Are systematic reviews up-to-date at the time of publication?

BACKGROUND: Systematic reviews provide a synthesis of evidence for practitioners, for clinical practice guideline developers, and for those designing and justifying primary research. Having an up-to-date and comprehensive review is therefore important. Our main objective was to determine the recency of systematic reviews at the time of their publication, as measured by the time from last search date to publication. We also wanted to study the time from search date to acceptance, and from acceptance to publication, and measure the proportion of systematic reviews with recorded information on search dates and information sources in the abstract and full text of the review. METHODS: A descriptive analysis of published systematic reviews indexed in Medline in 2009, 2010 and 2011 by three reviewers, independently extracting data. RESULTS: Of the 300 systematic reviews included, 271 (90%) provided the date of search in the full-text article, but only 141 (47%) stated this in the abstract. The median (standard error; minimum to maximum) survival time from last search to acceptance was 5.1 (0.58; 0 to 43.8) months (95% confidence interval = 3.9 to 6.2) and from last search to first publication time was 8.0 (0.35; 0 to 46.7) months (95% confidence interval = 7.3 to 8.7), respectively. Of the 300 reviews, 295 (98%) stated which databases had been searched, but only 181 (60%) stated the databases in the abstract. Most researchers searched three (35%) or four (21%) databases. The top-three most used databases were MEDLINE (79%), Cochrane library (76%), and EMBASE (64%). CONCLUSIONS: Being able to identify comprehensive, up-to-date reviews is important to clinicians, guideline groups, and those designing clinical trials. This study demonstrates that some reviews have a considerable delay between search and publication, but only 47% of systematic review abstracts stated the last search date and 60% stated the databases that had been searched. Improvements in the quality of abstracts of systematic reviews and ways to shorten the review and revision processes to make review publication more rapid are needed

Comparative study of an externship program versus a corporate-academic cooperation program for enhancing nursing competence of graduating students

BACKGROUND: New graduates report intense stress during the transition from school to their first work settings. Managing this transition is important to reduce turnover rates. This study compared the effects of an externship program and a corporate-academic cooperation program on enhancing junior college students’ nursing competence and retention rates in the first 3 months and 1 year of initial employment. METHODS: This two-phase study adopted a pretest and posttest quasi-experimental design. All participants were graduating students drawn from a 5-year junior nursing college in Taiwan. There were 19 and 24 students who participated in the phase I externship program and phase II corporate-academic cooperation program, respectively. The nursing competence of the students had to be evaluated by mentors within 48 hours of practicum training and after practicum training. The retention rate was also surveyed at 3 months and 1 year after beginning employment. RESULTS: Students who participated in the corporate-academic cooperation program achieved a statistically significant improvement in nursing competence and retention rates relative to those who participated in the externship program (p < 0.01 and p < 0.05, respectively). CONCLUSIONS: The corporate-academic cooperation program facilitates the transition of junior college nursing students into independent staff nurses, enhances their nursing competence, and boosts retention rates

Diagnostic Accuracy of Delirium Assessment Tools in Critical Ill Patients: A Systematic Review and Meta-analysis

Abstract presented at The Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, 13-15 May 2019, Adelaide, Australi

INDICATION for critical care nurses: Protocol for a quasi-experimental study testing the effects of a multi-modal education intervention for delirium care

Background: Delirium is associated with serious adverse health outcomes, particularly increased intensive care unit (ICU) stay and mortality rate. Critical care nurses lack sufficient knowledge about delirium and it remains undetected and poorly managed. Aim: In this protocol, the development, implementation and evaluation of the INDICATION (INnovative DelIrium CAre educaTION) program on delirium care knowledge, confidence, competence and clinical practice among critical care nurses in Taiwan is reported. Methods: A quasi-experimental trial will be performed to examine the effects of the INDICATION program. This study will be conducted at a teaching hospital in Taiwan. Two ICUs will provide the sites to recruit critical care nurses to participate. The INDICATION program for the intervention group will be delivered as a multi-modal delirium care education intervention consisting of: (1) one face-to-face education session; (2) five online delirium care learning modules; and (3) simulation education using scenario-based objective structured clinical examination. Participants in the comparison group will only receive: (1) One face-to-face education session; and 2) five online delirium care learning modules. Outcomes including knowledge, confidence and competence of delirium care will be collected at baseline (T0), immediately after the intervention (T1), and 6 weeks postintervention (T2) to evaluate changes over time. Findings: Study protocol. Discussion: It is anticipated that the INDICATION program will improve the detection and management of delirium by critical care nurses. Conclusion: The INDICATION program highlights the importance of achieving outcomes to improve the knowledge, confidence, competence, and clinical performance of delirium care among critical care nurses

Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta‐Analysis

Background Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment. Aim To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients. Methods We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta‐analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta‐analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks’ funnel plot. Data Synthesis We identified and evaluated 23 and 8 articles focused on CAM‐ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM‐ICU and ICDSC, respectively. The AUC of the CAM‐ICU was 0.96 (95% CI, 0.94–0.98), with DOR at 99 (95% CI, 55–177). The AUC of the ICDSC was 0.95 (95% CI, 0.92–0.96), and the DOR was 65 (95% CI, 27–153). Linking Evidence to Action CAM‐ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between‐study heterogeneity of this diagnostic test accuracy meta‐analysis

Increasing retractions of meta-analyses publications for methodological flaw

Abstract Purpose of this letter was to explore the trends regarding methodological flaws of systematic review and meta-analyses (SRMAs) based on retraction notes in the past decades, and the categories of reasons for the retractions. Content analysis with descriptive statistics, Cochran Q test, and multinomial logistic regression were used. Based on 187 records of retracted SRMAs, retraction announcements can be categorized into academic ethical violation, methodological flaw, and writing or reporting problem. The numbers of academic ethical violation were significantly higher than those with methodological flaw (z = 3.51; p < 0.01) or writing problem (z = 8.58; p < 0.001). The numbers of methodological flaw were also higher than that with writing problem (z = 6.47; p < 0.001). Moreover, an increased proportion of methodological flaw was observed since 2006, and the retraction year was significantly associated with increased proportion of methodological flaw when academic ethical violation as the reference group