0.88 to 1.14 per 10,000 athletic exposures (AE), with elbow injury rates ranging from 0.41 to 0.71 per 10,000 AE. In collegiate athletes, reported injury rates ranged from 3.76 to 5.93 per 10,000 AE for shoulder and 1.5 to 3.39 per 10,000 AE for elbow injuries. Shoulder and elbow injuries were reported more commonly during competition in high school athletes, and with greater frequency in the practice setting in collegiate athletes. No association between injury incidence and position was appreciated at either the high school or collegiate level. Most (81%-96%) athletes were able to return to sport within 3 weeks of injury. Conclusion The incidence of shoulder and elbow injuries was greater in collegiate softball athletes than in high school athletes.
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Background In recent decades, intra‐aortic balloon pump (IABP) technology has made significant progress (sheathless insertion technique, different balloon diameters, percutaneous technique and fibre optic IABP) in reducing complications and increasing patient support. Nonetheless, IABP‐related complications are still frequent and are associated with a poor prognosis. Aim The aim of this systematic review was to identify complications associated with IABP treatment in critically ill patients with a compromised cardiac function. Study Design A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines based on searches in CINAHL (EBSCO), Medline and Embase (Ovid) from January 2012 to April 2023. Quantitative studies were included if they reported as their primary outcome(s) complications of IABP in adult patients because of cardiovascular conditions and were published in English, Norwegian, Swedish or Danish. Study selection, methodological quality assessment and data extraction were performed independently by two authors. The results were synthesized narratively. Results A total of nine studies were included in the review, most of which were retrospective (eight of nine). Bleeding was the most frequently occurring complication, followed by limb ischaemia, stroke, infection, IABP malfunction, haematoma and other vascular complications. In addition, a correlation between IABP duration and vascular complications was found in three out of nine studies. Lastly, the incidence rate of stroke was higher in patients with axillary IABP than in those with femoral IABP. Conclusions This systematic review revealed that bleeding and limb ischaemia were the two most frequent complications associated with IABP therapy. We identified a correlation between (a) IABP support time and the development of vascular complications and (b) stroke and implantation of IABP catheter in the axillary artery. Further studies are needed to explore these findings directly. Relevance to Clinical Practice Increasing critical care nurses' knowledge regarding complications related to IABP support could lead to early identification, potentially lowering the incidence rate of complications.
Article
Introduction: Moral injury involves the adverse psychological, biological, spiritual, behavioural, and social consequences of actions that violate moral values. It can lead to anxiety, depression, burnout, and post-traumatic stress disorder. Nurses, who often face ethical dilemmas, are particularly vulnerable. Despite its significance, the relationship between moral injury and mental health outcomes in nurses remains underexplored. Aim: This systematic review aimed to describe the associations among moral injury, anxiety, depression, and quality of life in nurses. Methods: The review was registered in PROSPERO (CRD42023438731) and was conducted following the PRISMA guidelines. A literature search was performed in December 2023 across PubMed, CINAHL, Scopus, and Web of Science. Peer-reviewed primary research involving nurses, published in English or Italian, without time restrictions, was considered eligible. The risk of bias and the quality of evidence were assessed using the Joanna Briggs Institute checklist and the GRADE approach. Results: Out of 4730 articles identified, eight met the inclusion criteria. The analysis revealed significant positive associations between moral injury, anxiety, and depression, along with a significant negative association with quality of life. Conclusion: These findings highlight the need for healthcare systems to implement strategies that mitigate moral injury among nurses. Future research should prioritize longitudinal studies to explore causal relationships and develop targeted interventions. Additionally, standardizing the concept and measurements of moral injury is crucial for enhancing the comparability and understanding of this phenomenon.
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Computer-assisted preparation of porcelain laminate veneers (PLVs) using stereolithographic templates has been developed to enhance the accuracy of tooth preparation. However, the digital workflows involved in guided PLV preparation remain inconsistently defined across various practices. Therefore, this scoping review aimed to examine publications on computer-assisted PLV preparation to identify the key stage of digital workflows involved in designing and fabricating stereolithographic templates, as well as to highlight the limitations of various template designs. This scoping review aimed to identify publications on digital workflows for designing and fabricating stereolithographic templates in computer-assisted porcelain laminate veneer preparation. A systematic search on MEDLINE/PubMed, Web of Science and Scopus identified English-language articles published from 2014 to March 2024. Eligible articles focused on digitally designed and fabricated tooth reduction templates for porcelain laminate veneers, excluding conventional tooth preparation procedures for tooth reduction assessment. Seven clinical reports were included, demonstrating various 3D data acquisition techniques for virtual patient generation. All articles described virtual diagnostic wax-ups on digital casts, with two using a virtual articulator. Only five articles documented chair-side mock-ups with resin trial restorations to evaluate planned dental esthetics. Additionally, virtual tooth preparation prior to templates design was included in only four articles. The templates were designed using different software and ranged from simple designs with access windows to complex stacked templates with rotary instrument sleeved windows. Each template design had limitations affecting tooth reduction accuracy. All articles reported printing templates in clear acrylic resin using different technologies. In conclusion, the review highlights a lack of standardization in the digital workflow for designing stereolithographic templates for PLVs. Establishing a sound protocol for designing the tooth reduction templates is essential to ensure the accuracy and consistency of veneer preparation.
