Liz Dennett

Utilisation of search filters in systematic reviews of prognosis questions.

BACKGROUND Search filters are designed to increase efficiency of information retrieval and can be particularly useful in limiting the large numbers of articles retrieved for systematic reviews (SRs). Existing published prognosis search filters (or hedges) have lower sensitivity and precision values than their therapy counterparts. OBJECTIVES Taking into account the relatively poor performance of prognosis filters, this study seeks to identify which methods of limiting search results to prognostic studies are most often used by SR teams. METHODS One hundred and three SRs of prognostic studies published in 2009 and indexed in MEDLINE were retrieved. Each reviews search strategy was reviewed and prognosis-related search terms were extracted. RESULTS Forty-seven of 103 studies used prognosis-related terms to limit the search. Six SRs of 103 did not specify their search terms, and the remaining 50 SRs used content terms only (no terms related to methodology or prognosis). Of the 47 strategies using prognosis-related terms, only six used a published filter. Many SRs used few or poorly selected prognosis-related search terms which are unlikely to provide the sensitivity generally sought for SRs. CONCLUSIONS Published prognosis search filters are used in only a small minority of prognosis SRs.

Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review

Background Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies. Objective To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations. Materials and methods 5 electronic databases were systematically searched. Studies selected included original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. 2 independent authors assessed the quality (Downs and Black (DB) criteria) and level of evidence (Oxford Centre of Evidence-Based Medicine model). Results Of 4361 potential studies, 17 were included. The majority were low-quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). 4 studies considered inter-relationships between risk factors, 7 reported diagnostic accuracy and none tested an intervention programme targeting individuals identified as high risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations. Conclusions Future research should focus on high-quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating preparticipation screening and LE injury prevention programmes through high-quality randomised controlled trials targeting individuals at greater risk of injury based on screening tests with validated test properties.

An Economic Evaluation of the Parent–Child Assistance Program for Preventing Fetal Alcohol Spectrum Disorder in Alberta, Canada

Parent–Child Assistance Program (P-CAP) is a 3-year home visitation/harm reduction intervention to prevent alcohol exposed births, thereby births with fetal alcohol spectrum disorder, among high-risk women. This article used a decision analytic modeling technique to estimate the incremental cost–effectiveness ratio and the net monetary benefit of the P-CAP within the Alberta Fetal Alcohol Spectrum Disorder Service Networks in Canada. The results indicate that the P-CAP is cost–effective and support placing a high priority not only on reducing alcohol use during pregnancy, but also on providing effective contraceptive measures when a program is launched.

Value of databases other than medline for rapid health technology assessments.

OBJECTIVES The objective of this study was to explore the degree to which databases other than MEDLINE contribute studies relevant for inclusion in rapid health technology assessments (HTA). METHODS We determined the extent to which the clinical, economic, and social studies included in twenty-one full and four rapid HTAs published by three Canadian HTA agencies from 2007 to 2012 were indexed in MEDLINE. Other electronic databases, including EMBASE, were then searched, in sequence, to assess whether or not they indexed studies not found in MEDLINE. Assessment topics ranged from purely clinical (e.g., drug-eluting stents) to those with broader social implications (e.g., spousal violence). RESULTS MEDLINE contributed the majority of studies in all but two HTA reports, indexing a mean of 89.6 percent of clinical studies across all HTAs, and 88.3 percent of all clinical, economic, and social studies in twenty-four of twenty-five HTAs. While EMBASE contributed unique studies to twenty-two of twenty-five HTAs, three rapid HTAs did not include any EMBASE studies. In some instances, PsycINFO and CINAHL contributed as many, if not more, non-MEDLINE studies than EMBASE. CONCLUSIONS Our findings highlight the importance of assessing the topic-specific relative value of including EMBASE, or more specialized databases, in HTA search protocols. Although MEDLINE continues to be a key resource for HTAs, the time and resource limitations inherent in the production of rapid HTAs require that researchers carefully consider the value and limitations of other information sources to identify relevant studies.

Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review

A significant proportion of patients discharged from the emergency department (ED) with asthma exacerbations will relapse within 4 weeks. This systematic review summarises the evidence regarding relapses and factors associated with relapse in adult patients discharged from EDs after being treated for acute asthma. Following a registered protocol, comprehensive literature searches were conducted. Studies tracking outcomes for adults after ED management and discharge were included if they involved adjusted analyses. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Risk of Bias (RoB) Tool. Results were summarised using medians and IQRs or mean and SD, as appropriate. 178 articles underwent full-text review and 10 studies, of various methodologies, involving 32 923 patients were included. The majority of the studies were of high quality according to NOS and RoB Tool. Relapse proportions were 8±3%, 12±4% and 14±6% at 1, 2 and 4 weeks, respectively. Female sex was the most commonly reported and statistically significant factor associated with an increased risk of relapse within 4 weeks of ED discharge for acute asthma. Other factors significantly associated with relapse were past healthcare usage and previous inhaled corticosteroids (ICS) usage. A median of 17% of patients who are discharged from the ED will relapse within the first 4 weeks. Factors such as female sex, past healthcare usage and ICS use at presentation were commonly and significantly associated with relapse occurrence. Identifying patients with these features could provide clinicians with guidance during their ED discharge decision-making.

Gait deviations associated with concussion: a systematic review

BACKGROUND Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion. OBJECTIVE To identify quantifiable gait deviations associated with concussion across populations and time since injury. METHODS AND MATERIALS Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model). RESULTS Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity. CONCLUSION These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.BACKGROUND Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion. OBJECTIVE To identify quantifiable gait deviations associated with concussion across populations and time since injury. METHODS AND MATERIALS Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model). RESULTS Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity. CONCLUSION These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.

Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review

We conducted a scoping review of the tools used to measure therapeutic relationship in patients with haemophilia.

PREDICTING LOWER EXTREMITY INJURY RISK IN SPORT THROUGH MOVEMENT QUALITY SCREENING: A SYSTEMATIC REVIEW

Background The identification of risk factors for lower extremity musculoskeletal (MSK) injury in sport is required to inform primary and secondary injury prevention strategies. Objective To determine whether measures of poor movement quality are associated with lower extremity MSK injury in sport. Design Systematic Review. Methods Five electronic databases (Medline, EMBASE, CINAHL, Sport Discus, SCOPUS) were systematically searched using keywords and Medical Sub-heading terms. Studies selected included: English language; original data; prospective analytic design; a rating of movement compensation, asymmetry, impairment or efficiency through composite batteries and/or individual tests; and participants with lower extremity MSK injury sustained with sport participation. PRISMA guidelines were followed and two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model). Results Of 4361 potential relevant studies, 13 were included. The majority (11/13) of the studies were low quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–14). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen (FMS) was the most common movement quality outcome investigated (11/13 studies). Two studies considered interrelationships between risk factors, five reported diagnostic accuracy and none evaluated an intervention program targeting individuals identified as high-risk. There is inconsistent evidence that poor movement quality is associated with increased risk of lower extremity injury in sport. Conclusions There is insufficient evidence for widespread adoption of movement quality screening programs for predicting lower-extremity injury in sport. Future research should aim to identify the most relevant movement quality outcomes for predicting injury risk through high quality cohort studies. This should be followed by development and evaluation of pre-participation screening and lower extremity injury prevention programs through high quality randomized controlled trials targeting individuals at the greatest risk based on screening tests with validated test properties.

Teaching Health Librarianship with a Very Large Team: breaking the borders of the one-instructor model

Teaching with a very large team differs from courses in which an instructor invites many guest speakers in that all team members are involved in the course from beginning to end, taking various roles including curriculum development, coordination, teaching, setting assignments, interacting with students, marking assignments and evaluating the course While there are articles about small team teaching in the literature (Cruz and Zaragoza, George and Davis-Wiley), there are no examples of courses in health sciences librarianship taught by very large teams. Background