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Sugrue RP, Olsen J, Abi Antoun ME, Skalla LA, Cate J, James AH, Stonehill A, Watkins V, Telen MJ, Federspiel JJ. Standard Compared With Extended Red Blood Cell Antigen Matching for Prevention of Subsequent Hemolytic Disease of the Fetus and Newborn: A Systematic Review. Obstet Gynecol 2024:00006250-990000000-01126. [PMID: 39116441 DOI: 10.1097/aog.0000000000005701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To systematically review and meta-analyze alloimmunization among recipients of red blood cells (RBCs) matched for ABO blood type and Rhesus D (ABO+D) antigen compared with those also matched for c, E, and Kell (cEK). DATA SOURCES Four online databases (Medline, Scopus, EMBASE, ClinicalTrials.gov) were searched from March 28, 2023, to April 1, 2024. The search protocol was peer reviewed and published on PROSPERO (CRD42023411620). METHODS OF STUDY SELECTION Studies reporting alloimmunization as the primary outcome among recipients of RBCs matched for ABO+D or additional cEK matching were included. Patients transfused with unmatched RBCs or a mixture of matching regimens were excluded. Risk of bias was assessed with Cochrane Tool to Assess Risk of Bias in Cohort Studies and Tool for Risk of Bias. Random-effects meta-analysis was used to combine effect estimates. TABULATION, INTEGRATION, AND RESULTS Ten studies met criteria. Risk of bias was low. Overall, 91,221 patients were transfused, of whom 40,220 (44.1%) received additional cEK-matched RBCs. The overall rate of alloimmunization was 6.2% (95% CI, 2.5-14.9%) for ABO+D-only matching and 1.9% (95% CI, 0.7-5.1%) when cEK was added. Time of follow-up antibody testing ranged from 6 to 18 months after transfusion. Additional cEK match was associated with significantly less alloimmunization compared with standard ABO+D match (odds ratio [OR] 0.37, 95% CI, 0.20-0.69). This association remained when chronically transfused patients were excluded (OR 0.65, 95% CI, 0.54-0.79) and for alloimmunization to c, E, or K antigens only (OR 0.29, 95% CI, 0.18-0.47). CONCLUSION Additional cEK RBC matching protocols were associated with lower odds of recipient alloimmunization. Given severe sequelae of alloimmunization in pregnancy, routine cEK matching for transfusion in people with pregnancy potential younger than age 50 years in the United States merits consideration. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023411620.
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Affiliation(s)
- Ronan P Sugrue
- Department of Obstetrics and Gynecology, the Duke University Medical Center Library, the Department of Medicine, the Department of Pathology, and the Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; and the Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
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Tremblay F, Courtemanche Y, Bélanger RE, Turcotte-Tremblay AM. A systematic review of the association between history of sexually transmitted infections and subsequent condom use in adolescents. BMC Public Health 2024; 24:1000. [PMID: 38600483 PMCID: PMC11007949 DOI: 10.1186/s12889-024-18322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.Registration The protocol is registered in PROSPERO (CRD42023397443).
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Affiliation(s)
- Frédérique Tremblay
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada.
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada.
| | - Yohann Courtemanche
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Richard E Bélanger
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Department of Pediatrics, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Anne-Marie Turcotte-Tremblay
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Faculy of Nursing, Université Laval, 1050, avenue de la Médecine, Room 3645, Québec, (QC), G1V 0A6, Canada
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Carlson R, Nachman S, Zerden LDS, Mani N. Validation of an interprofessional education search strategy in PubMed to optimize IPE literature searching. J Med Libr Assoc 2024; 112:33-41. [PMID: 38911530 PMCID: PMC11189142 DOI: 10.5195/jmla.2024.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Objective With exponential growth in the publication of interprofessional education (IPE) research studies, it has become more difficult to find relevant literature and stay abreast of the latest research. To address this gap, we developed, evaluated, and validated search strategies for IPE studies in PubMed, to improve future access to and synthesis of IPE research. These search strategies, or search hedges, provide comprehensive, validated sets of search terms for IPE publications. Methods The search strategies were created for PubMed using relative recall methodology. The research methods followed the guidance of previous search hedge and search filter validation studies in creating a gold standard set of relevant references using systematic reviews, having expert searchers identify and test search terms, and using relative recall calculations to validate the searches' performance against the gold standard set. Results The three recommended search hedges for IPE studies presented had recall of 71.5%, 82.7%, and 95.1%; the first more focused for efficient literature searching, the last with high recall for comprehensive literature searching, and the remaining hedge as a middle ground between the other two options. Conclusion These validated search hedges can be used in PubMed to expedite finding relevant scholarships, staying up to date with IPE research, and conducting literature reviews and evidence syntheses.