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Background: Potentially inappropriate medication prescribing is prevalent and well studied in older adults. However, limited data are available on inappropriate drug dosing in those with dementia or cognitive impairment and renal impairment. Objectives: We aimed to examine the prevalence of, and factors associated with, inappropriate drug dosing in older patients with dementia or cognitive impairment and renal impairment. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the Cochrane Handbook for Systematic Reviews of Interventions. We searched Medline, Embase, CINAHL, and PubMed for studies on inappropriate drug dosing in older patients with dementia or cognitive impairment and renal impairment, published from 1 January 2000 to 31 August 2024, with English language restriction following the PICOS search strategy. Two reviewers independently screened all titles and abstracts, extracted data from included studies, and undertook quality assessment using the Joanna Briggs Institute (JBI) tool. Descriptive statistics were used to summarise and present findings. Results: In total, eight retrospective cohort studies were included. Of the total number of patients with dementia who had renal impairment (n = 5250), there were 2695 patients (51.3%; range: 0–60%) who had inappropriate drug dosing. Drugs commonly prescribed in inappropriate doses in patients with dementia who had renal impairment included memantine, baclofen, nonsteroidal anti-inflammatory drugs (NSAIDs), metformin, digoxin, morphine, and allopurinol. The studies did not identify statistically significant risk factors for inappropriate drug dosing. Conclusions: Inappropriate drug dosing among older adults with dementia or cognitive impairment and renal impairment appears to occur frequently. While our findings should be interpreted with caution owing to the small number of studies and substantial heterogeneity, proactive prevention, recognition, and management of inappropriate drug dosing in this population is warranted.
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Background: Faced with a deemed mediocre quality of life (QoL) in people with multiple sclerosis (pwMS), the effectiveness of therapeutic education (TPE) programs is called into question. This systematic review is conducted to examine the impact of the TPE programs on the QoL of pwMS. Methods: A search was performed in three databases (PubMed, Web of Science and Scopus) to identify relevant studies published between 2007 and 2022. The review followed the PRISMA guidelines. Two reviewers independently extracted data on the study and program characteristics. These data were presented in tables for detailed synthesis and descriptive analyses. The selected studies underwent assessment using recommended evaluation tools. Results: Of the 21 studies included in the review, 13 found a significant improvement in QoL, which was maintained during follow-up testing in 42% of the studies. TPE programs that focused on patients’ individual needs and aimed to develop their skills in a personalized manner appeared to promote QoL. Interaction formats (individual, group, remote), session duration [range=1.5-28] and number of sessions [range=1-18] varied between the studies reviewed. Conclusion: Thoughtful, structured design of educational programs requires a match between the educational aspects specific to each individual and the appropriate choice of content, delivery modalities of the interventions and evaluation protocol, as well as a reasonable follow-up time. The conclusions drawn could serve as guidelines to direct future research towards optimal educational interventions. Systematic Review Registration: PROSPERO CRD42022338651.
Article
Introduction: The cytology features of neoplastic paratesticular lesions are mostly documented as case reports. Thus, we conducted a case report-based literature review to identify the characteristics of paratesticular neoplasms and tried to determine the significance of FNAC in these tumors. Methods and materials: The studies were searched using PubMed and Scopus. The quality assessment was done using the JBI critical appraisal checklist for case reports. The articles that received an overall rating of "Include" underwent data extraction. The data were extracted from the articles and analyzed. Results: We included 34 case reports from 33 published articles. The mean age of patients was 44.74 (13-85) years, and the most common clinical manifestation was scrotal swelling (70.59%, 24/34). Lesions were commonly observed on the right side (65.63%, 21/32), and the most common tumor site was epididymis (35.29%, 12/34). A total of 38.24% (13/34) cases were nonmalignant, and 61.76% (21/34) were malignant on the cytological diagnosis. The adenomatoid tumor (53.85, 7/13) was the most common nonmalignant tumor. Other entities were schwannoma, benign spindle cell neoplasm with atypia, nerve sheath tumor, lipoma, undifferentiated pleomorphic sarcoma, rhabdomyosarcoma, epithelioid sarcoma, liposarcoma, malignant rhabdoid tumor, pigmented neuroectodermal tumor of infancy and mesothelioma. Considering the malignant and nonmalignant groups, the sensitivity, specificity, and diagnostic accuracy of cytology were 95.00%, 84.62%, and 90.91%, respectively. Conclusion: Cytopathologists should be familiar with the cytological features of various malignant and nonmalignant paratesticular tumors to prevent unnecessarily invasive surgical management. The current systematic review emphasizes usefulness of FNAC in the preoperative cytological identification of paratesticular tumors.
