scholarly journals A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Lynn Hendricks ◽  
Ingrid Eshun-Wilson ◽  
Anke Rohwer
Keyword(s):  
Behaviour Change ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Antiretroviral Treatment ◽  
Critical Appraisal ◽  
Data Extraction ◽  
Retention In Care ◽  
Barriers And Facilitators ◽  
Change Model ◽  
Qualitative Evidence

Abstract Background People living with human immunodeficiency virus (PLHIV) struggle with the challenges of living with a chronic disease and integrating antiretroviral treatment (ART) and care into their daily lives. The aims of this study were as follows: (1) to undertake the first mega-aggregation of qualitative evidence syntheses using the methods of framework synthesis and (2) make sense of existing qualitative evidence syntheses that explore the barriers and facilitators of adherence to antiretroviral treatment, linkage to care and retention in care for PLHIV to identify research gaps. Methods We conducted a comprehensive search and did all screening, data extraction and critical appraisal independently and in duplicate. We used the Kaufman HIV Behaviour Change model (Kaufman et al., 2014) as a framework to synthesise the findings using the mega-aggregative framework synthesis approach, which consists of 8 steps: (1) identify a clearly defined review question and objectives, (2) identify a theoretical framework or model, (3) decide on criteria for considering reviews for inclusion, (4) conduct searching and screening, (5) conduct quality appraisal of the included studies, (6) data extraction and categorisation, (7) present and synthesise the findings, and (8) transparent reporting. We evaluated systematic reviews up to July 2018 and assessed methodological quality, across reviews, using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. Results We included 33 systematic reviews from low, middle- and high-income countries, which reported on 1,111,964 PLHIV. The methodological quality of included reviews varied considerably. We identified 544 unique third-order concepts from the included systematic reviews, which were reclassified into 45 fourth-order themes within the individual, interpersonal, community, institutional and structural levels of the Kaufman HIV Behaviour Change model. We found that the main influencers of linkage, adherence and retention behaviours were psychosocial and personal characteristics—perceptions of ART, desires, fears, experiences of HIV and ART, coping strategies and mental health issues—interwoven with other factors on the interpersonal, community, institutional and structural level. Using this approach, we found interdependence between factors influencing ART linkage, retention and adherence and identified the need for qualitative evidence that explores, in greater depth, the complex relationships between structural factors and adherence, sociodemographic factors such as community violence and retention, and the experiences of growing up with HIV in low- and middle-income countries—specifically in children, youth, women and key populations. Conclusions This is the first mega-aggregation framework synthesis, or synthesis of qualitative evidence syntheses using the methods of framework synthesis at the overview level. We found the novel method to be a transparent and efficient method for assessing the quality and making sense of existing qualitative systematic reviews. Systematic review registration The protocol of this overview was registered on PROSPERO (CRD42017078155) on 17 December 2017.

scholarly journals Systematic Reviews and Meta-analysis Published in Indexed Portuguese Medical Journals: Time Trends and Critical Appraisal.

2021 ◽  
Author(s):  
Luísa Prada ◽  
Ana Prada ◽  
Miguel Antunes ◽  
Ricardo Fernandes ◽  
João Costa ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Critical Appraisal ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Measurement Tool ◽  
Medical Journals ◽  
Electronic Search ◽  
Potential Impact

Abstract Introduction:Over the last years, the number of systematic reviews published is steadily increasing due to the global interest in this type of evidence synthesis. However, little is known about the characteristics of this research published in Portuguese medical journals. This study aims to evaluate the publication trends and overall quality of these systematic reviews.Material and Methods:Systematic reviews were identified through an electronic search up to August 2020, targeting Portuguese Medical journals indexed in MEDLINE. Systematic reviews selection and data extraction were done independently by three authors. The overall quality critical appraisal using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR II) was independently assessed by three authors. Disagreements were solved by consensus.Results:Seventy systematic reviews published in 5 Portuguese medical journals were included. Most (n=57; 81,4%) were systematic reviews without meta-analysis. Until 2010, the number of systematic reviews per year increased. Since then, the number of reviews published has not remained stable and no less than 3 SRs were published per year. According to the systematic reviews’ typology, most have been predominantly conducted to assess the effectiveness of health interventions (n=28; 40,0%). General and Internal Medicine (n=26; 37,1%) was the most addressed field. Most systematic reviews (n=45; 64,3%) were rated as being of “critically low-quality”.Conclusions:There were consistent flaws in the methodological quality report of the systematic reviews included, particularly in establishing a prior protocol and not assessing the potential impact of the risk of bias on the results.Through the years, the number of systematic reviews published increased, yet their quality is suboptimal. There is a need to improve the reporting of systematic reviews in Portuguese medical journals, which can be achieved by better adherence to quality checklists/tools.Systematic review registration: INPLASY202090105

scholarly journals Why do healthcare professionals fail to escalate as per the Early Warning System (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

