A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

BackgroundComplex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base.MethodsWe searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013.ResultsOverall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.ConclusionsOur results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5

Searching for Controlled Trials of Complementary and Alternative Medicine: A Comparison of 15 Databases

This project aims to assess the utility of bibliographic databases beyond the three major ones (MEDLINE, EMBASE and Cochrane CENTRAL) for finding controlled trials of complementary and alternative medicine (CAM). Fifteen databases were searched to identify controlled clinical trials (CCTs) of CAM not also indexed in MEDLINE. Searches were conducted in May 2006 using the revised Cochrane highly sensitive search strategy (HSSS) and the PubMed CAM Subset. Yield of CAM trials per 100 records was determined, and databases were compared over a standardized period (2005). The Acudoc2 RCT, Acubriefs, Index to Chiropractic Literature (ICL) and Hom-Inform databases had the highest concentrations of non-MEDLINE records, with more than 100 non-MEDLINE records per 500. Other productive databases had ratios between 500 and 1500 records to 100 non-MEDLINE records—these were AMED, MANTIS, PsycINFO, CINAHL, Global Health and Alt HealthWatch. Five databases were found to be unproductive: AGRICOLA, CAIRSS, Datadiwan, Herb Research Foundation and IBIDS. Acudoc2 RCT yielded 100 CAM trials in the most recent 100 records screened. Acubriefs, AMED, Hom-Inform, MANTIS, PsycINFO and CINAHL had more than 25 CAM trials per 100 records screened. Global Health, ICL and Alt HealthWatch were below 25 in yield. There were 255 non-MEDLINE trials from eight databases in 2005, with only 10% indexed in more than one database. Yield varied greatly between databases; the most productive databases from both sampling methods were Acubriefs, Acudoc2 RCT, AMED and CINAHL. Low overlap between databases indicates comprehensive CAM literature searches will require multiple databases

Suicide rates and suicidal behaviour in displaced people: A systematic review

Background Refugees, and other forcibly displaced people, face mental distress and may be disproportionately affected by risk factors for suicide. Little is known about suicidal behaviour in these highly mobile populations because collecting timely, relevant, and reliable data is challenging. Methods and findings A systematic review was performed to identify studies of any design reporting on suicide, suicide attempts, or suicidal ideation among populations of displaced people. A sensitive electronic database search was performed in August 2020, and all retrieved studies were screened for relevance by two authors. Studies were categorised by the population being evaluated: refugees granted asylum, refugees living in temporary camps, asylum seekers, or internally displaced people. We distinguished between whether the sampling procedure in the studies was likely to be representative, or the sample examined a specific non-representative subgroup of displaced people (such as those already diagnosed with mental illness). Data on the rates of suicide or the prevalence of suicide attempts or suicidal ideation were extracted by one reviewer and verified by a second reviewer from each study and converted to common metrics. After screening 4347 articles, 87 reports of 77 unique studies were included. Of these, 53 were studies in representative samples, and 24 were based on samples of specific target populations. Most studies were conducted in high-income countries, and the most studied population subgroup was refugees granted asylum. There was substantial heterogeneity across data sources and measurement instruments utilised. Sample sizes of displaced people ranged from 33 to 196,941 in studies using general samples. Suicide rates varied considerably, from 4 to 290 per 100,000 person-years across studies. Only 8 studies were identified that compared suicide rates with the host population. The prevalence of suicide attempts ranged from 0.14% to 15.1% across all studies and varied according to the prevalence period evaluated. Suicidal ideation prevalence varied from 0.17% to 70.6% across studies. Among refugees granted asylum, there was evidence of a lower risk of suicide compared with the host population in 4 of 5 studies. In contrast, in asylum seekers there was evidence of a higher suicide risk in 2 of 3 studies, and of a higher risk of suicidal ideation among refugees living in camps in 2 of 3 studies compared to host populations. Conclusion While multiple studies overall have been published in the literature on this topic, the evidence base is still sparse for refugees in camps, asylum seekers, and internally displaced people. Less than half of the included studies reported on suicide or suicide attempt outcomes, with most reporting on suicidal ideation. International research networks could usefully define criteria, definitions, and study designs to help standardise and facilitate more research in this important area

A third of systematic reviews changed or did not specify the primary outcome : A PROSPERO register study

OBJECTIVES: To examine outcome reporting bias of systematic reviews registered in PROSPERO. STUDY DESIGN AND SETTING: Retrospective cohort study. The primary outcomes from systematic review publications were compared with those reported in the corresponding PROSPERO records; discrepancies in the primary outcomes were assessed as upgrades, additions, omissions or downgrades. Relative risks (RR) and 95% confidence intervals (CI) were calculated to determine the likelihood of having a change in primary outcome when the meta-analysis result was favourable and statistically significant. RESULTS: 96 systematic reviews were published. A discrepancy in the primary outcome occurred in 32% of the included reviews and 39% of the reviews did not explicitly specify a primary outcome(s); 6% of the primary outcomes were omitted. There was no significant increased risk of adding/upgrading (RR 2.14, 95% CI 0.53 to 8.63) or decreased risk of downgrading (RR 0.76, 0.27-2.17) an outcome when the meta-analysis result was favourable and statistically significant. As well, there was no significant increased risk of adding/upgrading (RR 0.89, 0.31-2.53) or decreased risk of downgrading (RR 0.56, 0.29-1.08) an outcome when the conclusion was positive. CONCLUSIONS: We recommend review authors carefully consider primary outcome selection and journals are encouraged to focus acceptance on registered systematic reviews

