PP283 Living Systematic Reviews In Time Of COVID-19: An Innovative Approach To Decision-making In An Environment Of Changing Evidence

IntroductionThe management of the COVID-19 pandemic is a challenge for Health Technology Assessment (HTA) methodology due to the need to formulate evidence-based recommendations in times of uncertainty in minimal time - for a large number of publications and with changing or even contradictory information. Living systematic reviews (LSRs) are systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. Since the COVID-19 pandemic fits all criteria to perform LSRs: (i) the Review question is a particular priority for decision-making, (ii) there is an high level of uncertainty about the existing evidence, and (iii) there is likely to be emerging evidence that will impact on the conclusions of the LSR, the aim of which is to analyze the role of LSRs as an innovative approach to HTA in recent years, and its impact on the management of the pandemic.MethodsA systematic search of LSRs (published or protocols) was run on the main biomedical databases (Medline, Embase and Cochrane Library) in November 2020 and it was rerun in June 2021 without time limit. The results will be analyzed and classified by year and category (epidemiology, treatment, prognosis, symptoms, diagnosis and vaccines).ResultsThe literature research has returned a total of 187 publications. The LSR concept emerged in 2014, from which some LSRs began to be published, but an exponential increase has been observed in 2020 with 76 references of which 66 percent were focused on the SARS-CoV-2. By category, 81.8 percent were focused on treatment, 41.8 percent on epidemiology, 20.9 percent on rehabilitation, 15.1 percent on diagnosis, 10.2 percent on prognosis and 2.2 percent on symptoms until June 2021. There wasn't any LSR for vaccines and 28 percent was focused on other fields.ConclusionsLSRs are particularly important during the COVID-19 pandemic, with research evidence emerging rapidly, current evidence being uncertain, and new research changing policy or decisions on health. The majority of LSRs published up to June 2021 were focused on the treatment of COVID-19.

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Overview of systematic reviews - a new type of study: part I: why and for whom?

Sao Paulo Medical Journal ◽

10.1590/s1516-31802012000600007 ◽

2012 ◽

Vol 130 (6) ◽

pp. 398-404 ◽

Cited By ~ 19

Author(s):

Valter Silva ◽

Antonio José Grande ◽

Ana Luiza Cabrera Martimbianco ◽

Rachel Riera ◽

Alan Pedrosa Viegas Carvalho

Keyword(s):

Decision Making ◽

Systematic Reviews ◽

Healthcare Professionals ◽

Setting Time ◽

Cochrane Library ◽

Healthcare Decision ◽

Level Of Evidence ◽

Overview Of Systematic Reviews ◽

New Type ◽

High Level

CONTEXT AND OBJECTIVE: Healthcare decision-making is complex and should involve healthcare professionals, patients and the best level of evidence. The speed of information production creates barriers against keeping up to date. In this light, methodologists have proposed a new type of study: overviews of systematic reviews (OoRs). The aim here was to introduce and demonstrate the role of OoRs in information synthesis for healthcare professionals, managers, researchers and patients. DESIGN AND SETTING: Time-series study conducted at the Brazilian Cochrane Center, jointly with the Postgraduate Program on Internal Medicine and Therapeutics, Discipline of Emergency Medicine and Evidence-Based Medicine, Department of Medicine, Federal University of São Paulo. METHODS: To show the growth in the numbers of published papers that provide high-level evidence and thus demonstrate the importance of OoRs for synthesis and integration of information, three filters for study designs were applied to two databases. An equation for predicting the expected number of published papers was developed and applied. RESULTS: Over the present decade, the number of randomized controlled trials in Medline might reach 2,863,203 and the number of systematic reviews might reach 174,262. Nine OoRs and 15 OoRs protocols have been published in the Cochrane Library. CONCLUSIONS: With the exponential growth of published papers, as shown in this study, a new type of study directed especially towards healthcare decision-makers was proposed, named "overview of systematic reviews". This could reduce the uncertainties in decision-making and generate a new hierarchy in the pyramid of evidence.