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This article presents the first systematic review and meta-analysis of the prevalence and correlates of different forms of intimate partner violence (IPV) among women and men in Mexico. To identify studies, a comprehensive search strategy was developed and executed across 11 databases (Academic Search Complete, APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, International Bibliography of the Social Sciences, LILACS, MEDLINE, SciELO, Sociological Abstracts, Web of Science). From the 1,746 studies screened, 155 full-text articles were reviewed, and this systematic review included 27 studies involving 249,557 participants to determine the prevalence of physical, psychological, sexual, threats, and other forms of IPV, according to gender and other sociodemographic characteristics. Overall IPV prevalence was 16.4%, with significant differences across pregnant and non-pregnant women. Physical IPV prevalence was 14.7%, revealing higher rates in men (29.5%) compared to women (14.2%). Psychological IPV prevalence was 27.3% and sexual IPV was at 6.6%, with differences across evaluation periods. Threats and other IPV forms showed a prevalence rate of 14.2% and 21.5%. Meta-regression analyses included gender, education, marital status, rural residency, pregnancy, age, and evaluation period. This study demonstrates that IPV is a critical public health concern in Mexico, impacting both women and men. It shows the vulnerability of rural residents, youth, and pregnant women. However, understanding IPV complexities in Mexico requires nuanced considerations of demographic and situational contexts. Urgent initiatives from municipal, state, and federal governments are needed to combat IPV, focusing on prevention and support for affected individuals.
Article
Purpose: Parents of children with disabilities often encounter challenges when supporting their child's physical activity (PA). Research on the psychological factors influencing parental support for PA has produced mixed results. The purpose of this meta-analysis was to a) synthesize psychological factors associated with parental support for PA, and b) evaluate the moderators of the association between parental support for PA and these psychological factors. Methods: Following PRISMA guidelines, this meta-analysis reviewed peer-reviewed English articles on parental support for children with disabilities (ages 0-18) from January 2009 to February 2022, with updates in February 2024. We searched six databases-PubMed, CINAHL, Academic Search Premier, SPORTDiscus, Scopus, and CENTRAL-and applied four statistical methods (Egger's regression, Duval and Tweedi's Trim and Fill, Classic Fail-safe N, and Begg's test) to assess study bias. Results: Twelve studies met the inclusion criteria, showing a medium association (r = .41, 95% CI [.28 - .50], p < .001) between parental PA support and psychological factors in parents of children with disabilities. Psychological constructs and child's age were not significant moderators. No publication biases were detected. Conclusion: Limitations include the use of convenience samples and the lack of disability type as a moderator. Future research should address these gaps. Emphasizing parental intentions, parental PA, and self-efficacy can enhance parental support for PA in children with disabilities, promoting their PA engagement.
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Background Physical activities performed under free-living conditions that are unsupervised in the home or community have the potential to modulate non-motor symptoms in people with Parkinson's disease. Objective This systematic review investigates the relationships between physical activities performed in free-living conditions and non-motor symptoms in people with Parkinson's disease: cognition, anxiety, apathy, depression, sleep disturbances, fatigue, and pain. Data sources A database search was performed on Scopus, Web of Science, Ovid (PsycINFO), CINAHL, PubMed, and ProQuest (Health and Medicine). Review methods Observational studies published from 2000 to 2024 that examined the relationships between physical activity and non-motor symptoms were included. The methodological quality of reports was evaluated using critical appraisal checklists appropriate to the study design. Where appropriate, a meta-analysis was conducted to combine data from the included articles. Results A total of 14 articles met the criteria and used various tools to evaluate non-motor symptoms and physical activity. Meta-analyses showed that people with Parkinson's who are more physically active have better global cognition [ β ranged from 0.12 to 0.28; p = 0.00–0.02] and less affective disorders [ β -0.20, p = 0.00]. Increased physical activity levels were also associated with better sleep quality ( n = 1) and less chronic pain ( n = 1). The overall methodological quality of the included articles was considered high. Conclusion Engagement in increased levels of physical activities performed under free-living conditions is associated with better cognition and less anxiety, apathy, and depression in people with Parkinson's disease.