Libraries Demonstrate Low Adherence to Virtual Reference Service Guidelines. A Review of: Shachaf, Pnina, and Sarah M. Horowitz. “Virtual Reference Service Evaluation: Adherence to RUSA Behavioral Guidelines and IFLA Digital Reference Guidelines.” Library & Information Science Research 30.2 (2008): 122-37.

<b>Objectives</b> – This study evaluates the level to which virtual (asynchronous e-mail) reference services adhere to professional guidelines. Specifically, it addresses the following research questions:<br>1) To what extent do virtual reference services adhere to the American Library Association (ALA) Reference and User Services Association (RUSA) and the International Federation of Library Associations (IFLA) guidelines?<br>2) How does the level of adherence to RUSA or IFLA guidelines vary based on request type, user name, and institution?<br>3) Is there a correlation between outcome measures of reference transactions (accuracy, completeness, and satisfaction) and the level of adherence to RUSA or IFLA guidelines?<br><b>Design</b> – Unobtrusive evaluation of researcher-generated queries.<br><b>Setting</b> – Fifty-four academic libraries in North America.<br><b>Subjects</b> – A total of 324 queries were sent to the 54 libraries, with each library receiving six different types of requests from six different user names.<br><b>Methods</b> – Researchers developed two coding schemes for the guidelines (34 codes and 12 attributes for the RUSA guidelines and 33 codes and 10 attributes for the IFLA guidelines). Each of the six user names used represented an ethnic and/or religious group identity: Mary Anderson (Caucasian, Christian), Moshe Cohen (Caucasian, Jewish), Ahmed Ibrahim (Arab), Latoya Johnson (African American), Rosa Manuz (Hispanic), and Chang Su (Asian). The six request types were designed so that three would be answered (questions 1-3) and three would be out of scope and not answered (questions 4-6). The following queries were sent, individualized for each institution: 1) Dissertation query; 2) Sports team query; 3) Population query; 4) Subject query; 5) Article query; 6) Request for a PDF copy. The 324 queries were uploaded into NVivo 2 software, and all e-mail transactions were coded and analyzed.<br><b>Main Results</b> – Analysis of the 324 transactions from 54 libraries showed the following results:1) Low levels of adherence to both sets of guidelines;2) Varied levels of adherence based on request types and user names on both sets of guidelines;3) Variation in institutional rank according to different sets of guidelines;4) No correlation between user satisfaction and adherence to either set of guidelines.<br><b>Conclusion</b> – This study suggests that higher levels of virtual reference service effectiveness could be achieved by automatically integrating some less observed behaviours (e.g., thank you notes) into replies sent to users and by increasing librarians’ awareness of professional guidelines through training and detailed institutional policies. The authors also suggest that librarians should be aware of their tendencies to react differently to different user groups, and that administrators can facilitate this by providing diversity workshops

Probiotics Evaluation in Oncological Surgery: A Systematic Review of 36 Randomized Controlled Trials Assessing 21 Diverse Formulations

Background: Objectives were to evaluate probiotics safety and efficacy in oncological surgery. Methods: Systematic review methodology guided by Cochrane, PRISMA, SWiM, and CIOMS. Protocol registered on PROSPERO (CRD42018086168). Results: 36 RCTs (on 3305 participants) and 6 nonrandomized/observational studies were included, mainly on digestive system cancers. There was evidence of a beneficial effect on preventing infections, with 70% of RCTs&rsquo; (21/30) direction of effect favoring probiotics. However, five RCTs (17%) favored controls for infections, including one trial with RR 1.57 (95% CI: 0.79, 3.12). One RCT that changed (balanced) its antibiotics protocol after enrolling some participants had mortality risk RR 3.55 (95% CI: 0.77, 16.47; 7/64 vs. 2/65 deaths). The RCT identified with the most promising results overall administered an oral formulation of Lactobacillus acidophilus LA-5 + Lactobacillus plantarum + Bifidobacterium lactis BB-12 + Saccharomyces boulardii. Methodological quality appraisals revealed an overall substantial risk-of-bias, with only five RCTs judged as low risk-of-bias. Conclusions: This large evidence synthesis found encouraging results from most formulations, though this was contrasted by potential harms from a few others, thus validating the literature that &ldquo;probiotics&rdquo; are not homogeneous microorganisms. Given microbiome developments and infections morbidity, further high-quality research is warranted using those promising probiotics identified herein