2021 ◽  
Author(s):  
Sinead M O Neill ◽  
Barbara Clyne ◽  
Miriam Bell ◽  
Avilene Casey ◽  
Brendan Leen ◽  
...  
Keyword(s):  
Early Warning ◽  
Clinical Judgment ◽  
Healthcare Professionals ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Warning System ◽  
Barriers And Facilitators ◽  
Qualitative Evidence Synthesis ◽  
Quality Appraisal ◽  
Qualitative Evidence

Abstract Background: Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods: A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorized into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence.Results: Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, Empowerement, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions: The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.

scholarly journals Assessing the methodological quality of systematic reviews using the AMSTAR tool

2020 ◽  
Author(s):  
Ana Beatriz Pizarro ◽  
Sebastián Carvajal ◽  
Adriana Buitrago-López
Keyword(s):  
Systematic Reviews ◽  
Health Professionals ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Internal Validity ◽  
Critical Assessment ◽  
Cochrane Library ◽  
Publication Date ◽  
Review Of Literature

Introduction: Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives: To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods: We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using “AMSTAR” and “Systematic Reviews” as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions: AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of an SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.

scholarly journals Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Keqin Liu ◽  
Jiaxin Tao ◽  
Jixin Yang ◽  
Yufeng Li ◽  
Yanwei Su ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Preterm Infants ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Cochrane Library ◽  
Qualitative Synthesis ◽  
Term Infants ◽  
Online Library

Abstract Background Preterm infants have higher nutrition needs than term infants. The effectiveness of various feeding supplementation was assessed by the improvement of health outcomes in single specific systematic reviews (SRs). The aim of this review was to comprehensively describe the effectiveness of feeding supplementation in promoting health outcomes of preterm infants. Methods A literature search was conducted in the PUBMED, EMBASE, Science Direct, Cochrane library, Web of Science, and Wiley online library. SRs selection followed clear inclusion and exclusion criteria. Pairs of reviewers independently applied the criteria to both titles/abstracts and full texts. Screening and data extraction were performed by using the advanced tables. The methodological quality of SRs and the quality of the evidence were carried out according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Grades of Recommendation, Assessment, Development, and Evaluation guidelines (GRADE) respectively. A qualitative synthesis of evidence is presented. Results Seventeen SRs were included in the review. Fifteen kinds of feeding supplementation were reported in the SRs. In preterm infants, the effectiveness of feeding supplementation in addition to regular breast-feeding was mainly shown in six aspects: physical health, neurodevelopment, biochemical outcomes, other health outcomes, morbidity and all-cause mortality. And the effectiveness of the interventions on health outcomes in preterm infants was found by most systematic reviews. The methodological quality of all the included SRs was high, and most of the evidences was of low or very low quality. Conclusions Our results will allow a better understanding of the feeding supplementation in preterm infants. Although the feeling supplements may improve the health outcomes of in preterm infants, the existing evidence is uncertain. Therefore, the clinical use of these supplements should be considered cautiously and more well-designed RCTs are still needed to further address the unsolved problems of the included SRs.

Systematic Reviews of Systematic Quantitative, Qualitative, and Mixed Studies Reviews in Healthcare Research: How to Assess the Methodological Quality of Included Reviews?

2021 ◽  
pp. 155868982110542
Author(s):  
Geneviève Rouleau ◽  
Quan Nha Hong ◽  
Navdeep Kaur ◽  
Marie‐Pierre Gagnon ◽  
José Côté ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Quantitative Data ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Healthcare Research ◽  
Discussion Paper ◽  
Qualitative And Quantitative ◽  
Review Of Reviews

Conducting a review of systematic reviews can be challenging, especially when combining systematic quantitative, qualitative and mixed studies reviews. In this methodological discussion paper, we propose (a) a typology for categorizing various types of review of reviews and (b) an exploration of criteria pertaining to three existing critical appraisal tools (ROBIS, AMSTAR 2, and MMSR) to identify those that could be adapted for qualitative and mixed studies reviews. Further work has to be done to develop methodological guidance in conducting, interpreting, and reporting reviews of reviews that combine qualitative and quantitative data.

scholarly journals Evaluating methodological quality of Prognostic models Including Patient-reported HeAlth outcomes iN oncologY (EPIPHANY): a systematic review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e025054 ◽  
Author(s):  
Nina Deliu ◽  
Francesco Cottone ◽  
Gary S Collins ◽  
Amélie Anota ◽  
Fabio Efficace
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Prognostic Models ◽  
Published Data ◽  
Evidence Based ◽  
Patient Reported ◽  
Data Extraction Form

IntroductionWhile there is mounting evidence of the independent prognostic value of patient-reported outcomes (PROs) for overall survival (OS) in patients with cancer, it is known that the conduct of these studies may hold a number of methodological challenges. The aim of this systematic review is to evaluate the quality of published studies in this research area, in order to identify methodological and statistical issues deserving special attention and to also possibly provide evidence-based recommendations.Methods and analysisAn electronic search strategy will be performed in PubMed to identify studies developing or validating a prognostic model which includes PROs as predictors. Two reviewers will independently be involved in data collection using a predefined and standardised data extraction form including information related to study characteristics, PROs measures used and multivariable prognostic models. Studies selection will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with data extraction form using fields from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist for multivariable models. Methodological quality assessment will also be performed and will be based on prespecified domains of the CHARMS checklist. As a substantial heterogeneity of included studies is expected, a narrative evidence synthesis will also be provided.Ethics and disseminationGiven that this systematic review will use only published data, ethical permissions will not be required. Findings from this review will be published in peer-reviewed scientific journals and presented at major international conferences. We anticipate that this review will contribute to identify key areas of improvement for conducting and reporting prognostic factor analyses with PROs in oncology and will lay the groundwork for developing future evidence-based recommendations in this area of research.Prospero registration numberCRD42018099160.

