Do school closures reduce community transmission of COVID-19? A systematic review of observational studies

AbstractIntroductionSchool closures are associated with significant negative consequences and may exacerbate inequalities. They were implemented worldwide to control SARS-CoV-2 in the first half of 2020, but their effectiveness remains uncertain. This review summarises the empirical evidence of their effect on SARS-CoV-2 community transmission.MethodsThe study protocol was registered on Prospero (ID:CRD42020213699). On 12 October 2020 we searched PubMed, Web of Science, Scopus, CINAHL, the WHO Global COVID-19 Research Database, ERIC, the British Education Index, and the Australian Education Index. We included empirical studies with quantitative estimates of the effect of school closures/reopenings on SARS-CoV-2 community transmission. We excluded prospective modelling studies and intra-school transmission studies. We performed a narrative synthesis due to data heterogeneity.ResultsWe identified 3,318 articles, of which ten were included, with data from 146 countries. All studies assessed school closures, and one additionally examined re-openings. There was substantial heterogeneity between studies. Three studies, including the two at lowest risk of bias, reported no impact of school closures on SARS-CoV-2 transmission; whilst the other seven reported protective effects. Effect sizes ranged from no association to substantial and important reductions in community transmission.DiscussionStudies were at risk of confounding and collinearity from other non-pharmacological interventions implemented close to school closures. Our results are consistent with school closures being ineffective to very effective. This variation may be attributable to differences in study design or real differences. With such varied evidence on effectiveness, and the harmful effects, policymakers should take a measured approach before implementing school closures.Panel: ‘Research in context’Evidence before this studyA previous systematic review, published by some of us in April 2020, found good evidence that school closures are effective for the control of influenza, but limited evidence of effectiveness for coronavirus outbreaks. At the time there was no available empirial evidence from the COVID-19 pandemic.Added value of this studyThis study is the first systematic review of the empirical evidence from observational studies of the effect of school closures and reopenings on community transmission of SARS-CoV-2. We include 10 studies, covering 146 countries. There was significant heterogeneity between studies. Some studies reported large reductions in incidence and mortality associated with school closures, however, studies were at risk of confounding and collinearity, and studies at lower risk of bias reported no association.Implications of all the available evidenceThe evidence is consistent with either no effect, or a protective effect of school closures. With such varied evidence on effectiveness, and the harmful effects, policymakers should take a measured approach before implementing school closures.

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Do school closures and school reopenings affect community transmission of COVID-19? A systematic review of observational studies

BMJ Open ◽

10.1136/bmjopen-2021-053371 ◽

2021 ◽

Vol 11 (8) ◽

pp. e053371

Author(s):

Sebastian Walsh ◽

Avirup Chowdhury ◽

Vickie Braithwaite ◽

Simon Russell ◽

Jack Michael Birch ◽

...

Keyword(s):

Primary Schools ◽

Lower Risk ◽

Risk Of Bias ◽

School Closure ◽

Early Years ◽

Mitigation Measures ◽

Research Database ◽

School Closures ◽

Low Transmission ◽

Community Transmission

ObjectivesTo systematically reivew the observational evidence of the effect of school closures and school reopenings on SARS-CoV-2 community transmission.SettingSchools (including early years settings, primary schools and secondary schools).InterventionSchool closures and reopenings.Outcome measureCommunity transmission of SARS-CoV-2 (including any measure of community infections rate, hospital admissions or mortality attributed to COVID-19).MethodsOn 7 January 2021, we searched PubMed, Web of Science, Scopus, CINAHL, the WHO Global COVID-19 Research Database, ERIC, the British Education Index, the Australian Education Index and Google, searching title and abstracts for terms related to SARS-CoV-2 AND terms related to schools or non-pharmaceutical interventions (NPIs). We used the Cochrane Risk of Bias In Non-randomised Studies of Interventions tool to evaluate bias.ResultsWe identified 7474 articles, of which 40 were included, with data from 150 countries. Of these, 32 studies assessed school closures and 11 examined reopenings. There was substantial heterogeneity between school closure studies, with half of the studies at lower risk of bias reporting reduced community transmission by up to 60% and half reporting null findings. The majority (n=3 out of 4) of school reopening studies at lower risk of bias reported no associated increases in transmission.ConclusionsSchool closure studies were at risk of confounding and collinearity from other non-pharmacological interventions implemented around the same time as school closures, and the effectiveness of closures remains uncertain. School reopenings, in areas of low transmission and with appropriate mitigation measures, were generally not accompanied by increasing community transmission. With such varied evidence on effectiveness, and the harmful effects, policymakers should take a measured approach before implementing school closures; and should look to reopen schools in times of low transmission, with appropriate mitigation measures.