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Background Post-stroke depression (PSD) is a frequent problem in stroke patients, affecting their rehabilitation process and functional outcomes. Several studies have investigated the relationship between PSD and functional outcomes, but the results have been inconsistent. Objective This systematic review of non-experimental studies aims to investigate the prevalence of post-stroke depression and the association between post-stroke depression and functional outcomes. Method A search of PubMed, MEDLINE, Web of Science, and CINAHL Plus with Full Text was carried out from inception until January 2024. The literature was screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with relevant papers included. We extracted data from non-experimental studies that examined associations between PSD and functional outcomes. The Joanna Briggs Institute for systematic reviews was used for critical appraisal. Results Twenty-one studies met the study criteria, including sixteen cohort studies, four cross-sectional studies, and one case-control study. PSD prevalences ranged from 12.2% to 32.2% in the first two weeks, 17.9 to 35.5% in the first month, and 10.4% to 32.0% in the third month following a stroke. Functional outcomes were evaluated in four domains: degree of dependence, basic activity of daily living, instrumental activity of daily living, and physical and cognitive function. Significant associations between PSD and functional outcomes were identified after controlling potential factors such as age, comorbidities, and stroke severity. PSD had negative associations with functional outcomes in all four measure domains from one month to five years after a stroke. Depression treatment showed positive results on functional outcomes in stroke patients. Conclusion PSD prevalence was high in the first three months after stroke. PSD is significantly associated with poor functional outcomes. PSD assessment and management should be performed on a frequent basis in the early stages of stroke to achieve the best possible functional recovery.
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The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review. The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
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Background Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate. Results Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions. Conclusions Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.
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Observed associations between consumption of diet foods and obesity have sparked controversy over whether intense sweeteners may promote weight gain, despite their negligible energy contribution. We conducted a scoping review of reviews, to obtain an overview of hypotheses, research approaches and features of the evidence on intense sweeteners’ potential relationships to appetite and weight changes. We searched for reviews of the scientific literature published from 2006 to May 2017. Two reviewers independently assessed title and abstracts, and full text publications. Arksey and O’Malley’s framework for scoping reviews guided the process. We extracted and charted data on characteristics of the reviews and the evidence presented. The 40 included reviews present hypotheses both on how intense sweeteners can reduce or maintain body weight and on how these can promote weight gain. We classified only five publications as systematic reviews; another nine presented some systematic approaches, while 26 reviews did not describe criteria for selecting or assessing the primary studies. Evidence was often presented for intense sweeteners as a group or unspecified, and against several comparators (e.g. sugar, water, placebo, intake levels) with limited discussion on the interpretation of different combinations. Apart from the observational studies, the presented primary evidence in humans is dominated by small studies with short follow-up—considered insufficient to assess weight change. Systematic reviews of animal studies are lacking in this topic area. The systematic evidence only partly explore forwarded hypotheses found in the literature. Primary studies in humans seem to be available for systematic exploration of some hypotheses, but long-term experimental studies in humans appear sparse. With few exceptions, the reviews on intense sweeteners and weight change underuse systematic methodology, and thus, the available evidence. Further studies and systematic reviews should be explicit about the hypothesis explored and elucidate possible underlying mechanisms.
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Study design: A systematic review and meta-analysis. Objective: To assess the measurement properties of the Functional Rating Index (FRI) and determine whether its measurement properties are comparable with other region-specific questionnaires. Summary of background data: In addition to low back pain (LBP) and neck pain (NP), multi-region spinal pain (SP) is a common problem with a considerable prevalence in the general population. The FRI was built to assess physical functioning in patients with SP. However, a systematic review assessing evidence of its measurement properties in separated populations and a comparison with other questionnaires regarding each measurement property is lacking. Methods: Articles concerning the FRI's measurement properties or head-to-head comparison with other questionnaires on measurement properties were obtained from MEDLINE, Embase, CINAHL, and PsycINFO. Two reviewers independently reviewed the articles, extracted data, and conducted the methodological quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of the included studies. Results: A total of 18 studies evaluating the FRI's measurement properties, including seven that carried out head-to-head comparisons in at least one measurement property with other questionnaires, were included in the current review. Our findings show strong positive evidence for structural validity and internal consistency in patients with SP and LBP. Evidence for most of the FRI's measurement properties is limited, conflicting, or even unknown. The current evidence shows that the FRI is comparable with both the ODI and the NDI in responsiveness. However, relevant information about the majority of the other measurement properties is lacking. Conclusion: Our finding suggests that clinicians and researchers should use the FRI with caution until there are more studies with high methodological quality that support the view that it is positive in all measurement properties, especially in regard to patients with multi-region SP. Level of evidence: 1.
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Purpose: Systematic reviews of patient-reported outcome measures (PROMs) differ from reviews of interventions and diagnostic test accuracy studies and are complex. In fact, conducting a review of one or more PROMs comprises of multiple reviews (i.e., one review for each measurement property of each PROM). In the absence of guidance specifically designed for reviews on measurement properties, our aim was to develop a guideline for conducting systematic reviews of PROMs. Methods: Based on literature reviews and expert opinions, and in concordance with existing guidelines, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) steering committee developed a guideline for systematic reviews of PROMs. Results: A consecutive ten-step procedure for conducting a systematic review of PROMs is proposed. Steps 1-4 concern preparing and performing the literature search, and selecting relevant studies. Steps 5-8 concern the evaluation of the quality of the eligible studies, the measurement properties, and the interpretability and feasibility aspects. Steps 9 and 10 concern formulating recommendations and reporting the systematic review. Conclusions: The COSMIN guideline for systematic reviews of PROMs includes methodology to combine the methodological quality of studies on measurement properties with the quality of the PROM itself (i.e., its measurement properties). This enables reviewers to draw transparent conclusions and making evidence-based recommendations on the quality of PROMs, and supports the evidence-based selection of PROMs for use in research and in clinical practice.
