A systematic review of outcome and outcome-measure reporting in randomised trials evaluating surgical interventions for anterior-compartment vaginal prolapse: a call to action to develop a core outcome set

INTRODUCTION: We assessed outcome and outcome-measure reporting in randomised controlled trials evaluating surgical interventions for anterior-compartment vaginal prolapse and explored the relationships between outcome reporting quality with journal impact factor, year of publication, and methodological quality. METHODS: We searched the bibliographical databases from inception to October 2017. Two researchers independently selected studies and assessed study characteristics, methodological quality (Jadad criteria; range 1-5), and outcome reporting quality Management of Otitis Media with Effusion in Cleft Palate (MOMENT) criteria; range 1-6], and extracted relevant data. We used a multivariate linear regression to assess associations between outcome reporting quality and other variables. RESULTS: Eighty publications reporting data from 10,924 participants were included. Seventeen different surgical interventions were evaluated. One hundred different outcomes and 112 outcome measures were reported. Outcomes were inconsistently reported across trials; for example, 43 trials reported anatomical treatment success rates (12 outcome measures), 25 trials reported quality of life (15 outcome measures) and eight trials reported postoperative pain (seven outcome measures). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β = 0.412; P = 0.018). No relationship was demonstrated between outcome reporting quality with impact factor (β = 0.078; P = 0.306), year of publication (β = 0.149; P = 0.295), study size (β = 0.008; P = 0.961) and commercial funding (β = -0.013; P = 0.918). CONCLUSIONS: Anterior-compartment vaginal prolapse trials report many different outcomes and outcome measures and often neglect to report important safety outcomes. Developing, disseminating and implementing a core outcome set will help address these issues

The effects of “pulling levers” focused deterrence strategies on crime

A number of American police departments have been experimenting with new problem-oriented policing frameworks to prevent gang and group-involved violence generally known as the “pulling levers” focused deterrence strategies. Focused deterrence strategies honor core deterrence ideas, such as increasing risks faced by offenders, while finding new and creative ways of deploying traditional and non-traditional law enforcement tools to do so, such as directly communicating incentives and disincentives to targeted offenders. Pioneered in Boston to halt serious gang violence, the focused deterrence framework has been applied in many American cities through federally sponsored violence prevention programs. In its simplest form, the approach consists of selecting a particular crime problem, such as gang homicide; convening an interagency working group of law enforcement, social-service, and community-based practitioners; conducting research to identify key offenders, groups, and behavior patterns; framing a response to offenders and groups of offenders that uses a varied menu of sanctions (“pulling levers”) to stop them from continuing their violent behavior; focusing social services and community resources on targeted offenders and groups to match law enforcement prevention efforts; and directly and repeatedly communicating with offenders to make them understand why they are receiving this special attention. These new strategic approaches have been applied to a range of crime problems, such as overt drug markets and individual repeat offenders, and have shown promising results in the reduction of crime. Objectives: To synthesize the extant evaluation literature and assess the effects of pulling levers focused deterrence strategies on crime. Conclusions: We conclude that pulling levers focused deterrence strategies seem to be effective in reducing crime. However, we urge caution in interpreting these results because of the lack of more rigorous randomized controlled trials in the existing body of scientific evidence on this approach