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Beneficial and harmful effects of antidepressants versus placebo, ‘active placebo’, or no intervention for adults with major depressive disorder: a protocol for a systematic review of published and unpublished data with meta-analyses and trial sequential analyses

Systematic Reviews ◽

10.1186/s13643-021-01705-6 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Sophie Juul ◽

Faiza Siddiqui ◽

Marija Barbateskovic ◽

Caroline Kamp Jørgensen ◽

Michael Pascal Hengartner ◽

...

Keyword(s):

Systematic Review ◽

Major Depressive Disorder ◽

Depressive Symptoms ◽

Adverse Events ◽

Depressive Disorder ◽

Meta Analysis ◽

Risk Of Bias ◽

Major Depressive ◽

Serious Adverse Events ◽

Harmful Effects

Abstract Background Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide. Antidepressants are frequently used to treat major depressive disorder. It has been shown repeatedly that antidepressants seem to reduce depressive symptoms with a statistically significant effect, but the clinical importance of the effect sizes seems questionable. Both beneficial and harmful effects of antidepressants have not previously been sufficiently assessed. The main objective of this review will be to evaluate the beneficial and harmful effects of antidepressants versus placebo, ‘active placebo’, or no intervention for adults with major depressive disorder. Methods/design A systematic review with meta-analysis will be reported as recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), bias will be assessed with the Cochrane Risk of Bias tool-version 2 (ROB2), our eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, Trial Sequential Analysis will be conducted to control for random errors, and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. To identify relevant trials, we will search both for published and unpublished trials in major medical databases from their inception to the present. Clinical study reports will be obtained from regulatory authorities and pharmaceutical companies. Two review authors will independently screen the results of the literature searches, extract data, and perform risk of bias assessment. We will include any published or unpublished randomised clinical trial comparing one or more antidepressants with placebo, ‘active placebo’, or no intervention for adults with major depressive disorder. The following active agents will be included: agomelatine, amineptine, amitriptyline, bupropion, butriptyline, cianopramine, citalopram, clomipramine, dapoxetine, demexiptiline, desipramine, desvenlafaxine, dibenzepin, dosulepin, dothiepin, doxepin, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, iprindole, levomilnacipran, lofepramine, maprotiline, melitracen, metapramine, milnacipran, mirtazapine, nefazodone, nortriptyline, noxiptiline, opipramol, paroxetine, protriptyline, quinupramine, reboxetine, sertraline, trazodone, tianeptine, trimipramine, venlafaxine, vilazodone, and vortioxetine. Primary outcomes will be depressive symptoms, serious adverse events, and quality of life. Secondary outcomes will be suicide or suicide attempt, suicidal ideation, and non-serious adverse events. Discussion As antidepressants are commonly used to treat major depressive disorder in adults, a systematic review evaluating their beneficial and harmful effects is urgently needed. This review will inform best practice in treatment and clinical research of this highly prevalent and burdensome disorder. Systematic review registration PROSPERO CRD42020220279

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Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis

European Journal of Orthodontics ◽

10.1093/ejo/cjab005 ◽

2021 ◽

Author(s):

Aldin Kapetanović ◽

Christina I Theodorou ◽

Stefaan J Bergé ◽

Jan G J H Schols ◽

Tong Xi

Keyword(s):

Systematic Review ◽

Success Rate ◽

Observational Studies ◽

Risk Of Bias ◽

Late Adolescents ◽

Maxillary Expansion ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Adolescents And Adults ◽

Maxillary Deficiency

Summary Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. Objectives This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. Search methods Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. Selection criteria Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. Data collection and analysis Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. Results Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. Limitations One of the main drawbacks was the lack of high-quality prospective studies in the literature. Conclusions and implications MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. Registration PROSPERO (CRD42020176618). Funding No grants or any other support funding were received.

