Moving towards a standards-based methodological quality assessment scheme for clinical research

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Nurses' intentions to wear gloves during venipuncture procedures: A behavioral psychology perspective

Registered nurses working at a teaching hospital in Kuwait were surveyed to assess the psychosocial variables associated with their intention to comply with glove-wearing recommendations. Perceived consequences and normative beliefs, as well as sex and years of nursing experience, significantly influenced their behavioral intentions, suggesting that improvements in intention to comply are more likely to come from practical demonstrations that show nurses the potential outcomes of both using and not using gloves

Visualizing stability in studies: the moving average meta-analysis (MA2)

Relative clinical benefits are often visually explored and formally analysed through a (cumulative) meta-analysis. In this manuscript, we introduce and further explore the moving average meta-analysis to aid towards the exploration and visualization of stability in a meta-analysis.Comment: 10 pages, 2 figures, 1 tabl

Differential impact of mass and targeted praziquantel delivery on schistosomiasis control in school-aged children: A systematic review and meta-analysis.

Schistosomiasis is a widespread public health concern in the poorest regions of the world. The principal control strategy is regular praziquantel administration to school-aged children in endemic areas. With calls for the elimination of schistosomiasis as a public health problem, expanding praziquantel delivery to all community members has been advocated. This systematic review and meta-analysis compares the impact of community-wide and child-targeted praziquantel distribution on schistosomiasis prevalence and intensity in school-aged children. We searched MEDLINE, Embase and Web of Science to identify papers that reported schistosome prevalence before and after praziquantel administration, either to children only or to all community members. Extracted data included Schistosoma species, drug administration strategy, number of treatment rounds, follow-up interval and prevalence and intensity before and after treatment. We used inverse variance weighted generalised linear models to examine the impact of mass versus targeted drug administration on prevalence reduction, and weighted boxplots to examine the impact on infection intensity reduction. This study is registered with PROSPERO, number CRD42018095377. In total, 34 articles were eligible for systematic review and 28 for meta-analysis. Schistosoma mansoni was reported in 20 studies; Schistosoma haematobium in 19 studies, and Schistosoma japonicum in two studies. Results of generalised linear models showed no detectable difference between mass and targeted treatment strategies on prevalence reduction in school-aged children for S. mansoni (odds ratio 0.47, 95%CI 0.13-1.68, p = 0.227) and S. haematobium (0.41, 95%CI 0.06-3.03, p = 0.358). Box plots also showed no apparent differences in intensity reduction between the two treatment strategies. The results of this meta-analysis do not support the hypothesis that community-wide treatment is more effective than targeted treatment at reducing schistosomiasis infections in children. This may be due to the relatively small number of included studies, insufficient treatment coverage, persistent infection hotspots and unmeasured confounders. Further field-based studies comparing mass and targeted treatment are required

The effect of right ventricular apical and non-apical pacing on the short- and long-term changes in left ventricular ejection fraction: a systematic review and meta-analysis of randomized-controlled trials

BACKGROUND The right ventricular apex (RVA) is the traditional lead site for chronic pacing but in some patients may cause impaired left ventricular (LV) systolic function over time. Comparisons with non-apical (RVNA) pacing sites have generated inconsistent results and recent meta-analyses have demonstrated unclear benefit due to heterogeneity across studies. METHODS AND RESULTS A systematic search for randomized controlled trials that compared LVEF outcomes between RVNA and RVA pacing was performed up to October 2014. Twenty four studies (n = 1628 patients) met the inclusion criteria. To avoid between study heterogeneity two homogenous groups were created; group one where studies reported a difference (in favor of RVNA pacing) and group two where studies reported no difference between pacing sites. For group one weighted mean difference (WMD) between RVNA and RVA pacing in terms of LVEF at follow-up was 5.40% (95% CI: 3.94 to 6.87), related in part to group one's RVA arm demonstrating a significant reduction (mean loss -3.31%; 95% CI: -6.19 to -0.43) in LVEF between study baseline and end of follow-up. Neither of these finding were seen in group two. Weighted regression modeling demonstrated that inclusion of poor baseline LVEF (<40%) in combination with greater than 12 months follow-up was three times more common in group one compared to group two (weighted RR 2.82; 95% CI 1.03 - 7.72; P = 0.043). CONCLUSIONS In patients requiring chronic right ventricular pacing where there is inclusion of impaired baseline LVEF (<40%), RVA pacing is associated with deterioration in LV function relative to RVNA pacing. This article is protected by copyright. All rights reserved