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Background Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. Method This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. ResultsCulture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. Conclusion While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.
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PurposeThe original COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was developed to assess the methodological quality of single studies on measurement properties of Patient-Reported Outcome Measures (PROMs). Now it is our aim to adapt the COSMIN checklist and its four-point rating system into a version exclusively for use in systematic reviews of PROMs, aiming to assess risk of bias of studies on measurement properties. Methods For each standard (i.e., a design requirement or preferred statistical method), it was discussed within the COSMIN steering committee if and how it should be adapted. The adapted checklist was pilot-tested to strengthen content validity in a systematic review on the quality of PROMs for patients with hand osteoarthritis. ResultsMost important changes were the reordering of the measurement properties to be assessed in a systematic review of PROMs; the deletion of standards that concerned reporting issues and standards that not necessarily lead to biased results; the integration of standards on general requirements for studies on item response theory with standards for specific measurement properties; the recommendation to the review team to specify hypotheses for construct validity and responsiveness in advance, and subsequently the removal of the standards about formulating hypotheses; and the change in the labels of the four-point rating system. Conclusions The COSMIN Risk of Bias checklist was developed exclusively for use in systematic reviews of PROMs to distinguish this application from other purposes of assessing the methodological quality of studies on measurement properties, such as guidance for designing or reporting a study on the measurement properties.
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The past 20 years have seen the development of instruments designed to specify standards and evaluate the adequacy of published studies with respect to the quality of study design, the quality of findings, as well as the quality of their reporting. In the field of psychometrics, the first minimum set of standards for the review of psychometric instruments was published in 1996 by the Scientific Advisory Committee of the Medical Outcomes Trust. Since then, a number of tools have been developed with similar aims. The present paper reviews basic psychometric properties (reliability, validity and responsiveness), compares six tools developed for the critical appraisal of psychometric studies and provides a worked example of using the COSMIN checklist, Terwee-m statistical quality criteria, and the levels of evidence synthesis using the method of Schellingerhout and colleagues (2012). This paper will aid users and reviewers of questionnaires in the quality appraisal and selection of appropriate instruments by presenting available assessment tools, their characteristics and utility.
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In observational studies, control of confounding can be done in the design and analysis phases. Using examples from large health care database studies, this article provides the clinicians with an overview of standard methods in the analysis phase, such as stratification, standardization, multivariable regression analysis and propensity score (PS) methods, together with the more advanced high-dimensional propensity score (HD-PS) method. We describe the progression from simple stratification confined to the inclusion of a few potential confounders to complex modeling procedures such as the HD-PS approach by which hundreds of potential confounders are extracted from large health care databases. Stratification and standardization assist in the understanding of the data at a detailed level, while accounting for potential confounders. Incorporating several potential confounders in the analysis typically implies the choice between multivariable analysis and PS methods. Although PS methods have gained remarkable popularity in recent years, there is an ongoing discussion on the advantages and disadvantages of PS methods as compared to those of multivariable analysis. Furthermore, the HD-PS method, despite its generous inclusion of potential confounders, is also associated with potential pitfalls. All methods are dependent on the assumption of no unknown, unmeasured and residual confounding and suffer from the difficulty of identifying true confounders. Even in large health care databases, insufficient or poor data may contribute to these challenges. The trend in data collection is to compile more fine-grained data on lifestyle and severity of diseases, based on self-reporting and modern technologies. This will surely improve our ability to incorporate relevant confounders or their proxies. However, despite a remarkable development of methods that account for confounding and new data opportunities, confounding will remain a serious issue. Considering the advantages and disadvantages of different methods, we emphasize the importance of the clinical input and of the interplay between clinicians and analysts to ensure a proper analysis.
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Background: The purpose of this study was to advance a checklist of evaluative criteria designed to assess patient-reported outcome (PRO) measures' developmental measurement properties and applicability, which can be used by systematic reviewers, researchers, and clinicians with a varied range of expertise in psychometric measure development methodology. Methods: A directed literature search was performed to identify original studies, textbooks, consensus guidelines, and published reports that propose criteria for assessing the quality of PRO measures. Recommendations from these sources were iteratively distilled into a checklist of key attributes. Preliminary items underwent evaluation through 24 cognitive interviews with clinicians and quantitative researchers. Six measurement theory methodological novices independently applied the final checklist to assess six PRO measures encompassing a variety of methods, applications, and clinical constructs. Agreement between novice and expert scores was assessed. Results: The distillation process yielded an 18-item checklist with six domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (5) scoring and interpretation, and (6) respondent burden and presentation. With minimal instruction, good agreement in checklist item ratings was achieved between quantitative researchers with expertise in measurement theory and less experienced clinicians (mean kappa 0.70; range 0.66-0.87). Conclusions: We present a simplified checklist that can help guide systematic reviewers, researchers, and clinicians with varied measurement theory expertise to evaluate the strengths and weakness of candidate PRO measures' developmental properties and the appropriateness for specific applications.