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Affiliation(s)
- Rebecca Carlson
- , Health Sciences Librarian and Liaison to the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC
| | - Sophie Nachman
- , Graduate Assistant, Health Sciences Library; Master of Public Health student, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
| | - Lisa de Saxe Zerden
- , Associate Professor, School of Social Work, University of North Carolina at Chapel Hill, NC
| | - Nandita Mani
- , Dean of University Libraries, University of Massachusetts Amherst, Amherst, MA
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Escobar Liquitay CM, Garegnani L, Garrote V, Solà I, Franco JV. Search strategies (filters) to identify systematic reviews in MEDLINE and Embase. Cochrane Database Syst Rev 2023; 9:MR000054. [PMID: 37681507 PMCID: PMC10485899 DOI: 10.1002/14651858.mr000054.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bibliographic databases provide access to an international body of scientific literature in health and medical sciences. Systematic reviews are an important source of evidence for clinicians, researchers, consumers, and policymakers as they address a specific health-related question and use explicit methods to identify, appraise and synthesize evidence from which conclusions can be drawn and decisions made. Methodological search filters help database end-users search the literature effectively with different levels of sensitivity and specificity. These filters have been developed for various study designs and have been found to be particularly useful for intervention studies. Other filters have been developed for finding systematic reviews. Considering the variety and number of available search filters for systematic reviews, there is a need for a review of them in order to provide evidence about their retrieval properties at the time they were developed. OBJECTIVES To review systematically empirical studies that report the development, evaluation, or comparison of search filters to retrieve reports of systematic reviews in MEDLINE and Embase. SEARCH METHODS We searched the following databases from inception to January 2023: MEDLINE, Embase, PsycINFO; Library, Information Science & Technology Abstracts (LISTA) and Science Citation Index (Web of Science). SELECTION CRITERIA We included studies if one of their primary objectives is the development, evaluation, or comparison of a search filter that could be used to retrieve systematic reviews on MEDLINE, Embase, or both. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-specified and piloted data extraction form using InterTASC Information Specialist Subgroup (ISSG) Search Filter Evaluation Checklist. MAIN RESULTS We identified eight studies that developed filters for MEDLINE and three studies that developed filters for Embase. Most studies are very old and some were limited to systematic reviews in specific clinical areas. Six included studies reported the sensitivity of their developed filter. Seven studies reported precision and six studies reported specificity. Only one study reported the number needed to read and positive predictive value. None of the filters were designed to differentiate systematic reviews on the basis of their methodological quality. For MEDLINE, all filters showed similar sensitivity and precision, and one filter showed higher levels of specificity. For Embase, filters showed variable sensitivity and precision, with limited study reports that may affect accuracy assessments. The report of these studies had some limitations, and the assessments of their accuracy may suffer from indirectness, considering that they were mostly developed before the release of the PRISMA 2009 statement or due to their limited scope in the selection of systematic review topics. Search filters for MEDLINE Three studies produced filters with sensitivity > 90% with variable degrees of precision, and only one of them was developed and validated in a gold-standard database, which allowed the calculation of specificity. The other two search filters had lower levels of sensitivity. One of these produced a filter with higher levels of specificity (> 90%). All filters showed similar sensitivity and precision in the external validation, except for one which was not externally validated and another one which was conceptually derived and only externally validated. Search filters for Embase We identified three studies that developed filters for this database. One of these studies developed filters with variable sensitivity and precision, including highly sensitive strategies (> 90%); however, it was not externally validated. The other study produced a filter with a lower sensitivity (72.7%) but high specificity (99.1%) with a similar performance in the external validation. AUTHORS' CONCLUSIONS Studies reporting the development, evaluation, or comparison of search filters to retrieve reports of systematic reviews in MEDLINE showed similar sensitivity and precision, with one filter showing higher levels of specificity. For Embase, filters showed variable sensitivity and precision, with limited information about how the filter was produced, which leaves us uncertain about their performance assessments. Newer filters had limitations in their methods or scope, including very focused subject topics for their gold standards, limiting their applicability across other topics. Our findings highlight that consensus guidance on the conduct of search filters and standardized reporting of search filters are needed, as we found highly heterogeneous development methods, accuracy assessments and outcome selection. New strategies adaptable across interfaces could enhance their usability. Moreover, the performance of existing filters needs to be evaluated in light of the impact of reporting guidelines, including the PRISMA 2009, on how systematic reviews are reported. Finally, future filter developments should also consider comparing the filters against a common reference set to establish comparative performance and assess the quality of systematic reviews retrieved by strategies.