Inter-rater reliability, intra-rater reliability and internal consistency of the Brisbane Evidence-Based Language Test

Purpose: To examine the inter-rater reliability, intra-rater reliability, internal consistency and practice effects associated with a new test, the Brisbane Evidence-Based Language Test. Methods: Reliability estimates were obtained in a repeated-measures design through analysis of clinician video ratings of stroke participants completing the Brisbane Evidence-Based Language Test. Inter-rater reliability was determined by comparing 15 independent clinicians’ scores of 15 randomly selected videos. Intra-rater reliability was determined by comparing two clinicians’ scores of 35 videos when re-scored after a two-week interval. Results: Intraclass correlation coefficient (ICC) analysis demonstrated almost perfect inter-rater reliability (0.995; 95% confidence interval: 0.990–0.998), intra-rater reliability (0.994; 95% confidence interval: 0.989–0.997) and internal consistency (Cronbach’s α = 0.940 (95% confidence interval: 0.920–1.0)). Almost perfect correlations (0.998; 95% confidence interval: 0.995–0.999) between face-to-face and video ratings were obtained. Conclusion: The Brisbane Evidence-Based Language Test demonstrates almost perfect inter-rater reliability, intra-rater reliability and internal consistency. High correlation coefficients and narrow confidence intervals demonstrated minimal practice effects with scoring or influence of years of clinical experience on test scores. Almost perfect correlations between face-to-face and video scoring methods indicate these reliability estimates have direct application to everyday practice. The test is available from brisbanetest.org. Implications for Rehabilitation The Brisbane Evidence-Based Language Test is a new measure for the assessment of acquired language disorders. The Brisbane Evidence-Based Language Test demonstrated almost perfect inter-rater reliability, intra-rater reliability and internal consistency. High reliability estimates and narrow confidence intervals indicated that test ratings vary minimally when administered by clinicians of different experience levels, or different levels of familiarity with the new measure. The test is a reliable measure of language performance for use in clinical practice and research

Effect of Immediate Administration of Antibiotics in Patients With Sepsis in Tertiary Care:A Systematic Review and Meta-analysis

Purpose The goal of this review was to synthesize existing evidence regarding outcomes (mortality) for patients who present to the emergency department, are administered antibiotics immediately (within 1 hour) or later (>1 hour), and are diagnosed with sepsis. Methods A search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL, using the MeSH descriptors “sepsis,” “systemic inflammatory response syndrome,” “mortality,” “emergency,” and “antibiotics,” was performed to identify studies reporting time to antibiotic administration and mortality outcome in patients with sepsis. The included studies (published in English between 1990 and 2016) listed patient mortality based on time to antibiotic administration. Studies were evaluated for methodologic quality, and data were extracted by using a data extraction form tailored to this study. From an initial pool of 582 potentially relevant studies, 11 studies met our inclusion criteria, 10 of which had quantitative data for meta-analysis. Three different models (a random effects model, a bias-adjusted quality-effects [synthetic bias] model, and an inverse variance heterogeneity model) were used to perform the meta-analysis. Findings The pooled results suggest a significant 33% reduction in mortality odds for immediate (within 1 hour) compared with later (>1 hour) antibiotic administration (OR, 0.67 [95% CI, 0.59–0.75]) in patients with sepsis. Implications Immediate antibiotic administration (<1 hour) seemed to reduce patient mortality. There was some minor negative asymmetry suggesting that the evidence may be biased toward the direction of effect. Nevertheless, this study provides strong evidence for early, comprehensive, sepsis management in the emergency department

