Elizabeth Stovold

Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review

We conducted a meta-analysis of randomised trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Airways Group Register of Trials from inception until March 2014. 12 trials with 1264 adult patients were included, of which five were unpublished studies. Eight trials on 590 patients contributed data to the meta-analysis. Amikacin, aztreonam, ciprofloxacin, gentamicin, colistin or tobramycin were used for 4 weeks to 12 months. Inhaled antibiotics were more effective than placebo or symptomatic treatment in reducing sputum bacterial load (five trials; weighted mean difference −2.65 log10 CFU·g−1, 95% CI -4.38– -0.92 log10 CFU·g−1), eradicating the bacteria from sputum (six trials; risk ratio 4.2, 95% CI 1.66–10.64) and reducing the risk of acute exacerbations (five trials; risk ratio 0.72, 95% CI 0.55–0.94). Bronchospasm occurred in 10% of patients treated with inhaled antibiotics compared with 2.3% in the control group (seven trials; risk ratio 2.96, 95% CI 1.30–6.73), but the two groups had the same withdrawal rate due to adverse events (12.2%). Inhaled antibiotics may provide an effective suppressive antibiotic therapy with an acceptable safety profile in adult patients with stable non-CF bronchiectasis and chronic bronchial infection. Inhaled antibiotics are effective with an acceptable safety profile in adults with stable non-CF bronchiectasis http://ow.ly/wxsGg

Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram

Cochrane systematic reviews are conducted and reported according to rigorous standards. A study flow diagram must be included in a new review, and there is clear guidance from the PRISMA statement on how to do this. However, for a review update, there is currently no guidance on how study flow diagrams should be presented. To address this, a working group was formed to find a solution and produce guidance on how to use these diagrams in review updates.A number of different options were devised for how these flow diagrams could be used in review updates, and also in cases where multiple searches for a review or review update have been conducted. These options were circulated to the Cochrane information specialist community for consultation and feedback. Following the consultation period, the working group refined the guidance and made the recommendation that for review updates an adapted PRISMA flow diagram should be used, which includes an additional box with the number of previously included studies feeding into the total. Where multiple searches have been conducted, the results should be added together and treated as one set of results.There is no existing guidance for using study flow diagrams in review updates. Our adapted diagram is a simple and pragmatic solution for showing the flow of studies in review updates.

Cochrane Airways Group reviews were prioritized for updating using a pragmatic approach.

OBJECTIVES Cochrane Reviews should address the most important questions for guideline writers, clinicians, and the public. It is not possible to keep all reviews up-to-date, so the Cochrane Airways Group (CAG) decided to prioritize updates and new reviews without requesting additional resources. The aim of the objective was to develop pragmatic and transparent prioritization techniques to identify 25 to 35 high-priority updates from a total of 270 CAG Reviews and become more selective over which new reviews we publish. STUDY DESIGN AND SETTING We used elements from existing prioritization processes, including existing health care uncertainties, expert opinion, and a decision tool. We did not conduct a full face-to-face workshop or an iterative group decision-making process. RESULTS We prioritized 30 reviews in need of updating and aimed to update these within 2 years. Within the first 18 months, nine of these have been published. CONCLUSION A pragmatic approach to prioritization can indicate priority reviews without an excessive drain on time and resources. The steps provide us with better control over the reviews in our scope and can be built on in the future.

How to make sense of a Cochrane systematic review

More and more papers are published in medical journals every day, so how do you decide which ones to read and, having read a paper, how do you decide whether to change your practice as a result of what you have read? Perhaps the paper was atypical in some way. What does the other research on the topic say? The purpose of systematic reviews is to summarise all the available, high-quality evidence that can be found on a particular topic. A narrative review, in which an expert can cite a selection of papers that support a particular viewpoint, says very little about the papers that do not. In contrast, a systematic review involves a search for all available literature, whatever the findings may be. Systematic reviews start with a well-defined clinical question, and aim to identify, appraise, synthesise and then apply all the available good-quality evidence that can be found (published or unpublished) that is relevant to the question. In particular, Cochrane systematic reviews have to meet a defined set of quality standards and the authors and editors set out to make them the best around. They are the current gold standard in the systematic review field. The Cochrane Collaboration is an international group which is now 20 years old. The collaboration depends upon the voluntary contribution of thousands of authors and is supported by editorial bases and methodologists. In the UK, these bases are supported by funding from the National Institute of Health Research (NIHR), and any funding for editorial bases must be free from commercial interests. Review groups are divided up into areas of clinical interest and, within the respiratory field, there are groups for lung cancer (based in France), acute respiratory infections (based in Australia), cystic fibrosis (based in the UK) and airways (based in the UK …

