Contraception advice and provision for the prevention of under 18 conceptions and STIs : A rapid review

Report conducted by the Centre for Research in Primary and Community Care (CRIPACC

Systematic review of prognostic models in traumatic brain injury

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability world-wide. The ability to accurately predict patient outcome after TBI has an important role in clinical practice and research. Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcome. They may improve predictions in TBI patients. Multiple prognostic models for TBI have accumulated for decades but none of them is widely used in clinical practice. The objective of this systematic review is to critically assess existing prognostic models for TBI METHODS: Studies that combine at least two variables to predict any outcome in patients with TBI were searched in PUBMED and EMBASE. Two reviewers independently examined titles, abstracts and assessed whether each met the pre-defined inclusion criteria. RESULTS: A total of 53 reports including 102 models were identified. Almost half (47%) were derived from adult patients. Three quarters of the models included less than 500 patients. Most of the models (93%) were from high income countries populations. Logistic regression was the most common analytical strategy to derived models (47%). In relation to the quality of the derivation models (n:66), only 15% reported less than 10% pf loss to follow-up, 68% did not justify the rationale to include the predictors, 11% conducted an external validation and only 19% of the logistic models presented the results in a clinically user-friendly way CONCLUSION: Prognostic models are frequently published but they are developed from small samples of patients, their methodological quality is poor and they are rarely validated on external populations. Furthermore, they are not clinically practical as they are not presented to physicians in a user-friendly way. Finally because only a few are developed using populations from low and middle income countries, where most of trauma occurs, the generalizability to these setting is limited

Update on review of reviews on teenage pregnancy and parenthood : Submitted as an Addendum to the first evidence briefing 2003

This is a peer-reviewed report and can be accessed from the URL linkThis report presents the findings from reviews identified since December 2001 to update the first evidence briefing relating to teenage pregnancy and parenthood published in 2003 (Swann et al 2003). Following on from the comprehensive work carried out by the Social Exclusion Unit (SEU 1999) the evidence briefing provided an overview of the effectiveness of interventions aimed at reducing unintended teenage pregnancy and supporting teenage parents, drawn from review-level evidence. It identified the need for more good quality studies and reviews, especially within the UK to provide clear messages for policy and practice

Preventing teenage pregnancy : Evidence from systematic reviews

This was the first meeting of the RCOG Group, follow up meeting and impact are shown on URLWe have recently undertaken an update of the review of reviews (Evidence briefing 2003) on behalf of NICE and in this chapter we briefly summarise the findings of the first review, report in more detail on the results of our recent update and look at the implications of both. Aims and objectives: The purpose of our study was to: • Conduct an update of the first edition of the review of reviews on teenage pregnancy and parenthood • Identify and evaluate all relevant systematic reviews, syntheses, meta-analyses and review-level papers published since the searches for the first edition (December 2001) • Highlight new findings on ‘what works’ to prevent teenage pregnancies • Identify gaps in the evidence • Highlight emerging issues pertinent to the scope of the work and identify areas that would merit further development and research Scope of the review: We conducted a systematic review of reviews which included: • Evaluations of interventions to prevent teenage/adolescent pregnancy, increase contraceptive use and/or delay the onset of sexual intercourse, and/or to delay or reduce repeat pregnancies. • Evaluations of interventions to improve outcomes for teenage parents and their children •Reported outcome measures relevant to teenage pregnancy prevention including pregnancy rates, contraceptive use, sexual behaviour and knowledge/attitudes We excluded single studies and reviews focusing on interventions specifically for the prevention of Human immunodeficiency virus (HIV) and/or sexually transmitted infections (STIs) and those reporting findings from developing countries were excluded. Narrative synthesis of reviews included We describe the quality assessment and rating of the reviews and critically appraise the evidence. We report findings from the first evidence briefing and our update. Our findings include a variety of settings which included schools, clinics, primary care, the community and homes. We discuss the reviews included in this update and the first briefing which considered a variety of interventions. These included: Education/information interventions primarily to increase knowledge Skills/self-esteem approaches to equip participants with the necessary social skills in terms of relationships and decision-making Peer education approaches, which can be educational, motivational, support or skills-based, and use ‘peers’ as facilitators Abstinence programmes that either wholly or partly promote an abstinence message. Programmes involving parental participation Other approaches such as access, multi-agency support, clinical/social service, employment/training We summarise findings from these reviews on what works to prevent teenage pregnancy, where the gaps are and implications for practice and research. Whilst our review does address school based sex education programmes, we provide an overview on effective approaches and service and programme characteristics in a variety of settings based on the evidence.Peer reviewe

Update on review of reviews of teenage pregnancy and parenthood

This review was commisioned by the National Institute for Health and Clinical Excellence (NICE) and conducted by the Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire. It is an update of the original review conducted by the former Health Education Authority in 1999

Evidence from the systematic reviews

Non peer reviewe