Development and diagnostic validation of the Brisbane Evidence-Based Language Test

Purpose: To describe the development and determine the diagnostic accuracy of the Brisbane Evidence-Based Language Test in detecting aphasia. Methods: Consecutive acute stroke admissions (n = 100; mean = 66.49y) participated in a single (assessor) blinded cross-sectional study. Index assessment was the ∼45 min Brisbane Evidence-Based Language Test. The Brisbane Evidence-Based Language Test is further divided into four 15–25 min Short Tests: two Foundation Tests (severe impairment), Standard (moderate) and High Level Test (mild). Independent reference standard included the Language Screening Test, Aphasia Screening Test, Comprehensive Aphasia Test and/or Measure for Cognitive-Linguistic Abilities, treating team diagnosis and aphasia referral post-ward discharge. Results: Brisbane Evidence-Based Language Test cut-off score of ≤ 157 demonstrated 80.8% (LR+ =10.9) sensitivity and 92.6% (LR− =0.21) specificity. All Short Tests reported specificities of ≥ 92.6%. Foundation Tests I (cut-off ≤ 61) and II (cut-off ≤ 51) reported lower sensitivity (≥ 57.5%) given their focus on severe conditions. The Standard (cut-off ≤ 90) and High Level Test (cut-off ≤ 78) reported sensitivities of ≥ 72.6%. Conclusion: The Brisbane Evidence-Based Language Test is a sensitive assessment of aphasia. Diagnostically, the High Level Test recorded the highest psychometric capabilities of the Short Tests, equivalent to the full Brisbane Evidence-Based Language Test. The test is available for download from brisbanetest.org. Implications for rehabilitation: Aphasia is a debilitating condition and accurate identification of language disorders is important in healthcare. Language assessment is complex and the accuracy of assessment procedures is dependent upon a variety of factors. The Brisbane Evidence-Based Language Test is a new evidence-based language test specifically designed to adapt to varying patient need, clinical contexts and co-occurring conditions. In this cross-sectional validation study, the Brisbane Evidence-Based Language Test was found to be a sensitive measure for identifying aphasia in stroke

Questionable utility of the relative risk in clinical research: A call for change to practice

ObjectiveIn clinical trials, the relative risk or risk ratio (RR) is a mainstay of reporting of the effect magnitude for an intervention. The RR is the ratio of the probability of an outcome in an intervention group to its probability in a control group. Thus the RR provides a measure of change in the likelihood of an event linked to a given intervention. This measure has been widely used because it is today considered a measure with ‘portability’ across varying outcome prevalence, especially when the outcome is rare. It turns out however that there is a much more important problem with this ratio, and this paper aims to demonstrate this problem. MethodsWe used mathematical derivation to determine if the RR is a measure of effect magnitude alone (i.e. a larger absolute value always indicating a stronger effect) or not. We also used the same derivation to determine its relationship to prevalence of an outcome. We confirm the derivation results with a follow-up analysis of 140,620 trials scraped from the Cochrane. ResultsWe demonstrate that the RR varies for reasons other than magnitude of the effect because it is a ratio of two posterior probabilities, both of which are dependent on baseline prevalence of an outcome. Additionally we demonstrate that the RR shifts towards its null value with increasing outcome prevalence. The shift towards the null happens regardless of the strength of the association between intervention and outcome. The odds ratio (OR), the other commonly used ratio, measures solely the effect magnitude and has no relationship to prevalence of an outcome in a study nor does it overestimate the RR as is commonly thought. ConclusionsThe results demonstrate the need to a) end the primary use of the RR in clinical trials and meta-analyses as its direct interpretation is not meaningful; b) replace the RR by the OR; and c) only use the post-intervention risk recalculated from the OR for any expected level of baseline risk in absolute terms for purposes of interpretation such as the number needed to treat. These results will have far reaching implications such as reducing misleading results from clinical trials and meta-analyses and ushering in a new era in the reporting of such trials or meta-analyses in practice