Comparison of outpatient and home-based exercise training programmes for COPD: A systematic review and meta-analysis: Review COPD exercise training setting

Chronic obstructive pulmonary disease is a common, preventable and treatable disease. Exercise training programmes (ETPs) improve symptoms, health‐related quality of life (HRQoL) and exercise capacity, but the optimal setting is unknown. In this review, we compared the effects of ETPs in different settings on HRQoL and exercise capacity. We searched (5 July 2016) the Cochrane Airways Group Specialised Register, ClinicalTrials.gov and World Health Organization trials portal. We selected studies, extracted data and assessed risk of bias with two independent reviewers. We calculated mean differences (MD) with 95% CI. We assessed the quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation.

Twitter Users with Access to Academic Library Services Request Health Sciences Literature through Social Media

A Review of: Swab, M., & Romme, K. (2016). Scholarly sharing via Twitter: #icanhazpdf requests for health sciences literature. Journal of the Canadian Health Libraries Association, 37(1), 6-11. http://dx.doi.org/10.5596/c16-009 Abstract Objective – To analyze article sharing requests for health sciences literature on Twitter, received through the #icanhazpdf protocol. Design – Social media content analysis. Setting – Twitter. Subjects – 302 tweets requesting health sciences articles with the #icanhazpdf tag. Methods – The authors used a subscription service called RowFeeder to collect public tweets posted with the hashtag #icanhazpdf between February and April 2015. Rowfeeder recorded the Twitter user name, location, date and time, URL, and content of the tweet. The authors excluded all retweets and then each reviewed one of two sets. They recorded the geographic region and affiliation of the requestor, whether the tweet was a request or comment, type of material requested, how the item was identified, and if the subject of the request was health or non-health. Health requests were further classified using the Scopus subject category of the journal. A journal could be classified with more than one category. Any uncertainties during the coding process were resolved by both authors reviewing the tweet and reaching a consensus. Main results – After excluding all the retweets and comments, 1079 tweets were coded as heath or non-health related. A final set of 302 health related requests were further analyzed. Almost all the requests were for journal articles (99%, n=300). The highest-ranking subject was medicine (64.9%, n=196), and the lowest was dentistry (0.3%, n=1). The most common article identifier was a link to the publisher’s website (50%, n=152), followed by a link to the PubMed record (22%, n=67). Articles were also identified by citation information (11%, n=32), DOI (5%, n=14), a direct request to an individual (3%, n=9), another method (2%, n=6), or multiple identifiers (7%, n=22). The majority of requests originated from the UK and Ireland (29.1%, n=88), the United States (26.5%, n=80), and the rest of Europe (19.2%, n=58. Many requests came from people with affiliations to an academic institution (45%, n=136). These included librarians (3.3%, n=10), students (13.6%, n=41), and academics (28.1%, n=85). When tweets of unknown affiliation were excluded (n=117), over 70% of the requests were from people with academic links. Other requesters included journalists, clinicians, non-profit organisations, patients, and industry employees. The authors examined comments in the tweets to gain some understanding of the reasons for seeking articles through #icanhazpdf, although this was not the primary focus of their study. A preliminary examination of the comments suggested that users value the ease, convenience, and the ability to connect with other researchers that social media offers. Conclusion – The authors concluded that the number of requests for health sciences literature through this channel is modest, but health librarians should be aware of #icanhazpdf as another method through which their users might seek to obtain articles. The authors recommend further research into the reasons why users sometimes choose social media over the library to obtain articles.