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Background A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Primary Objective. Develop, disseminate, and implement systematic reporting guidelines for case reports. Methods We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. Results This consensus process involved 27 participants and resulted in a 13-item checklist—a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. Conclusions We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery.
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Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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Objective: To develop an evidence-based guideline for Peer Review of Electronic Search Strategies (PRESS) for systematic reviews (SRs), health technology assessments, and other evidence syntheses. Study design and setting: An SR, Web-based survey of experts, and consensus development forum were undertaken to identify checklists that evaluated or validated electronic literature search strategies and to determine which of their elements related to search quality or errors. Results: Systematic review: No new search elements were identified for addition to the existing (2008-2010) PRESS 2015 Evidence-Based Checklist, and there was no evidence refuting any of its elements. Results suggested that structured PRESS could identify search errors and improve the selection of search terms. Web-based survey of experts: Most respondents felt that peer review should be undertaken after the MEDLINE search had been prepared but before it had been translated to other databases. Consensus development forum: Of the seven original PRESS elements, six were retained: translation of the research question; Boolean and proximity operators; subject headings; text word search; spelling, syntax and line numbers; and limits and filters. The seventh (skilled translation of the search strategy to additional databases) was removed, as there was consensus that this should be left to the discretion of searchers. An updated PRESS 2015 Guideline Statement was developed, which includes the following four documents: PRESS 2015 Evidence-Based Checklist, PRESS 2015 Recommendations for Librarian Practice, PRESS 2015 Implementation Strategies, and PRESS 2015 Guideline Assessment Form. Conclusion: The PRESS 2015 Guideline Statement should help to guide and improve the peer review of electronic literature search strategies.
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Background Integrated knowledge translation (IKT) refers to collaboration between researchers and decision-makers. While advocated as an approach for enhancing the relevance and use of research, IKT is challenging and inconsistently applied. This study sought to inform future IKT practice and research by synthesizing studies that empirically evaluated IKT and identifying knowledge gaps. Methods We performed a scoping review. We searched MEDLINE, EMBASE, and the Cochrane Library from 2005 to 2014 for English language studies that evaluated IKT interventions involving researchers and organizational or policy-level decision-makers. Data were extracted on study characteristics, IKT intervention (theory, content, mode, duration, frequency, personnel, participants, timing from initiation, initiator, source of funding, decision-maker involvement), and enablers, barriers, and outcomes reported by studies. We performed content analysis and reported summary statistics. ResultsThirteen studies were eligible after screening 14,754 titles and reviewing 106 full-text studies. Details about IKT activities were poorly reported, and none were formally based on theory. Studies varied in the number and type of interactions between researchers and decision-makers; meetings were the most common format. All studies reported barriers and facilitators. Studies reported a range of positive and sub-optimal outcomes. Outcomes did not appear to be associated with initiator of the partnership, dedicated funding, partnership maturity, nature of decision-maker involvement, presence or absence of enablers or barriers, or the number of different IKT activities. Conclusions The IKT strategies that achieve beneficial outcomes remain unknown. We generated a summary of IKT approaches, enablers, barriers, conditions, and outcomes that can serve as the basis for a future review or for planning ongoing primary research. Future research can contribute to three identified knowledge gaps by examining (1) how different IKT strategies influence outcomes, (2) the relationship between the logic or theory underlying IKT interventions and beneficial outcomes, and (3) when and how decision-makers should be involved in the research process. Future IKT initiatives should more systematically plan and document their design and implementation, and evaluations should report the findings with sufficient detail to reveal how IKT was associated with outcomes.
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Objective: Scoping reviews are used to assess the extent of a body of literature on a particular topic, and often to ensure that further research in that area is a beneficial addition to world knowledge. The aim of this paper reports upon the development of a methodology for scoping reviews based upon the Arksey and O'Malley framework, the Levac, Colquhoun, and O'Brien, and the Joanna Briggs Institute method of evidence synthesis. Methods: A working group consisting of members of the Joanna Briggs collaborating organizations met to discuss the proposed framework for the methodology and develop a draft for the scoping review methodology based on the Arksey and O'Malley framework and the Levac et al. This was followed by a workshop attended by other members of the organizations consisting of 30 international researchers to discuss the proposed methodology. Further refinement of the methodology was undertaken as a result of the feedback received from the workshop. Results: The development of the methodology focused on five stages of the protocol and review development. These were identifying the research question by clarifying and linking the purpose and research question, identifying the relevant studies using a three-step literature search in order to balance feasibility with breadth and comprehensiveness, careful selection of the studies to using a team approach, charting the data and collating the results to identify the implications of the study findings for policy, practice, or research. Linking evidence to action: The current methodology recommends including both quantitative and qualitative research, as well as evidence from economic and expert opinion sources to answer questions of effectiveness, appropriateness, meaningfulness and feasibility of health practices and delivery methods. The proposed framework has the potential to provide options when faced with complex concepts or broad research questions.