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Affiliation(s)
| | - Luis Garegnani
- Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Virginia Garrote
- Central Library, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Heron L, Buitrago-Garcia D, Ipekci AM, Baumann R, Imeri H, Salanti G, Counotte MJ, Low N. How to update a living systematic review and keep it alive during a pandemic: a practical guide. Syst Rev 2023; 12:156. [PMID: 37660117 PMCID: PMC10474670 DOI: 10.1186/s13643-023-02325-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 08/17/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The covid-19 pandemic has highlighted the role of living systematic reviews. The speed of evidence generated during the covid-19 pandemic accentuated the challenges of managing high volumes of research literature. METHODS In this article, we summarise the characteristics of ongoing living systematic reviews on covid-19, and we follow a life cycle approach to describe key steps in a living systematic review. RESULTS We identified 97 living systematic reviews on covid-19, published up to 7th November 2022, which focused mostly on the effects of pharmacological interventions (n = 46, 47%) or the prevalence of associated conditions or risk factors (n = 30, 31%). The scopes of several reviews overlapped considerably. Most living systematic reviews included both observational and randomised study designs (n = 45, 46%). Only one-third of the reviews has been updated at least once (n = 34, 35%). We address practical aspects of living systematic reviews including how to judge whether to start a living systematic review, methods for study identification and selection, data extraction and evaluation, and give recommendations at each step, drawing from our own experience. We also discuss when it is time to stop and how to publish updates. CONCLUSIONS Methods to improve the efficiency of searching, study selection, and data extraction using machine learning technologies are being developed, their performance and applicability, particularly for reviews based on observational study designs should improve, and ways of publishing living systematic reviews and their updates will continue to evolve. Finally, knowing when to end a living systematic review is as important as knowing when to start.
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Affiliation(s)
- Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rico Baumann
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zürich, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michel Jacques Counotte
- Wageningen Bioveterinary Research, Wageningen University & Research, Lelystad, The Netherlands
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Zhu L, Yang Z, Deng H, Zhang Y, Liao X, Clarke M. Citation of updated and co-published Cochrane Methodology Reviews. Syst Rev 2023; 12:120. [PMID: 37443094 PMCID: PMC10347811 DOI: 10.1186/s13643-023-02270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND To evaluate the number of citations for Cochrane Methodology Reviews after they have been updated or co-published in another journal, and the effect of co-publishing the review on the co-publishing journal's impact factor (IF). METHODS We identified all Cochrane Methodology Reviews published in the Cochrane Database of Systematic Reviews (CDSR) before 2018 and searched for co-published versions in the Web of Science Core Collection database up to 16 August 2022. The included reviews were in two cohorts: those that had been published and updated in CDSR and those that had been published in CDSR and co-published in another journal. The primary outcome measured the citation number to updated and original reviews in the first five years after publication of the updated review, and assessed the citation number of co-published and non-co-published reviews in the first five years after publication of the co-published version. The secondary outcome was the ratio of an adjusted IF and the actual IF of the co-publishing journal. RESULTS Eight updated and six original reviews were identified for the updated cohort of reviews, and four co-published reviews were included in the co-published cohort. The original reviews continued to be cited after the update was published but the median for the total number of citations was non-significantly higher for the updated reviews than for their original version[161 (Interquartile range (IQR) 85, 198) versus 113 (IQR 15, 433)]. The median number of total citations [362 (IQR 179, 840) versus 145 (IQR 75, 445)] and the median number of citations to the review in the first five years after co-publication combined and in each of those years was higher in the co-published group than in the non-co-published group. One of the three journals that co-published Reviews in the first year and two journals in the second year had a lower IF after co-publication. CONCLUSIONS Earlier versions of Cochrane Methodology Reviews continue to be cited after an update is published, which raises doubts about whether those citing are using the most recent evidence or are aware of the update. Co-publication facilitates broader application and dissemination of Cochrane methodology evidence.