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Appraisal of systematic reviews on interventions for postpartum depression: systematic review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03496-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ryan Chow ◽

Eileen Huang ◽

Allen Li ◽

Sophie Li ◽

Sarah Y. Fu ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Depression ◽

Systematic Reviews ◽

Methodological Quality ◽

A Priori ◽

Behavioural Therapy ◽

Therapeutic Interventions ◽

Current Evidence ◽

Cochrane Library ◽

Measurement Tool

Abstract Background Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions. Methods An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD. Results Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, − 0.09 to 0.34), or source of funding (p = 0.19). Conclusion Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.

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Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-044472 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044472

Author(s):

Saar Hommes ◽

Ruben Vromans ◽

Felix Clouth ◽

Xander Verbeek ◽

Ignace de Hingh ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Decision Making ◽

Systematic Reviews ◽

Decision Aids ◽

Specific Treatment ◽

Cochrane Library ◽

Plain Language ◽

Patient Decision

ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

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Antibiotic prophylaxis for surgical procedures: a scoping review

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2021.62 ◽

2021 ◽

Vol 45 ◽

pp. 1

Author(s):

Eva Brocard ◽

Ludovic Reveiz ◽

Jean-Philippe Régnaux ◽

Veronica Abdala ◽

Pilar Ramón-Pardo ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Systematic Reviews ◽

Scoping Review ◽

First Generation ◽

Evidence Base ◽

Current Evidence ◽

Cochrane Library ◽

Antibiotic Administration ◽

Significant Difference ◽

Surgical Antibiotic Prophylaxis

Objectives. To map the current evidence on surgical antibiotic prophylaxis (SAP) administration and identify knowledge gaps in the literature available in this field. Methods. The PubMed, Cochrane Library, Epistemonikos, and Health Systems Evidence databases were searched from January 2015 to March 2020 for systematic reviews published in English, French, Portuguese, and Spanish. Results. Eighty-three systematic reviews were included, the quality of the reviews was assessed using AMSTAR 2, and data were extracted for all primary outcomes. Perioperative antibiotic administration, the use of first generation cephalosporins, and surgical site infection (SSI) were the most commonly reported for timing of antibiotic administration, drug class, and primary outcome, respectively. Findings showed that, overall, SAP may reduce SSIs compared with a placebo or with no SAP. Results suggested that intraoperative SAP may lower SSI, while postoperative SAP did not show a statistically significant difference. Conclusions. Findings have confirmed the role of SAP in reducing postoperative SSI across various surgeries and do not support the use of antibiotics after surgery to prevent infections. The findings of this scoping review have enhanced the evidence base that can inform decisions regarding the development of global guidelines for the prevention of SSI. However, high-quality systematic reviews and research reflecting diverse populations and settings are needed.

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Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review

Systematic Reviews ◽

10.1186/s13643-019-1179-1 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Bridget Heijkoop ◽

Natalie Parker ◽

George Kiroff ◽

Daniel Spernat

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Systematic Reviews ◽

Pelvic Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Vte Prophylaxis ◽

Optimum Duration ◽

Number Of Patients ◽

Increased Risk

Abstract Background Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. Methods We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. Discussion This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. Systematic review registration In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961, and it was last updated on December 1, 2018.

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What is the impact of physicians in prehospital treatment for patients in need of acute critical care? – An overview of reviews

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318003616 ◽

2019 ◽

Vol 35 (1) ◽

pp. 27-35 ◽

Cited By ~ 1

Author(s):

Gitte Valentin ◽

Lotte Groth Jensen

Keyword(s):