Web-Scale Discovery Services Retrieve Relevant Results in Health Sciences Topics Including MEDLINE Content

A Review of: Hanneke, R., & O’Brien, K. K. (2016). Comparison of three web-scale discovery services for health sciences research. Journal of the Medical Library Association, 104(2), 109-117. http://dx.doi.org/10.3163/1536-5050.104.2.004 Abstract Objective – To compare the results of health sciences search queries in three web-scale discovery (WSD) services for relevance, duplicate detection, and retrieval of MEDLINE content. Design – Comparative evaluation and bibliometric study. Setting – Six university libraries in the United States of America. Subjects – Three commercial WSD services: Primo, Summon, and EBSCO Discovery Service (EDS). Methods – The authors collected data at six universities, including their own. They tested each of the three WSDs at two data collection sites. However, since one of the sites was using a legacy version of Summon that was due to be upgraded, data collected for Summon at this site were considered obsolete and excluded from the analysis. The authors generated three questions for each of six major health disciplines, then designed simple keyword searches to mimic typical student search behaviours. They captured the first 20 results from each query run at each test site, to represent the first “page” of results, giving a total of 2,086 total search results. These were independently assessed for relevance to the topic. Authors resolved disagreements by discussion, and calculated a kappa inter-observer score. They retained duplicate records within the results so that the duplicate detection by the WSDs could be compared. They assessed MEDLINE coverage by the WSDs in several ways. Using precise strategies to generate a relevant set of articles, they conducted one search from each of the six disciplines in PubMed so that they could compare retrieval of MEDLINE content. These results were cross-checked against the first 20 results from the corresponding query in the WSDs. To aid investigation of overall coverage of MEDLINE, they recorded the first 50 results from each of the 6 PubMed searches in a spreadsheet. During data collection at the WSD sites, they searched for these references to discover if the WSD tool at each site indexed these known items. Authors adopted measures to control for any customisation of the product setup at each data collection site. In particular, they excluded local holdings from the results by limiting the searches to scholarly, peer-reviewed articles. Main results – Authors reported results for 5 of the 6 sites. All of the WSD tools retrieved between 50-60% relevant results. EDS retrieved the highest number of relevant records (195/360 and 216/360), while Primo retrieved the lowest (167/328 and 169/325). There was good observer agreement (k=0.725) for the relevance assessment. The duplicate detection rate was similar in EDS and Summon (between 96-97% unique articles), while the Primo searches returned 82.9-84.9% unique articles. All three tools retrieved relevant results that were not indexed in MEDLINE, and retrieved relevant material indexed in MEDLINE that was not retrieved in the PubMed searches. EDS and Summon retrieved more non-MEDLINE material than Primo. EDS performed best in the known-item searches, with 300/300 and 299/300 items retrieved, while Primo performed worst with 230/300 and 267/300 items retrieved. The Summon platform features an “automated query expansion” search function, where user-entered keywords are matched to related search terms and these are automatically searched along with the original keyword. The authors observed that this function resulted in a wholly relevant first page of results for one of the search questions tested in Summon. Conclusion – While EDS performed slightly better overall, the difference was not great enough in this small sample of test sites to recommend EDS over the other tools being tested. The automated query expansion found in Summon is a useful function that is worthy of further investigation by the WSD vendors. The ability of the WSDs to retrieve MEDLINE content through simple keyword searches demonstrates the potential value of using a WSD tool in health sciences research, particularly for inexpert searchers.