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Affiliation(s)
- Linlin Zhu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ziyu Yang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hongyu Deng
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xiaoyang Liao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Mike Clarke
- Northern Ireland Methodology Hub, Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland.
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The global evolution of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2022; 315:70-95. [PMID: 35842064 PMCID: PMC9278995 DOI: 10.1016/j.jad.2022.07.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic impacted mental health, but the global evolution of mental health problems during the pandemic is unknown. We conducted a systematic review and meta-analysis of longitudinal studies to evaluate the global evolution of mental health problems during the pandemic. METHODS To conduct this systematic review, we searched for published articles from APA PsycInfo (Ovid), CINAHL (EBSCOhost), Embase (Ovid), MEDLINE (Ovid), and Web of Science. Longitudinal (at least 2 waves during the COVID-19 pandemic) and peer-reviewed articles on mental health problems conducted as from 2020 and after were included in the current study. Of 394 eligible full texts, 64 articles were included in the analysis. We computed random effects, standardized mean differences, and log odds ratio (LOR) with 95 % CIs. The meta-analysis protocol was registered with PROSPERO (CRD42021273624). RESULTS Results showed that anxiety (LOR = -0.33; 95 % CI, -0.54, -0.12) and depression symptoms (LOR = -0.12; 95 % CI, -0.21, -0.04) decreased from baseline to follow up. However, other mental health problems showed no change. Higher prevalence rates (40.9 %; 95 % CI, 16.1 %-65.8 %) of psychological distress were found in months after July 2020, respectively, while there were no significant month differences for the prevalence of other mental health problems. Higher means of anxiety (d = 3.63, 95 % CI, 1.66, 5.61), depression (d = 3.93; 95 % CI, 1.68, 6.17), and loneliness (d = 5.96; 95 % CI, 3.22, 8.70) were observed in May 2020. Higher prevalence of anxiety, depression, and PTSD and higher means of anxiety, depression and loneliness were observed in North America. The prevalence of psychological distress and insomnia was higher in Latin America and Europe, respectively. LIMITATIONS There is a lack of longitudinal studies in some parts of the world, such as Africa, the Caribbean, India, the Middle East, in Latin America, and Asia. CONCLUSIONS Results indicated that anxiety and depression symptoms decreased during the COVID-19 pandemic while other mental health problems showed no statistical change. The findings reveal that mental health problems peaked in April and May 2020. Prevalence of mental health problems remains high during the pandemic and mental health prevention, promotion and intervention programs should be implemented to mitigate the consequences of the COVID-19 pandemic on the global population.
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Brand A, Visser ME, Schoonees A, Naude CE. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Cochrane Database Syst Rev 2022; 8:CD015207. [PMID: 35944931 PMCID: PMC9363242 DOI: 10.1002/14651858.cd015207] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium contribute to elevated blood pressure. The WHO recommends decreasing mean population sodium intake through effective and safe strategies to reduce hypertension and its associated disease burden. Incorporating low-sodium salt substitutes (LSSS) into population strategies has increasingly been recognised as a possible sodium reduction strategy, particularly in populations where a substantial proportion of overall sodium intake comes from discretionary salt. The LSSS contain lower concentrations of sodium through its displacement with potassium predominantly, or other minerals. Potassium-containing LSSS can potentially simultaneously decrease sodium intake and increase potassium intake. Benefits of LSSS include their potential blood pressure-lowering effect and relatively low cost. However, there are concerns about potential adverse effects of LSSS, such as hyperkalaemia, particularly in people at risk, for example, those with chronic kidney disease (CKD) or taking medications that impair potassium excretion. OBJECTIVES To assess the effects and safety of replacing salt with LSSS to reduce sodium intake on cardiovascular health in adults, pregnant women and children. SEARCH METHODS We searched MEDLINE (PubMed), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 18 August 2021, and screened reference lists of included trials and relevant systematic reviews. No language or publication restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) and prospective analytical cohort studies in participants of any age in the general population, from any setting in any country. This included participants with non-communicable diseases and those taking medications that impair potassium excretion. Studies had to compare any type and method of implementation of LSSS with the use of regular salt, or no active intervention, at an individual, household or community level, for any duration. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles to determine eligibility; and extracted data, assessed risk of bias (RoB) using the Cochrane RoB tool, and assessed the certainty of the evidence using GRADE. We stratified analyses by adults, children (≤ 18 years) and pregnant women. Primary effectiveness outcomes were change in diastolic and systolic blood pressure (DBP and SBP), hypertension and blood pressure control; cardiovascular events and cardiovascular mortality were additionally assessed as primary effectiveness outcomes in adults. Primary safety outcomes were change in blood potassium, hyperkalaemia and hypokalaemia. MAIN RESULTS We included 26 RCTs, 16 randomising individual participants and 10 randomising clusters (families, households or villages). A total of 34,961 adult participants and 92 children were randomised to either LSSS or regular salt, with the smallest trial including 10 and the largest including 20,995 participants. No studies in pregnant women were identified. Studies included only participants with hypertension (11/26), normal blood pressure (1/26), pre-hypertension (1/26), or participants with and without hypertension (11/26). This was unknown in the remaining studies. The largest study included only participants with an elevated risk of stroke at baseline. Seven studies included adult participants possibly at risk of hyperkalaemia. All 26 trials specifically excluded participants in whom an increased potassium intake is known to be potentially harmful. The majority of trials were conducted in rural or suburban settings, with more than half (14/26) conducted in low- and middle-income countries. The proportion of sodium chloride replacement in the LSSS interventions varied from approximately 3% to 77%. The majority of trials (23/26) investigated LSSS where potassium-containing salts were used to substitute sodium. In most trials, LSSS implementation was discretionary (22/26). Trial duration ranged from two months to nearly five years. We assessed the overall risk of bias as high in six trials and unclear in 12 trials. LSSS compared to regular salt in adults: LSSS compared to regular salt probably reduce DBP on average (mean difference (MD) -2.43 mmHg, 95% confidence interval (CI) -3.50 to -1.36; 20,830 participants, 19 RCTs, moderate-certainty evidence) and SBP (MD -4.76 mmHg, 95% CI -6.01 to -3.50; 21,414 participants, 20 RCTs, moderate-certainty evidence) slightly. On average, LSSS probably reduce non-fatal stroke (absolute effect (AE) 20 fewer/100,000 person-years, 95% CI -40 to 2; 21,250 participants, 3 RCTs, moderate-certainty evidence), non-fatal acute coronary syndrome (AE 150 fewer/100,000 person-years, 95% CI -250 to -30; 20,995 participants, 1 RCT, moderate-certainty evidence) and cardiovascular mortality (AE 180 fewer/100,000 person-years, 95% CI -310 to 0; 23,200 participants, 3 RCTs, moderate-certainty evidence) slightly, and probably increase blood potassium slightly (MD 0.12 mmol/L, 95% CI 0.07 to 0.18; 784 participants, 6 RCTs, moderate-certainty evidence), compared to regular salt. LSSS may result in little to no difference, on average, in hypertension (AE 17 fewer/1000, 95% CI -58 to 17; 2566 participants, 1 RCT, low-certainty evidence) and hyperkalaemia (AE 4 more/100,000, 95% CI -47 to 121; 22,849 participants, 5 RCTs, moderate-certainty evidence) compared to regular salt. The evidence is very uncertain about the effects of LSSS on blood pressure control, various cardiovascular events, stroke mortality, hypokalaemia, and other adverse events (very-low certainty evidence). LSSS compared to regular salt in children: The evidence is very uncertain about the effects of LSSS on DBP and SBP in children. We found no evidence about the effects of LSSS on hypertension, blood pressure control, blood potassium, hyperkalaemia and hypokalaemia in children. AUTHORS' CONCLUSIONS When compared to regular salt, LSSS probably reduce blood pressure, non-fatal cardiovascular events and cardiovascular mortality slightly in adults. However, LSSS also probably increase blood potassium slightly in adults. These small effects may be important when LSSS interventions are implemented at the population level. Evidence is limited for adults without elevated blood pressure, and there is a lack of evidence in pregnant women and people in whom an increased potassium intake is known to be potentially harmful, limiting conclusions on the safety of LSSS in the general population. We also cannot draw firm conclusions about effects of non-discretionary LSSS implementations. The evidence is very uncertain about the effects of LSSS on blood pressure in children.