Cardiac Arrest ◽

Systematic Reviews ◽

Critical Conditions ◽

Current Evidence ◽

Cochrane Library ◽

Future Research ◽

Success Rates ◽

Prehospital Treatment ◽

The Impact ◽

Hospital Cardiac Arrest

AbstractObjectivesThe aim of this overview was to systematically identify and synthesize existing evidence from systematic reviews on the impact of prehospital physician involvement.MethodsThe Medline, Embase, and Cochrane library were searched from 1 January 2000 to 17 November 2017. We included systematic reviews comparing physician-based with non–physician-based prehospital treatment in patients with one of five critical conditions requiring a rapid response.ResultsTen reviews published from 2009 to 2017 were included. Physician treatment was associated with increased survival in patients with out-of-hospital cardiac arrest and patients with severe trauma; in the latter group, the result was based on more limited evidence. The success rate of prehospital endotracheal intubation (ETI) has improved over the years, but ETI by physicians is still associated with higher success rates than intubation by paramedics. In patients with severe traumatic brain injury, intubation by paramedics who were not well skilled to do so markedly increased mortality.ConclusionsCurrent evidence is hinting at a benefit of physicians in selected aspects of prehospital emergency services, including treatment of patients with out-of-hospital cardiac arrest and critically ill or injured patients in need of prehospital intubation. Evidence is, however, limited by confounding and bias, and comparison is hampered by differences in case mix and the organization of emergency medical services. Future research should strive to design studies that enable appropriate control of baseline confounding and obtain follow-up data for the proportion of patients who die in the prehospital setting.

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Use of head camera-cued recall and debrief to externalise expertise: a systematic review of literature from multiple fields of practice

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2018-000341 ◽

2018 ◽

Vol 5 (3) ◽

pp. 121-129

Author(s):

Vivienne Isabella Blackhall ◽

Kenneth Grant Walker ◽

Iya Whiteley ◽

Philip Wilson

Keyword(s):

Decision Making ◽

Visual Cues ◽

Video Recording ◽

Cognitive Activity ◽

Cued Recall ◽

Point Of View ◽

Current Evidence ◽

Training Tool ◽

Registration Number ◽

High Level

BackgroundThe study of decision making in complex naturalistic environments poses several challenges. In response to these, video-stimulated cued-recall-debrief was developed. It involves an individual wearing a head-mounted camera which records a task from their point of view. Afterwards, footage captured is reviewed along with a facilitated debrief to help externalise cognitive processes. In theory, motion, audio and visual cues generate a high level of experiential immersion which helps the expert to articulate previously hidden thoughts and actions.ObjectiveTo examine the current evidence for video-stimulated cued-recall-debrief as a means of explicating expert thoughts and feelings in complex tasks in a range of environments.Study selectionMEDLINE, EMBASE, Education Resources Information Center, SPORTDiscus, PsycINFO and Google Scholar were searched for articles containing the key terms ‘cued-recall (debrief)’, ‘decision making’, ‘skills’ and ‘video recording’. Studies were included if they examined the following outcomes: (1) feasibility, (2) extent of experiential immersion, (3) ability to generate unique insight into decision-making processes and (4) current applications. 1831 articles were identified initially, and 9 studies were included in the final review.FindingsVideo-stimulated cued-recall-debrief is associated with a high level of experiential immersion and generates between two and four times the number of recollections compared with free recall. It can be used to build models of cognitive activity and to characterise the way in which more and less skilled individuals tend to think and feel.ConclusionsThe technique could be used to explicate expertise within medicine: these insights into performance could be used as a training tool for other practitioners.Trial registration numberCRD42017057484.

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Management of haemorrhoids: protocol of an umbrella review of systematic reviews and meta-analyses

BMJ Open ◽

10.1136/bmjopen-2019-035287 ◽

2020 ◽

Vol 10 (3) ◽

pp. e035287

Author(s):

Min Chen ◽

Tai-Chun Tang ◽

Tao-Hong He ◽

Yong-Jun Du ◽

Di Qin ◽

...

Keyword(s):

Systematic Reviews ◽

Meta Analysis ◽

Random Effect Model ◽

Current Evidence ◽

Cochrane Library ◽

Final Report ◽

Umbrella Review ◽

Effect Model ◽

Meta Analyses ◽

The Impact

IntroductionThe prevalence of haemorrhoidal diseases was high in general population, and many treatments are proposed for the management of haemorrhoids. The treatments include conservative and surgical interventions; the credibility and strength of current evidence of their effectiveness are not comprehensively evaluated. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness of the treatments for haemorrhoidal diseases through an umbrella review.Methods and analysisWe will search Ovid Medline, Embase, Cochrane library and Web of Science from inception to March 2020 without any language restriction. We will include meta-analyses that examine the effectiveness of treatments in the management of haemorrhoids. Two reviewers will independently screen the titles and abstracts of retrieved articles, and they will extract data from the included meta-analyses. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane’s Q and I2statistics) and small-study effect (Egger’s test); we will also estimate the evidence of excess significance bias. Evidence of each treatment will be graded according to prespecified criteria. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. The corrected cover area method will be used to assess the impact of overlap in reviews on the findings of the umbrella review.Ethics and disseminationWe will present the results of the umbrella review at conferences and publish the final report in a peer-reviewed journal. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42019140702.