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Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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Aims: With the increase in the number of systematic reviews available, a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of reviews of existing systematic reviews. Syntheses of existing systematic reviews are referred to by many different names, one of which is an umbrella review. An umbrella review allows the findings of reviews relevant to a review question to be compared and contrasted. An umbrella review's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence, namely other systematic reviews and meta-analyses. A methodology working group was formed by the Joanna Briggs Institute to develop methodological guidance for the conduct of an umbrella review, including diverse types of evidence, both quantitative and qualitative. The aim of this study is to describe the development and guidance for the conduct of an umbrella review. Methods: Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group. The working group comprised six participants who corresponded via teleconference, e-mail and face-to-face meeting during this development period. In October 2013, the methodology was presented in a workshop at the Joanna Briggs Institute Convention. Workshop participants, review authors and methodologists provided further testing, critique and feedback on the proposed methodology. Results: This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic reviews and meta-analyses as the analytical unit of the review. Details are provided regarding the essential elements of an umbrella review, including presentation of the review question in a Population, Intervention, Comparator, Outcome format, nuances of the inclusion criteria and search strategy. A critical appraisal tool with 10 questions to help assess risk of bias in systematic reviews and meta-analyses was also developed and tested. Relevant details to extract from included reviews and how to best present the findings of both quantitative and qualitative systematic reviews in a reader friendly format are provided. Conclusions: Umbrella reviews provide a ready means for decision makers in healthcare to gain a clear understanding of a broad topic area. The umbrella review methodology described here is the first to consider reviews that report other than quantitative evidence derived from randomized controlled trials. The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available, highest level of evidence relevant to the question posed.
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Background Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings.Objective This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined.Methods Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis.FindingsA total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care.Conclusion Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.
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Meta-analysis of diagnostic studies experiences the common problem that different stud-ies might not be comparable since they have been using a different cut-off value for the continuous or ordered categorical diagnostic test value defining different regions for which the diagnostic test is defined to be positive. Hence specificities and sensitivities arising from different studies might vary just because the underlying cut-off value had been different. To cope with the cut-off value problem, interest is usually directed towards the receiver operating characteristic (ROC) curve which consists of pairs of sensitivities and false positive rate (1–specificity). In the context of meta-analysis, one pair rep-resents one study and the associated diagram is called SROC curve where the S stands for 'summary'. The paper will consider—as a novel approach—modelling SROC curves with the Lehmann family that assumes log-sensitivity is proportional to the log-false positive rate across studies. The approach allows for study-specific false positive rates which are treated as (infinitely many) nuisance parameters and eliminated by means of the profile likelihood. The adjusted profile likelihood turns out to have a simple univariate Gaussian structure which is ultimately used for building inference for the parameter of the Lehmann family. The Lehmann model is further extended by allowing the constant of proportionality to vary across studies to cope with unobserved heterogeneity. The simple Gaussian form of the adjusted profile likelihood allows this extension easily as a form of a mixed model in which unobserved het-erogeneity is incorporated by means of a normal random effect. Some meta-analytic applications on diagnostic studies including brain natriuretic peptides for heart failure, alcohol use disorder identifica-tion test (AUDIT) and the consumption part of AUDIT for detection of unhealthy alcohol use as well as the mini-mental state examination for cognitive disorders are discussed to illustrate the methodology.
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Scoping reviews are a useful approach to synthesizing research evidence although the objectives and methods are different to that of systematic reviews, yet some confusion persists around how to plan and prepare so that a completed scoping review complies with best practice in methods and meets international standards for reporting criteria. This paper describes how to use available guidance to ensure a scoping review project meets global standards, has transparency of methods and promotes readability though the use of innovative approaches to data analysis and presentation. We address some of the common issues such as which projects are more suited to systematic reviews, how to avoid an inadequate search and/or poorly reported search strategy, poorly described methods and lack of transparency, and the issue of how to plan and present results that are clear, visually compelling and accessible to readers. Effective pre-planning, adhering to protocol and detailed consideration of how the results data will be communicated to the readership are critical. The aim of this article is to provide clarity about what is meant by conceptual clarity and how pre-planning enables review authors to produce scoping reviews which are of high quality, reliability and readily publishable.