Metadata Quality in Institutional Repositories May be Improved by Addressing Staffing Issues

A Review of: Moulaison Sandy, H., & Dykas, F. (2016). High-quality metadata and repository staffing: Perceptions of United States–based OpenDOAR participants. Cataloging & Classification Quarterly, 54(2), 101-116. http://dx.doi.org/10.1080/01639374.2015.1116480 Objective – To investigate the quality of institutional repository metadata, metadata practices, and identify barriers to quality. Design – Survey questionnaire. Setting – The OpenDOAR online registry of worldwide repositories. Subjects – A random sample of 50 from 358 administrators of institutional repositories in the United States of America listed in the OpenDOAR registry. Methods – The authors surveyed a random sample of administrators of American institutional repositories included in the OpenDOAR registry. The survey was distributed electronically. Recipients were asked to forward the email if they felt someone else was better suited to respond. There were questions about the demographics of the repository, the metadata creation environment, metadata quality, standards and practices, and obstacles to quality. Results were analyzed in Excel, and qualitative responses were coded by two researchers together. Main results – There was a 42% (n=21) response rate to the section on metadata quality, a 40% (n=20) response rate to the metadata creation section, and 40% (n=20) to the section on obstacles to quality. The majority of respondents rated their metadata quality as average (65%, n=13) or above average (30%, n=5). No one rated the quality as high or poor, while 10% (n=2) rated the quality as below average. The survey found that the majority of descriptive metadata was created by professional (84%, n=16) or paraprofessional (53%, n=10) library staff. Professional staff were commonly involved in creating administrative metadata, reviewing the metadata, and selecting standards and documentation. Department heads and advisory committees were also involved in standards and documentation selection. The majority of repositories used locally established standards (61%, n=11). When asked about obstacles to metadata quality, the majority identified time and staff hours (85%, n=17) as a barrier, as well as repository software (60%, n=12). When the responses to questions about obstacles to quality were tabulated with the responses to quality rating, time limitations and staff hours came out as the top or joint-top answer, regardless of the quality rating. Finally, the authors present a sample of responses to the question on how metadata could be improved and these offer some solutions to staffing issues, the application of standards, and the repository system in use. Conclusion – The authors conclude that staffing, standards, and systems are all concerns in providing quality metadata. However, they suggest that standards and software issues could be overcome if adequate numbers of qualified staff are in place.

Librarian-Led Information Literacy Training Delivered in Small Groups Improved Medical Students’ Confidence in Their Ability to Use Evidence Based Resources Effectively

A Review of: McClurg, C., Powelson, S., Lang, E., Aghajafari, F., & Edworthy, S. (2015). Evaluating effectiveness of small group information literacy instruction for Undergraduate Medical Education students using a pre- and post-survey study design. Health Information & Libraries Journal. 32(2), 120-130. http://doi.org/10.1111/hir.12098 Abstract Objective – To assess the effectiveness of librarian-led small group information literacy sessions, which were integrated into the second year of a three-year undergraduate medical course. Design – A pre- and post-intervention survey questionnaire. Setting – A large university in Canada. Subjects – A cohort of 160 second year undergraduate medical students enrolled in the three-year programme of a large university in Canada. Methods – As part of the redevelopment of the undergraduate three-year medical course, information literacy skills in evidence based medicine were integrated into the seminar and small group teaching programme. Every week for five weeks, 3 librarians each visited 4 small groups of 15 students to deliver a 15-minute session as part of a 2-hour long seminar led by practising physicians. The sessions did not include a formal hands-on component, however, students were encouraged to try out searches on their own devices. Each 15-minute session covered 3 learning objectives, including how to use PubMed clinical queries, how to use MeSH, and how to search for systematic reviews and guidelines. A pre- and post-intervention survey design was used to assess students’ perceptions of the impact of these sessions. The students were asked to complete an online Survey Monkey survey before and after the five week lecture block. The questions covered resource selection, perception of barriers to finding evidence based information, and the students’ confidence in using evidence based resources. The data were analysed descriptively. Main results – The pre-survey achieved a 90% (144/160) response rate while the post-survey achieved a 75% (112/160) response rate. The post-survey indicated an increase in the likelihood that students would use Ovid MEDLINE, carry out a literature search, and consult a librarian, with a decrease in those who would consult a print or online textbook. There was limited change in the students’ confidence that they could find answers quickly, but more of an increase in the proportion of students who were confident they could find systematic reviews and guidelines, and use search limits, PICO, and MeSH. Before the intervention, “knowing where to search,” devising a search strategy, and retrieving too many results were all thought to be obstacles by the students. After the small group training, students considered these issues less of a problem. The post-survey also included an opportunity for the students to comment on their experience with the programme overall. Of the 54 responses received, 34 identified the library component as being the most important thing they had learned in the small group part of the course. Conclusion – The authors conclude that integrating information literacy into the undergraduate curriculum as part of the small group seminar series is effective. They suggest future directions for research, such as a study to assess the impact of the training on specific skills rather than student confidence and evaluations of other teaching methods.