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Vaccines to prevent COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING VACCINE Project)

Systematic Reviews ◽

10.1186/s13643-020-01516-1 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Steven Kwasi Korang ◽

Sophie Juul ◽

Emil Eik Nielsen ◽

Joshua Feinberg ◽

Faiza Siddiqui ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Individual Patient Data ◽

Viral Vector ◽

Meta Analysis ◽

Risk Of Bias ◽

Serious Adverse Events ◽

Meta Analyses ◽

Harmful Effects

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) which has rapidly spread worldwide. Several human randomized clinical trials assessing potential vaccines are currently underway. There is an urgent need for a living systematic review that continuously assesses the beneficial and harmful effects of all available vaccines for COVID-19. Methods/design We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and conduct risk of bias assessments. We will include randomized clinical trials comparing any vaccine aiming to prevent COVID-19 (including but not limited to messenger RNA; DNA; non-replicating viral vector; replicating viral vector; inactivated virus; protein subunit; dendritic cell; other vaccines) with any comparator (placebo; “active placebo;” no intervention; standard care; an “active” intervention; another vaccine for COVID-19) for participants in all age groups. Primary outcomes will be all-cause mortality; a diagnosis of COVID-19; and serious adverse events. Secondary outcomes will be quality of life and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, trial sequential analyses, network meta-analyses, and individual patient data meta-analyses. Within-study bias will be assessed using Cochrane risk of bias tool. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta-Analysis (CINeMA) approaches will be used to assess certainty of evidence. Observational studies describing harms identified during the search for trials will also be included and described and analyzed separately. Discussion COVID-19 has become a pandemic with substantial mortality. A living systematic review assessing the beneficial and harmful effects of different vaccines is urgently needed. This living systematic review will regularly inform best practice in vaccine prevention and clinical research of this highly prevalent disease. Systematic review registration PROSPERO CRD42020196492

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Ultrasound assessment of the myofascial trigger point. A systematic review

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3401889 ◽

2019 ◽

Vol 02 (02) ◽

pp. 068-068

Author(s):

López San Miguel G. ◽

Barbe Mendibil I. ◽

Torres Chica B. ◽

Ríos Diaz J.

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Public Health Problem ◽

Trigger Points ◽

Risk Of Bias ◽

Quality Analysis ◽

Lumbar Region ◽

Myofascial Trigger Points ◽

Upper Trapezius ◽

Black Scale

Abstract Introduction Myofascial pain syndrome is an important and prevalent public health problem. The lack of consensus on the diagnostic criteria, together with the scarce reliability of the manual detection of the manual detection of myofascial trigger points (MTrPs) point to the need to develop objective methods to enable confirmation of the presence of MTrPs. Ultrasound is an accessible method which enables the assessment of tissue properties in real time, helping to characterize the MTrP, understand its physiopathology and define its diagnosis. Aims To identify observational studies researching the use of ultrasound in the assessment of MTrPs. Also, to learn about and compile the advances in the study of the characteristics of MTrPs and their sonographic diagnosis. Material and Methods A systematic review was performed by two independent reviewers, searching biomedical databases using terms related with “ultrasound” and “trigger points”. Observational studies were selected evaluating the characteristics of MTrPs. Subsequently, an analysis of the diagnostic quality of studies was performed using the QAREL scale and a study of the methodological quality took place based on the Downs and Black scale. Furthermore, an assessment of the reproducibility of the acquirement of images was performed, via the analysis of the description of the ultrasound method. The risk of bias was evaluated according to the Cochrane guidelines. Results 18 studies based on B Mode methods, elastography and Doppler, were included in the review. The anatomic regions which were most explored were the cervical area and the upper limb, evaluated in 14 of the 18 papers. The most common muscle was the upper trapezius (61%). Two articles were located corresponding to the lumbar region and one article concerned the lower limb. The analysis of the sonographic method showed a low level, 5 of the 9 items did not overcome 17% of fulfillment, in 3 papers the frequency was below 6%. The QAREL scale also displayed low levels, only 3 items out of 11. Inter-evaluator blinding, correct testing and statistical methods were fulfilled in over 50%. The mean score obtained by the studies in the Downs and Black scale was 5.4 points out of 10, ranging between 2 and 7 points. The risk of bias according to the Cochrane guidelines was mid- to high. Conclusion Important steps have been taken in the study of the sonograhic characteristics of the MTrP, however, we are still far from standardizing the use of the same as a diagnostic method. The poor results in the quality analysis of the present study suggest caution in the interpretation of the present findings. Future research is necessary, including different anatomic regions, analytic methods, better defined exploration protocols and more robust reliability studies for the different methods available.