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Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review

BMJ Open ◽

10.1136/bmjopen-2019-030779 ◽

2019 ◽

Vol 9 (12) ◽

pp. e030779 ◽

Cited By ~ 2

Author(s):

Sheree M Smith ◽

Anne E Holland ◽

Christine F McDonald

Keyword(s):

Decision Making ◽

Length Of Stay ◽

Systematic Reviews ◽

Verbal Communication ◽

Small Sample ◽

Acute Hospital ◽

Cochrane Library ◽

Sample Sizes ◽

Health Services Needs ◽

The Impact

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention is aimed at enhancing care and reducing unnecessary acute hospital service use. The influence of verbal communication between health staff and patients to inform decision making regarding use of acute hospital services within telemonitoring studies has not been assessed.MethodA systematic overview of published systematic reviews of COPD and telemonitoring was conducted using ana prioriprotocol to ascertain the impact of verbal communication in telemonitoring studies on health service outcomes such as emergency department attendances, hospitalisation and hospital length of stay. The search of the following electronic databases: Cochrane Library, Medline, Pubmed, CINAHL, Embase, TROVE, Australian Digital Thesis and Proquest International Dissertations and Theses was conducted in 2017 and updated in September 2019.ResultsSix systematic reviews were identified. All reviews involved home monitoring of COPD symptoms and biometric data. Included reviews reported 5–28 studies with sample sizes ranging from 310 to 2891 participants. Many studies reported in the systematic reviews were excluded as they were telephone support, cost effectiveness studies, and/or did not report the outcomes of interest for this overview. Irrespective of group assignment, verbal communication with the health or research team did not alter the emergency attendance or hospitalisation outcome. The length of stay was longer for those who were assigned home telemonitoring in the majority of studies.ConclusionThis overview of telemonitoring for COPD had small sample sizes and a wide variety of included studies. Communication was not consistent in all included studies. Understanding the context of communication with study participants and the decision-making process for referring patients to various health services needs to be reported in future studies of telemonitoring and COPD.

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Front End Projects Benefits Realisation from a Requirements Management Perspective—A Systematic Literature Review

Buildings ◽

10.3390/buildings10050083 ◽

2020 ◽

Vol 10 (5) ◽

pp. 83

Author(s):

Joas Serugga ◽

Mike Kagioglou ◽

Patricia Tzortzopoulos

Keyword(s):

Decision Making ◽

Management Practice ◽

Integrated Design ◽

Current Evidence ◽

Design Decision ◽

Requirements Management ◽

Support Design ◽

Front End ◽

Improved Performance ◽

New Research

The recent notable emergence of a body of research in requirements management on one hand and benefits realisation has contributed to addressing a growing need for improved performance in Architecture, Engineering and Construction (AEC) projects. However, front end design (FED) as one of the vital processes in the project life cycle and delivery has attracted limited research to date within this understanding. This paper aims to map current evidence on requirements management in facilitating benefits realisation from an FED perspective. This is to bring about an updated and unified position on requirements management for its impact on design decision making. A systematic review of the literature covering the last ten years (2008–2018) aims first to build understanding and support identification of these emergent conceptual positions and secondly underscore essential requirements and their categorisations that impact on design discourse in FED. One hundred sixty-one peer-reviewed journal papers in the areas of benefits realisation and/or requirements management and/or FED based are identified on a pre-determined inclusion and exclusion criteria. Thirty-six requirements are identified as important in influencing use case changes important in design decision making broadly grouped into nine major categories. Following analysis, this research finds little evidence supporting an integrated requirements management practice and understanding to support design decision making. The research further finds bias in current research discourse towards four requirements categories (technical, economics, governance and environment); and 14 requirements, dominated by three strategic values, collaboration and project governance, with over 80% share of literature. The least 14 requirements such as “flow of spaces, social status/aspiration, mobility and integrated design” among others only account for less than 10% of literature. The authors argue for new research to bridge this gap, highlight the essential role of requirements management and broaden understanding to improve benefits realisation, particularly for FED processes.

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