scholarly journals A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Romy Lauche ◽  
Holger Cramer ◽  
Winfried Häuser ◽  
Gustav Dobos ◽  
Jost Langhorst
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Fibromyalgia Syndrome ◽  
Data Extraction ◽  
Scientific Evidence ◽  
Cochrane Library ◽  
Overview Of Reviews ◽  
Systematic Overview ◽  
Complementary And Alternative

Objectives.This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS).Methods.The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument.Results.Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment.Conclusions.Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

scholarly journals Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. O’Neill ◽  
B. Clyne ◽  
M. Bell ◽  
A. Casey ◽  
B. Leen ◽  
...  
Keyword(s):  
Early Warning ◽  
Clinical Judgment ◽  
Healthcare Professionals ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Warning System ◽  
Barriers And Facilitators ◽  
Qualitative Evidence Synthesis ◽  
Quality Appraisal ◽  
Qualitative Evidence

Abstract Background Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorised into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence. Results Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, empowerment, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.

Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses of Atopic Dermatitis Treatments and Interventions

Dermatology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Vanessa Lin ◽  
Raahi Patel ◽  
Alexis Wirtz ◽  
Deepika Mannem ◽  
Ryan Ottwell ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Included Study ◽  
Primary Objective ◽  
Quality Of Reporting ◽  
Study Characteristics ◽  
Meta Analyses

<b><i>Background:</i></b> Spin – the misrepresentation of a study’s results – has been identified in abstracts of studies focused on a variety of disorders from multiple fields of medicine. <b><i>Objectives:</i></b> This study’s primary objective was to evaluate the abstracts of systematic reviews and meta-analyses focused on the treatment of atopic dermatitis for the nine most severe forms of spin. <b><i>Methods:</i></b> We systematically searched Embase and MEDLINE for systematic reviews of atopic dermatitis therapies. Screening and data extraction occurred in a masked, duplicate fashion. Each included study was evaluated for the nine most severe types of spin and other study characteristics. <b><i>Results:</i></b> Our searches retrieved 2,456 studies, of which 113 were included for data extraction. Spin was found in 74.3% of our included studies (84/113). Spin type 6 occurred most frequently (68/113, 60.2%). Spin types 1, 2, and 9 were not identified. All industry-funded systematic reviews contained spin in their abstract. The presence of spin was not associated with any specific study characteristics, including the methodological quality of the study. <b><i>Conclusions:</i></b> Severe forms of spin were found in the majority of abstracts for systematic reviews of atopic dermatitis treatments. Steps should be taken to prevent spin to improve the quality of reporting in abstracts.

scholarly journals Methodological quality assessment in systematic reviews in health sciences that included observational studies: a cross-sectional study/ Avaliação da qualidade metodológica em revisões sistemáticas na área das ciências da saúde que incluíram estudos observacionais: um estudo transversal

2021 ◽  
Vol 4 (5) ◽  
pp. 23002-23018
Author(s):  
Carla Massignan ◽  
Luciana Butini Oliveira ◽  
Lia Rosana Honnef ◽  
Júlia Meller de Oliveira ◽  
Karyn Lehmkuhl ◽  
...  
Keyword(s):  
Quality Assessment ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Methodological Quality ◽  
Data Extraction ◽  
Sample Size Calculation ◽  
Health Science ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Protocol Registration

There is great variability in methodological quality assessment (MQ) systematic reviews (SRs). We identified how MQ assessment in SRs that included observational studies in Health Science is applied and explored associated characteristics. A search was conducted in PubMed and five trained reviewers randomly selected 1,025 references after sample size calculation. Only SR published in English (September 2019/2020) were included. Selection and data extraction were conducted in two phases. Data were analyzed descriptively and using logistic regressions. After eligibility criteria application, 205 SRs were included. Only 27.8% informed the protocol registration and 80.0% described having followed a reporting guideline. Proportion’ SRs did not seem to present MQ assessment (OR 4.22; 95% CI: 1.38-12.87; P =0.01). SRs that did not register the study protocol (9.70; 95% CI: 1.95-48.27; P 0.001), those that did not inform the included study design (5.96; 95% CI: 1.63-21.77; P 0.001) and those without MA (OR 8.90; 95% CI: 2.79-28.43; p0.001) increased the odds of not evaluating MQ. Newcastle-Ottawa (47.5%), Joanna Briggs Institute (8.2%) and National Institute of Health (7.1%) were the most commonly used MQ tools. Lack of protocol registration, absence of information about the design of included studies, absence of MA, and proportion’ SRs were associated with lack of MQ assessment.

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