scholarly journals Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031747 ◽  
Author(s):  
Pier-Alexandre Tardif ◽  
Lynne Moore ◽  
François Lauzier ◽  
Imen Farhat ◽  
Patrick Archambault ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Methodological Quality ◽  
Healthcare Quality ◽  
Cochrane Central Register ◽  
Clinical Practices ◽  
Umbrella Review

IntroductionTraumatic brain injury (TBI) leads to 50 000 deaths, 85 000 disabilities and costs $60 billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI.Methods and analysisUsing umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation).Ethics and disseminationEthics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient–partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care.PROSPERO registration numberCRD42019132428.

scholarly journals Low-Value Clinical Practices In Adult Traumatic Brain Injury: An Umbrella Review

2020 ◽  
Author(s):  
Lynne Moore ◽  
Pier-Alexandre Tardif ◽  
François Lauzier ◽  
Mélanie Bérubé ◽  
Patrick Archambault ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Practice ◽  
Brain Injury ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
External Ventricular Drain ◽  
Treatment Options ◽  
Clinical Practices ◽  
Umbrella Review ◽  
Mild Tbi

Abstract Background Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last three decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Methods Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (AMSTAR-2), reported effect sizes and credibility of evidence (I to IV). Results The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: CT in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. Conclusions We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality and most included studies had a high risk of bias. Protocol registration PROSPERO: CRD42019132428

scholarly journals Methodological quality of systematic reviews addressing therapeutic hypothermia and/or cooling therapy for traumatic brain injury

2019 ◽  
Vol 43 (4) ◽  
pp. 996-1015
Author(s):  
Carolina Oliveira Cruz Latorraca ◽  
Raphael Einsfeld Simões Ferreira ◽  
Bernardo Lembo Conde de Paiva ◽  
Ricardo Silva Centeno ◽  
Ana Luiza Cabrera Martimbianco ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Systematic Reviews ◽  
Methodological Quality

scholarly journals Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson’s disease and stroke: an umbrella review

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicola O’Malley ◽  
Amanda M. Clifford ◽  
Mairéad Conneely ◽  
Bláthín Casey ◽  
Susan Coote
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Falls Prevention ◽  
Umbrella Review ◽  
Falls Risk ◽  
Prevention Interventions ◽  
Evidence Table

Abstract Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

scholarly journals Protocol for a scoping review on rehabilitation among individuals who experience homelessness and traumatic brain injury

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052942
Author(s):  
Vincy Chan ◽  
Maria Jennifer Estrella ◽  
Jessica Babineau ◽  
Angela Colantonio
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Lived Experience ◽  
Scoping Review ◽  
Service Providers ◽  
Grey Literature ◽  
Future Research ◽  
Reference List ◽  
Cochrane Central Register ◽  
Scientific Meetings

IntroductionRehabilitation is key to improving outcomes and quality of life after traumatic brain injury (TBI). However, individuals experiencing homelessness are rarely represented in research that informs evidence-based rehabilitation guidelines even though TBI is disproportionately prevalent among this population. This protocol is for a scoping review to explore the extent to which rehabilitation, including the types of rehabilitation interventions, is available to, or used by, individuals who experience homelessness and TBI to inform (1) opportunities to integrate rehabilitation for individuals experiencing homelessness and TBI, (2) considerations for existing clinical and practice guidelines for rehabilitation and (3) recommendations for future research.Methods and analysisThe scoping review will be guided by six stages described in scoping review methodology frameworks. Electronic databases (MEDLINE, Embase and Embase Classic, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Nursing and Allied Health), reference list of included articles and scoping or systematic reviews identified from the search and grey literature, defined as reports from relevant brain injury, housing and rehabilitation organisations, will be searched. Two reviewers will independently screen all articles based on predetermined inclusion and exclusion criteria. A descriptive numerical summary of data items will be provided and qualitative content analytic techniques will be used to identify and report common themes. Preliminary findings will be shared with stakeholders to seek feedback on the implications of the results.Ethics and disseminationEthics review will not be required, as only publicly available data will be analysed. Findings from the scoping review will be published in a peer-reviewed journal and presented at scientific meetings and to stakeholders, defined as service providers in the housing and TBI sectors; health professionals who provide care for individuals with TBI and/or homelessness; health administrators, decision-makers and policy-makers; researchers; and caregivers or family members of individuals with lived experience of TBI and homelessness.

scholarly journals Effectiveness of pharmacotherapy for smoking cessation: Umbrella review and quality assessment of systematic reviews

2020 ◽  
Author(s):  
Alemu Sufa Melka ◽  
Catherine L Chojenta ◽  
Elizabeth G Holliday ◽  
Ayele G Bali ◽  
Deborah J Loxton
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Nicotine Replacement ◽  
Risk Of Cancer

