Developing, Implementing, and Applying Novel Techniques During Systematic Reviews of Primary Space Medicine Data

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This is a duplicate record, please see for the original record. Andrew Winnard has been leading systematic review methods for space medicine projects many years to facilitate high quality and transparent synthesis of primary data to enable evidence-based practice. You can find the most up to date methods here: This paper outlines evolution of space medicine synthesis methods and discussion of their initial application. Space medicine systematic review guidance has been developed for protocol planning, quantitative and qualitative synthesis, sourcing grey data, and assessing quality and transferability of space medicine human spaceflight simulation study environments. Decision algorithms for guidance and tool usage were created based on usage. Six reviews used quantitative methods in which no meta analyses were possible due to lack of controlled trials or reporting issues. All reviews scored the quality and transferability of space simulation environments. One review was qualitative. Several research gaps were identified. Successful use of the developed methods demonstrates usability and initial validity. The current space medicine evidence base resulting in no meta analyses to be possible shows the need for standardized guidance on how to synthesize data in this field. It also provides evidence to call for increasing use of controlled trials, standardizing outcome measures and improving minimum reporting standards. Space medicine is a unique field of medical research that requires specific systematic review methods.

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... They presented the current conceptions of space medicine, and postulated the need for space medicine to mature as a distinct discipline. In one of recent papers, Winnard et al [7] provided evolution of space medicine synthesis methods. The scholars proposed space medicine systematic analysis direction for procedure arranging, quantifiable and subjective synthesis, sourcing gray information, and evaluating quality and transferability of space medicine human spaceflight simulation training settings. ...
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Background: The recent discovery of a venous thrombosis in the internal jugular vein of an astronaut has highlighted the need to predict the risk of venous thromboembolism in otherwise healthy individuals (VTE) in space. Virchow’s triad defines the three classic risk factors for VTE: blood stasis, hypercoagulability, and endothelial disruption/dysfunction. Among these risk factors, venous endothelial disruption/dysfunction remains incompletely understood, making it difficult to accurately predict risk, set up relevant prophylactic measures and initiate timely treatment of VTE, especially in an extreme environment. Methods: A qualitative systematic review focused on endothelial disruption/dysfunction was conducted following the guidelines produced by the Space Biomedicine Systematic Review Group, which are based on Cochrane review guidelines. We aimed to assess the venous endothelial biochemical and imaging markers that may predict increased risk of VTE during spaceflight by surveying the existing knowledge base surrounding these markers in analogous populations to astronauts on the ground. Results: Limited imaging markers related to endothelial dysfunction that were outside the bounds of routine clinical practice were identified. While multiple potential biomarkers were identified that may provide insight into the etiology of endothelial dysfunction and its link to future VTE, insufficient prospective evidence is available to formally recommend screening potential astronauts or healthy patients with any currently available novel biomarker. Conclusion: Our review highlights a critical knowledge gap regarding the role biomarkers of venous endothelial disruption have in predicting and identifying VTE. Future population-based prospective studies are required to link potential risk factors and biomarkers for venous endothelial dysfunction to occurrence of VTE.
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