A Systematic Review of Librarian-Provided Services Delivered in Healthcare Settings Finds a Positive Effect on Clinician and Patient Relevant Outcomes and Identifies Gaps in the Evidence

A Review of: Perrier, L., Farrell, A., Ayala, A. P., Lightfoot, D., Kenny, T., Aaronson, E., . . . Weiss, A. ( 2014). Effects of librarian-provided services in healthcare settings: A systematic review. Journal of the American Medical Informatics Association, 21(6), 1118-1124. http://dx.doi.org/10.1136/amiajnl-2014-002825 Abstract Objective – To assess the effects of librarian-provided services, in any healthcare setting, on outcomes important to patients, healthcare providers, and researchers. Design – Systematic review and narrative synthesis. Setting – MEDLINE, CINAHL, ERIC, LISA, and CENTRAL databases; library-related websites, conference proceedings, and reference lists of included studies. Subjects – Twenty-five studies identified through a systematic literature search. Methods – In consultation with the review team, a librarian designed a search to be run in MEDLINE that was peer-reviewed against a published checklist. The team then conducted searches in the five identified databases, adapting the search as appropriate for each database. Authors also checked the websites of library and evidence based healthcare organisations, along with abstracts of relevant conference proceedings, to supplement the electronic search. Two authors screened the literature search results for eligible studies, and reached agreement by consensus. Studies of any librarian-delivered service in a healthcare setting, directed at either patients, clinicians of any type, researchers, or students, along with studies reporting outcomes relevant to clinicians, patients, or researchers, were eligible for inclusion. The authors assessed results initially on the titles and abstracts, and then on the full-text of potentially relevant reports. The data from included studies were then extracted into a piloted data extraction form, and each study was assessed for quality using the Cochrane EPOC risk of bias tool or the Newcastle-Ottawa scale. The results were synthesised narratively. Main Results – The searches retrieved a total of 25 studies that met the inclusion criteria, comprised of 22 primary papers and 3 companion reports. Authors identified 12 randomised trials, 4 controlled before-and-after studies, 3 cohorts, 2 non-randomised trials, and 1 case-control study. They identified three main categories of intervention: librarians teaching search skills; providing literature searching as a service; and a combination of the teaching and provision of search services. The interventions were delivered to a mix of trainees, clinicians, and students. None of the studies examined services delivered directly to patients or to researchers. The quality assessment found most of the studies had a mid- to high-risk of bias due to factors such as lack of random sequence generation, a lack of validated tools for data collection, or a lack of statistical analysis included in the study. Two studies measured patient relevant outcomes and reported that searches provided by librarians to clinicians had a positive impact on the patient’s length of stay in hospital. Five studies examined the effect of librarian provided services on outcomes important to clinicians, such as whether a literature search influenced a clinical decision. There was a trend towards a positive effect, although two studies found no significant difference. The majority of studies investigated the impact of training delivered to trainees and students on their literature search skills. Twelve of these studies found a positive effect of training on the recipients’ search skills, while three found no difference. The secondary outcomes considered by this review were satisfaction with the service (8 studies), relevance of the answers provided by librarians (2), and cost (3). The majority reported good satisfaction, and relevance. A cost benefit was found in 2 of 3 studies that reported this outcome. Conclusion – Authors report a positive effect of training on the literature search skills of trainees and students, and identified a benefit in the small number of studies that examined librarian services to clinicians. Future studies should use validated data collection tools, and further research should be conducted in the area of services provided to clinicians. Research is needed on the effect of librarian-provided services to patients and researchers as no studies meeting the inclusion criteria examining these two groups were identified by the literature search.