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Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review

British Journal of General Practice ◽

10.3399/bjgp19x705461 ◽

2019 ◽

Vol 69 (687) ◽

pp. e665-e674 ◽

Cited By ~ 6

Author(s):

Benedict Hayhoe ◽

Jose Acuyo Cespedes ◽

Kimberley Foley ◽

Azeem Majeed ◽

Judith Ruzangi ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Health System ◽

Quality Assessment ◽

Observational Studies ◽

Assessment Tool ◽

Risk Of Bias ◽

Controlled Trials ◽

Cochrane Central Register ◽

Quality Assessment Tool

BackgroundEvidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.AimTo identify the key impacts of pharmacists’ integration into primary care on health system indicators, such as healthcare utilisation and costs.Design and settingA systematic review of literature.MethodEmbase, MEDLINE, Scopus, the Health Management Information Consortium, CINAHL, and the Cochrane Central Register of Controlled Trials databases were examined, along with reference lists of relevant studies. Randomised controlled trials (RCTs) and observational studies published up until June 2018, which considered health system outcomes of the integration of pharmacists into primary care, were included. The Cochrane risk of bias quality assessment tool was used to assess risk of bias for RCTs; the National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool was used for observational studies. Data were extracted from published reports and findings synthesised.ResultsSearches identified 3058 studies, of which 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department (ED) attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs.ConclusionIntegrating pharmacists into primary care may reduce GP workload and ED attendance. However, further higher quality studies are needed, including research to clarify the cost-effectiveness of the intervention and the long-term impact on health system outcomes.

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Dietary factors and diabetes-related health outcomes in patients with type 2 diabetes: protocol for a systematic review and meta-analysis of prospective observational studies

BMJ Open ◽

10.1136/bmjopen-2018-027298 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027298

Author(s):

Janett Barbaresko ◽

Manuela Neuenschwander ◽

Lukas Schwingshackl ◽

Sabrina Schlesinger

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Observational Studies ◽

Meta Analysis ◽

Risk Of Bias ◽

Dietary Factors ◽

Dietary Behaviour ◽

Health Concern

IntroductionType 2 diabetes (T2D) is a major health concern associated with several comorbidities such as diabetic chronic kidney disease, neuropathy and cardiovascular diseases. Many of these complications may be preventable by an adequate lifestyle, including a favourable dietary behaviour, additionally to pharmacological management. In general, dietary guidelines for patients with diabetes recommend a hypocaloric diet to achieve a normal weight, but there is a lack of detailed instructions on specific nutrients and foods to prevent diabetes-related outcomes. Therefore, the aim of this systematic review and meta-analysis is to summarise the available evidence on the association between dietary factors and health-related outcomes in patients with T2D.Methods and analysisA systematic literature search will be conducted in PubMed and Web of Science in May 2019 to identify prospective observational studies investigating dietary factors in association with major complications in patients with T2D. We will include studies investigating dietary patterns, food groups, foods, macronutrients and micronutrients as well as secondary plant compounds. As diabetes-related outcomes, we will include macrovascular (cardiovascular and cerebrovascular diseases) and microvascular outcomes (nephropathy, neuropathy and retinopathy), as well as cancer, quality of life, depression, cognitive disorders and mortality. We will conduct dose-response meta-analyses using random effects models. We will investigate heterogeneity across studies and publication bias. To assess the risk of bias and quality of the included studies, we will use the Cochrane risk of bias tool ROBINS-I and the quality of evidence will be assessed using Grades of Recommendation, Assessment, Development, and Evaluation.Ethics and disseminationAs the systematic review is based on published studies, ethical considerations are not required. The systematic review and meta-analysis will be published in a peer-reviewed Journal.PROSPERO registration numberCRD42018110669

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Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis

British Journal of General Practice ◽

10.3399/bjgp20x708125 ◽

2020 ◽

Vol 70 (692) ◽

pp. e200-e207 ◽

Cited By ~ 3

Author(s):

Anna Mae Scott ◽

Justin Clark ◽

Chris Del Mar ◽

Paul Glasziou

Keyword(s):

Systematic Review ◽

At Risk ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Primary Outcome ◽

Fluid Intake ◽

Risk Of Bias ◽

Antimicrobial Use ◽

Recurrent Utis ◽

Tract Infections

BackgroundApproximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AimTo assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).Design and settingA systematic review.MethodThe authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.ResultsEight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.ConclusionGiven the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

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Gastric Residual Volumes in the Adult Intensive Care Patient: a Systematic Review

10.26686/wgtn.16968496 ◽

2021 ◽

Author(s):

◽

Rebecca Jane Jarden

Keyword(s):