Abstract Background : In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. This umbrella review aimed to assess the effect of pharmacological interventions on smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews. Methods: Databases including the Cochrane library, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus and Google Scholar were used to retrieve reviews. Systematic reviews that included only randomized controlled trials designed to assess pharmacotherapeutic interventions supporting abstinence from smoking were considered in this umbrella review. The methodological quality of the included reviews was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors (AM, AB) screened the titles and abstracts of all reviews obtained by the search strategy, assessed the full text of selected articles for inclusion and extracted data independently. Two authors (AM, AB) also performed a quality appraisal independently. The findings of the studies were narrated qualitatively to describe the evidence regarding the effectiveness of pharmacotherapies for smoking cessation. Results: Ten reviews were included in this umbrella review . Most of the reviews included in this review reported that Nicotine Replacement Therapy (NRT), bupropion and varenicline and cytisine were effective for smoking cessation. The combination of a nicotine patch with other nicotine formulations was also more effective than monotherapy. Similarly, the combination of nicotine with the non-nicotine therapy varenicline was found to be more effective than varenicline alone. However, the opioid antagonist naltrexone alone was not found to be effective for smoking cessation nor in combination with nicotine replacement therapy. Based on the AMSTAR 2 rating, one review scored high quality, two scored moderate quality, four scored low quality, and three scored critically low quality. Conclusions: This review revealed that drugs approved by the US Food and Drug Administration (FDA) are effective for smoking cessation. A combination of nicotine patches with other nicotine formulations was also effective for smoking cessation compared to nicotine monotherapy.

scholarly journals The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0198676 ◽  
Author(s):  
Anneliese Synnot ◽  
Peter Bragge ◽  
Carole Lunny ◽  
David Menon ◽  
Ornella Clavisi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Systematic Reviews ◽  
Severe Traumatic Brain Injury ◽  
Acute Management ◽  
Evidence Map

scholarly journals Wake up and smell the coffee: caffeine supplementation and exercise performance—an umbrella review of 21 published meta-analyses

2019 ◽  
Vol 54 (11) ◽  
pp. 681-688 ◽  
Author(s):  
Jozo Grgic ◽  
Ivana Grgic ◽  
Craig Pickering ◽  
Brad J Schoenfeld ◽  
David J Bishop ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Systematic Reviews ◽  
Exercise Performance ◽  
Methodological Quality ◽  
Muscle Endurance ◽  
Umbrella Review ◽  
Caffeine Ingestion ◽  
Quality Of Evidence ◽  
Meta Analyses

ObjectiveTo systematically review, summarise and appraise findings of published meta-analyses that examined the effects of caffeine on exercise performance.DesignUmbrella review.Data sourcesTwelve databases.Eligibility criteria for selecting studiesMeta-analyses that examined the effects of caffeine ingestion on exercise performance.ResultsEleven reviews (with a total of 21 meta-analyses) were included, all being of moderate or high methodological quality (assessed using the Assessing the Methodological Quality of Systematic Reviews 2 checklist). In the meta-analyses, caffeine was ergogenic for aerobic endurance, muscle strength, muscle endurance, power, jumping performance and exercise speed. However, not all analyses provided a definite direction for the effect of caffeine when considering the 95% prediction interval. Using the Grading of Recommendations Assessment, Development and Evaluation criteria the quality of evidence was generally categorised as moderate (with some low to very low quality of evidence). Most individual studies included in the published meta-analyses were conducted among young men.Summary/conclusionSynthesis of the currently available meta-analyses suggest that caffeine ingestion improves exercise performance in a broad range of exercise tasks. Ergogenic effects of caffeine on muscle endurance, muscle strength, anaerobic power and aerobic endurance were substantiated by moderate quality of evidence coming from moderate-to-high quality systematic reviews. For other outcomes, we found moderate quality reviews that presented evidence of very low or low quality. It seems that the magnitude of the effect of caffeine is generally greater for aerobic as compared with anaerobic exercise. More primary studies should be conducted among women, middle-aged and older adults to improve the generalisability of these findings.

scholarly journals Eye health and quality of life: an umbrella review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037648
Author(s):  
Lama Assi ◽  
Lori Rosman ◽  
Fatimah Chamseddine ◽  
Perla Ibrahim ◽  
Hadi Sabbagh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Vision Impairment ◽  
Eye Disease ◽  
Umbrella Review ◽  
Eye Health ◽  
The Impact

IntroductionVision impairment and eye disease are major global health concerns and have been associated with increased morbidity and mortality, and lower quality of life. Quality of life, whether generic, vision-specific or disease-specific, is an important measure of the impact of eye health on people’s daily activities, well-being and visual function, and is increasingly used to evaluate the impact of ophthalmic interventions and new devices. While many studies and reviews have examined the relationship between vision or eye health and quality of life across different contexts, there has yet to be a synthesis of the impact of vision impairment, eye disease and ophthalmic interventions on quality of life globally and across the lifespan.Methods and analysisAn umbrella review of systematic reviews will be conducted to address these two questions: (1) What is the association of vision impairment and eye disease with quality of life? (2) What is the impact of ophthalmic interventions on quality of life? A search of related literature will be performed on the 11 February 2020 in Medline Ovid, Embase.com, Cochrane Database of Systematic Reviews, Proquest Dissertations and Theses Global, and the grey literature, and repeated at the synthesis stage. Title/abstract and full-text screening, methodological quality assessment and data extraction will be conducted by reviewers working independently and in duplicate. Assessment of methodological quality and data extraction will be performed using Joanna Briggs Institute standard forms. Findings from the systematic reviews and their methodological quality will be summarised qualitatively in the text and using tables.Ethics and disseminationNo ethical approval is required. Results of this umbrella review will be published in a peer-reviewed journal and summarised in the Lancet Global Health Commission on Global Eye Health.Trial registration numberThis protocol was registered in the Open Science Framework Registries (https://osf.io/qhv9g/).

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