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Affiliation(s)
- Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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9
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CHIN WL, CHU ECP, CHIANG R. Screening and Diagnosing Osteoporosis Among Postmenopausal Women in Primary Care Settings in Malaysia: A Systematic Review. MAEDICA 2022; 17:492-504. [PMID: 36032605 PMCID: PMC9375864 DOI: 10.26574/maedica.2022.17.2.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: As the population of Malaysia is aging, osteoporosis is becoming more common, prompting the development of various clinical practice guidelines for screening and diagnosing in primary care settings. Given the lack of a systematic assessment of recommendations, we aimed to determine the extent between the guidelines and actuarial screening and diagnosing among postmenopausal women in Malaysia. Methods:The present research is a systematic review following the Cochrane Handbook for Systematic Reviews and the preferred reporting items for systematic reviews and meta-analyses (PRISMA) for clinical practice guidelines on the screening and diagnosing of osteoporosis in primary care settings (updated January 1, 2022). For this purpose, several databases were searched, including MEDLINE, EMBASE and CINAHL. Medical subject headings search terms were related to diagnosis and treatment of osteoporosis, clinical practice guidelines, primary settings and postmenopausal women. Two authors assessed records following consensus and evidence-based processes and reviewed the quality of identified studies using the Joanna Briggs Institute Critical Appraisal tools. Results:Six cross-sectional studies were included in our review. All of them showed a fair level of osteoporosis screening among postmenopausal women in Malaysia primary care settings. Included studies reported that 50% of participants had been diagnosed as osteopenia or osteoporosis. Advancing age, increase of menopause years, low bone mass index, low calcium intake, low education level and low income are positive indicators for osteoporosis. The diagnosis of osteoporosis is influenced by the accessibility of primary care providers on osteoporosis care and knowledge of osteoporosis among postmenopausal women. Conclusions:This systematic review has confirmed that there was a fair screening status in Malaysia. A renewed effort in primary care is needed to reduce the explicit gap in practice and meet the osteoporosis guideline. However, further reviews are needed to best inform future practice, specifically examine the challenges of primary care providers in osteoporosis management.
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Affiliation(s)
- Wui Ling CHIN
- Faculty of Medical and Human Sciences, University of Manchester, United Kingdom
| | - Eric Chun-Pu CHU
- New York Chiropractic and Physiotherapy Centre, EC Healthcare, Hong Kong SAR, China
| | - Ricky CHIANG
- School of Health and Rehabilitation Sciences, the University of Queensland, St Lucia QLD 4072, Australia
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10
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Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review protocol. J Diabetes Metab Disord 2022; 21:1207-1215. [PMID: 35673417 PMCID: PMC9167269 DOI: 10.1007/s40200-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Objective This systematic review aims to investigate the key socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. Methods A pre-specified search strategy will be used to search for studies in the electronic databases and citation indexes: PubMed, EMBASE, Web of Science, and PsycINFO. Two researchers will screen the title and the abstract independently, then will read and critically appraise the full text of each included study. A third independent reviewer will resolve disagreements in data extraction until consensus. Data will be extracted using the Population, Exposure, Outcomes, Study characteristics framework. Study selection will follow the updated guideline for reporting systematic reviews (PRISMA 2020) and will take place from 15 October 2021 to 1 January 2022. The methodological quality and risk of bias of the observational studies will be assessed by the JBI Critical Appraisal Checklist for Cohort and JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results A qualitative narrative synthesis will present the characteristics and the quality of studies and the outcomes of concern. Conclusion Based on the contemporary literature, this review will synthesize the evidence on the socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. The findings will help design patient-centered interventions to promote adherence to insulin in this age group, guide patients’ consultations and diabetes self-management education (DSME) programs. Protocol registration: PROSPERO ID: CRD42021233074.