Article
Background context: Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties. Purpose: To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication. Study design: A systematic review and meta-analysis. Methods: A systematic search was conducted on the following seven databases: PubMed, PsychINFO, Web of Science, Embase, CINAHL, MEDLINE, and Cochrane Central Register of Controlled Trials. Clinical studies that assessed a measurement property of a walking outcome measure for patients with neurogenic claudication were selected. The methodological quality of studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria from Terwee et al. (2007). Results: Twelve studies that evaluated 15 separate walking outcome measures were included. Out of the 12 studies included, half had poor methodological quality. Four measures had acceptable test-retest reliability: the self-paced walking test (intraclass correlation coefficient, or ICC was 0.98, 95% CI: 0.95-0.99), Physical Function Scale (PFS) (pooled analysis ICC = 0.79, 95% CI: 0.77-0.89), PFS walk item (ICC = 0.81, 95% CI: 0.68-0.89), and Oswestry Disability Index (ODI) walk item (ICC = 0.86, 95% CI: 0.76-0.92). Responsiveness was assessed on five walking outcome measures, and three had adequate responsiveness: the ODI walk item (Area under the Curve, or AUC, was 0.76, SD 0.15), Treadmill test (AUC = 0.70), and PFS (AUC = 0.77, SD 0.14). A meta-analysis demonstrated the PFS had adequate test retest reliability (pooled ICC = 0.79, 95% CI: 0.77-0.89) and internal consistency (pooled Cronbach's αlpha (α) = 0.84, 95% CI: 0.81-0.86), but not criterion validity (pooled correlation coefficient = -0.59, 95% CI: -0.71, -0.45). Measures that recorded adequate criterion validity were the ODI walk item (pooled correlation coefficient = -0.71, 95% CI: -0.80, -0.58), Treadmill test (pooled correlation coefficient = 0.86, 95% CI: 0.78-0.91), and self predicted walking item (pooled correlation coefficient = 0.74, 95% CI: 0.63-0.82). Conclusions: The results of our systematic review demonstrated that high-quality studies that asses the measurement properties of walking outcome measures for patients with neurogenic claudication are lacking. There was only limited evidence available for each walking measure, which prevented any single outcome from being confirmed as the gold standard measure of neurogenic claudication. Clinicians and researchers are recommended to use the self-paced walking test and ODI walk item until further evidence is available. Future research should focus on producing high-quality studies with excellent methodology and larger sample sizes.
Article
Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback‐rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation‐specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self‐reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end‐user needs more effectively, competency development for end‐users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers. Level of Evidence IV
Article
The sensitivity, specificity and likelihood ratios of binary diagnostic tests are often thought of as being independent of disease prevalence. Empirical studies, however, have frequently revealed substantial variation of these measures for the same diagnostic test in different populations. One reason for this discrepancy is related to the fact that only few diagnostic tests are inherently dichotomous. The majority of tests are based on categorization of individuals according to one or several underlying continuous traits. For these tests, the magnitude of diagnostic misclassification depends not only on the magnitude of the measurement or perception error of the underlying trait(s), but also on the distribution of the underlying trait(s) in the population relative to the diagnostic cutpoint. Since this distribution also determines prevalence of the disease in the population, diagnostic misclassification and disease prevalence are related for this type of test. We assess the variation of various measures of validity of diagnostic tests with disease prevalence for simple models of the distribution of the underlying trait(s) and the measurement or perception error. We illustrate that variation with disease prevalence is typically strong for sensitivity and specificity, and even more so for the likelihood ratios. Although positive and negative predictive values also strongly vary with disease prevalence, this variation is usually less pronounced than one would expect if sensitivity and specificity were independent of disease prevalence. © 1997 by John Wiley & Sons, Ltd. Stat. Med., Vol. 16, 981—991 (1997).
Article
Meta-analysis involves combining summary information from related but independent studies. The objectives of a meta-analysis include increasing power to detect an overall treatment effect, estimation of the degree of benefit associated with a particular study treatment, assessment of the amount of variability between studies, or identification of study characteristics associated with particularly effective treatments. This article presents a tutorial on meta-analysis intended for anyone with a mathematical statistics background. Search strategies and review methods of the literature are discussed. Emphasis is focused on analytic methods for estimation of the parameters of interest. Three modes of inference are discussed: maximum likelihood; restricted maximum likelihood, and Bayesian. Finally, software for performing inference using restricted maximum likelihood and fully Bayesian methods are demonstrated. Methods are illustrated using two examples: an evaluation of mortality from prophylactic use of lidocaine after a heart attack, and a comparison of length of hospital stay for stroke patients under two different management protocols. Copyright © 1999 John Wiley & Sons, Ltd.
Article
Objectives/hypothesis: Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. Study design: A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. Methods: Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. Results: Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. Conclusions: This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. Level of evidence: NA Laryngoscope, 2017.