Systematic Review ◽

At Risk ◽

Intensive Care ◽

Enteral Nutrition ◽

Outcome Measures ◽

Full Text ◽

Primary Outcome ◽

Risk Of Bias ◽

Randomised Controlled ◽

Patient At Risk

<p>Background: Enteral nutrition is one method of delivering nutrition to intubated patients. There are several issues that prevent optimal delivery of the prescribed enteral nutrition goal rates. The measurement of the patient's gastric residual volume (GRV) may demonstrate tolerability, or intolerability, of enteral nutrition. Identifying a safe GRV, at which to accept and continue enteral nutrition delivery, is essential to ensure the delivery of enteral nutrition adequately achieves the nutritional requirements of patients, and to mitigate the risks associated with the delivery of enteral nutrition. Objectives: This systematic review sought to answer the research question: what is the maximum GRV to accept in order to continue the delivery of enteral nutrition in the Intensive Care Unit (ICU) adult patient? This is specifically related to the primary outcome measures indicative of accepting a specified GRV that is too high or too low. Accepting a GRV that is too high would put the patient at risk of vomiting, regurgitation, aspiration of gastric contents and potentially aspiration pneumonia. Conversely, accepting a GRV that is too low would put the patient at risk of not achieving caloric needs, potentially placing the patient at risk of malnutrition and increased morbidity. Search methods: Databases searched included: CCTR, CLCMR, CLTA, CLEED, OVID MEDLINE (R) (Ovid SP), EMBASE, CINAHL Plus with Full Text (EBSCO host via helicon), AMED, Ovid Nursing Full Text plus, CDSR, ACP Journal Club, DARE, Proquest via helicon (advanced search), Pubmed via helicon (limits "all adult", "humans", "abstract", "title"), all EBM reviews, and the reference lists of articles. Selection criteria: The types of studies eligible for inclusion were published randomised controlled trials, case controlled studies, cohort studies and observational studies. Interventions considered were a comparison of two or more GRV measures. The participants eligible were adult ICU or critical care patients receiving enteral nutrition. The primary outcome measures for study inclusion were caloric requirement met, and specified potential adverse events including vomiting, regurgitation, or aspiration. Data collection and analysis: Data was extracted using a data extraction tool created by the researcher. Risk of bias was assessed by the author using two risk of bias assessment tools. Main results: Three studies met the inclusion criteria for the systematic review (McClave et al., 2005; Metheny, Schallom, Oliver, & Clouse, 2008; Pinilla, Samphire, Arnold, Liu, & Thiessen, 2001). Each of these studies contained methodological risks of bias and limitations related to their study designs. McClave et al.'s study was a prospective study (n = 40), Metheny et al.'s study was a prospective descriptive study (n = 206), and Pinilla et al.'s study was a randomised controlled trial (n = 80). No one study, or a combination of studies, provided conclusive evidence to support the use of one particular GRV over another. Author's conclusion: No recommendation for a definitive GRV was made in this systematic review due to the lack of strong evidentiary support for one GRV over another. There remain opportunities for enhancing practice through developing a consistent, multidisciplinary approach to managing GRVs. There are future research opportunities related to improving the management of GRVs in the enterally fed ICU patient, and achieving optimal volumes of nutrition delivered.</p>

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Selecting Risk of Bias Tools for Observational Studies for a Systematic Review of Anthropometric Measurements and Dental Caries among Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168623 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8623

Author(s):

Rokiah Mamikutty ◽

Ameera Syafiqah Aly ◽

Jamaludin Marhazlinda

Keyword(s):

Systematic Review ◽

Dental Caries ◽

Observational Studies ◽

Cross Sectional Study ◽

Risk Of Bias ◽

Anthropometric Measurements ◽

Sectional Study ◽

Kappa Score ◽

Cross Sectional ◽

Advantages And Disadvantages

In conducting a systematic review, assessing the risk of bias of the included studies is a vital step; thus, choosing the most pertinent risk of bias (ROB) tools is crucial. This paper determined the most appropriate ROB tools for assessing observational studies in a systematic review assessing the association between anthropometric measurements and dental caries among children. First, we determined the ROB tools used in previous reviews on a similar topic. Subsequently, we reviewed articles on ROB tools to identify the most recommended ROB tools for observational studies. Of the twelve ROB tools identified from the previous steps, three ROB tools that best fit the eight criteria of a good ROB tool were the Newcastle–Ottawa Scale (NOS) for cohort and case-control studies, and Agency for Healthcare Research and Quality (AHRQ) and the Effective Public Health Practice Project (EPHPP) for a cross-sectional study. We further assessed the inter-rater reliability for all three tools by analysing the percentage agreement, inter-class correlation coefficient (ICC) and kappa score. The overall percentage agreements and reliability scores of these tools ranged from good to excellent. Two ROB tools for the cross-sectional study were further evaluated qualitatively against nine of a tool’s advantages and disadvantages. Finally, the AHRQ and NOS were selected as the most appropriate ROB tool to assess cross-sectional and cohort studies in the present review.

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