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11
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Rizzo RRN, Cashin AG, Bagg MK, Gustin SM, Lee H, McAuley JH. A Systematic Review of the Reporting Quality of Observational Studies That Use Mediation Analyses. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1041-1052. [PMID: 35167030 PMCID: PMC9343342 DOI: 10.1007/s11121-022-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
Mediation analysis is a common statistical method used to investigate mechanisms of health exposure and interventions. The reporting quality of mediation studies used in randomised controlled trials has been considered heterogeneous and incomplete. The reporting quality of mediation analysis in observational studies is unknown. We conducted a systematic review to describe the reporting standards of recently published observational studies that used mediation analysis to understand the mechanism of health exposures. We searched for studies published between June 2017 and June 2019 indexed in EMBASE, MEDLINE and PsycINFO. Two reviewers screened articles and selected a random sample of 50 eligible studies for inclusion. We included studies across 13 healthcare fields and ten different health conditions. Most studies (74%) collected data on healthy individuals to assess their risk of developing a health disorder. Psychosocial and behavioural factors (self-control, self-esteem, alcohol consumption, pain) were the most prevalent exposures (n = 30, 60%), outcomes (n = 23, 46%) and mediators (n = 29, 58%). Most studies used a cross-sectional design (64%, n = 32), and a few studies reported sample size calculations (4%, n = 8). In 20% (n = 10) of the studies, adjustment for confounders was reported. Only 10% (n = 5) of studies reported the assumptions underlying the mediation analysis, and 14% (n = 7) of studies conducted some sensitivity analysis to assess the degree which unmeasured confounders would affect the estimate of the mediation effect. Mediation analysis is a common method used to investigate mechanisms in prevention research. The reporting of mediation analysis in observational studies is incomplete and may impact reproducibility, evidence synthesis and implementation.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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12
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Avau B, Van Remoortel H, De Buck E. Translation and validation of PubMed and Embase search filters for identification of systematic reviews, intervention studies, and observational studies in the field of first aid. J Med Libr Assoc 2021; 109:599-608. [PMID: 34858089 PMCID: PMC8608173 DOI: 10.5195/jmla.2021.1219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this project was to validate search filters for systematic reviews, intervention studies, and observational studies translated from Ovid MEDLINE and Embase syntax and used for searches in PubMed and Embase.com during the development of evidence summaries supporting first aid guidelines. We aimed to achieve a balance among recall, specificity, precision, and number needed to read (NNR). Methods Reference gold standards were constructed per study type derived from existing evidence summaries. Search filter performance was assessed through retrospective searches and measurement of relative recall, specificity, precision, and NNR when using the translated search filters. Where necessary, search filters were optimized. Adapted filters were validated in separate validation gold standards. Results Search filters for systematic reviews and observational studies reached recall of ≥85% in both PubMed and Embase. Corresponding specificities for systematic review filters were ≥96% in both databases, with a precision of 9.7% (NNR 10) in PubMed and 5.4% (NNR 19) in Embase. For observational study filters, specificity, precision, and NNR were 68%, 2%, and 51 in PubMed and 47%, 0.8%, and 123 in Embase, respectively. These filters were considered sufficiently effective. Search filters for intervention studies reached a recall of 85% and 83% in PubMed and Embase, respectively. Optimization led to recall of ≥95% with specificity, precision, and NNR of 49%, 1.3%, and 79 in PubMed and 56%, 0.74%, and 136 in Embase, respectively. Conclusions We report validated filters to search for systematic reviews, observational studies, and intervention studies in guideline projects in PubMed and Embase.com.
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Affiliation(s)
- Bert Avau
- , Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Hans Van Remoortel
- , Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- , Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium; Cochrane First Aid, Mechelen, Belgium
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Mamikutty R, Aly AS, Marhazlinda J. Databases Selection in a Systematic Review of the Association between Anthropometric Measurements and Dental Caries among Children in Asia. CHILDREN-BASEL 2021; 8:children8070565. [PMID: 34209268 PMCID: PMC8306381 DOI: 10.3390/children8070565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
A comprehensive search for primary studies using a sufficient number and relevant databases is critical to minimise bias and increase the validity of a systematic review. We examined the frequency and choices of databases commonly used to provide an efficient search of primary studies for a systematic review of anthropometric measurements and dental caries among children in Asia. Twelve previous systematic reviews on a similar topic were retrieved from six databases. The frequency and choice of databases used by reviewers were determined from the methods sections. We also identified the lists of other databases usually searched in other reviews. Eligibility criteria for final databases selection were the database's scope, the topic of interest, design of the study, type of article, and the accessibility of the databases. Of the 77 databases identified, previous reviews on this topic used 21 databases, ranging from 2 to 12 databases in each review. Medline, Cochrane Library, Web of Science, and PubMed were employed most frequently. Twenty-six databases were eligible and selected for the present review. Twelve were regional databases to provide comprehensive coverage of primary studies. A systematic approach in selecting appropriate databases for searching primary studies is paramount to reduce errors, ensure coverage, and increase the validity of systematic reviews' conclusions.
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Affiliation(s)
- Rokiah Mamikutty
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
- Oral Health Programme, Ministry of Health Malaysia, Level 5, Block E10, Parcel E, Precinct 1, Federal Government Administrative Centre, Putrajaya 62590, Malaysia
| | - Ameera Syafiqah Aly
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
- Oral Health Programme, Ministry of Health Malaysia, Level 5, Block E10, Parcel E, Precinct 1, Federal Government Administrative Centre, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia; (R.M.); (A.S.A.)
- Correspondence: ; Tel.: +60-3-7967-4805
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Publication Trends of Pediatric and Adult Randomized Controlled Trials in General Medical Journals, 2005-2018: A Citation Analysis. CHILDREN-BASEL 2020; 7:children7120293. [PMID: 33333770 PMCID: PMC7765242 DOI: 10.3390/children7120293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/30/2022]
Abstract
Policy has been developed to promote the conduct of high-quality pediatric randomized controlled trials (RCTs). Whether these strategies have influenced publication trends in high-impact journals is unknown. We aim to evaluate characteristics, citation patterns, and publication trends of pediatric RCTs published in general medical journals (GMJs) compared with adult RCTs over a 13-year period. Studies were identified using Medline, and impact metrics were collected from Web of Science and Scopus. All RCTs published from 2005–2018 in 7 GMJs with the highest impact factors were identified for analysis. A random sample of matched pediatric and adult RCTs were assessed for publication characteristics, academic and non-academic citation. Citations were counted from publication until June 2019. Among 4146 RCTs, 2794 (67.3%) enrolled adults, 591 (14.2%) enrolled children, and 761 RCTs (18.3%) enrolled adult and pediatric patients. Adult RCTs published in GMJs grew by 5.1 publications per year (95% CI: 3.3–6.9), while the number of pediatric RCTs did not show significant change (−0.4 RCTs/year, 95% CI: −1.4–0.6). Adult RCTs were cited more than pediatric RCTs (median(IQR): 29.9 (68.5–462.8) citations/year vs. 13.2 (6.8–24.9) citations/year; p < 0.001); however, social media attention was similar (median(IQR) Altmetric Attention Score: 37 (13.75–133.8) vs. 26 (6.2–107.5); p = 0.25). Despite policies which may facilitate conduct of pediatric RCTs, the publishing gap in high-impact GMJs is widening.
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Franco JVA, Garrote V, Vietto V, Escobar Liquitay CM, Solà I. Search strategies (filters) to identify systematic reviews in MEDLINE and Embase. Hippokratia 2020. [DOI: 10.1002/14651858.mr000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Juan VA Franco
- Argentine Cochrane Centre; Instituto Universitario Hospital Italiano; Buenos Aires Argentina
| | - Virginia Garrote
- Central Library; Instituto Universitario Hospital Italiano; Buenos Aires Argentina
| | - Valeria Vietto
- Family and Community Medicine Service; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
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16
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Rastegarfar B, Ardalan A, Nejat S, Abbasali A, Moradian MJ. Search Strategy for Search Performance; Off-the-cuff or Being Sensitive. Bull Emerg Trauma 2019; 7:431-432. [PMID: 31858011 PMCID: PMC6911708 DOI: 10.29252/beat-070417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/29/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Behnaz Rastegarfar
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ardalan
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nejat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Abbasali
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Moradian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Disaster and Emergency Health, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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Tudor Car L, Li L, Smith H, Atun R. Cochrane review: Search strategies to identify observational studies in MEDLINE and EMBASE. J Evid Based Med 2019; 12:225-226. [PMID: 31441237 DOI: 10.1111/jebm.12358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Li Li
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Office of Medical Education, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
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