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Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination.Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE.There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality.This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.

Older adults are at high risk of influenza-related complications or hospitalization. The purpose of this systematic review is to assess the relative cost-effectiveness of all influenza vaccine options for older adults.This systematic review identified economic evaluation studies assessing the cost-effectiveness of influenza vaccines in adults ≥65 years of age from 5 literature databases. Two reviewers independently selected, extracted, and appraised relevant studies using the JBI Critical Appraisal Checklist for Economic Evaluations and Heyland's generalizability checklist. Costs were converted to 2019 Canadian dollars and adjusted for inflation and purchasing power parity.A total of 27 studies were included. There were 18 comparisons of quadrivalent inactivated vaccine (QIV) versus trivalent inactivated vaccine (TIV): 5 showed QIV dominated TIV (ie, lower costs and higher health benefit), and 13 showed the results depended on willingness to pay (WTP). There were 9 comparisons of high-dose TIV (TIV-HD) versus TIV: 5 showed TIV-HD dominated TIV, and 4 showed the results depended on WTP. There were 8 comparisons of adjuvanted TIV (TIV-ADJ) versus TIV: 4 showed TIV-ADJ dominated TIV, and 4 showed the results depended on WTP. There were few pairwise comparisons among QIV, TIV-HD, and TIV-ADJ.The evidence suggests QIV, TIV-HD, and TIV-ADJ are cost-effective against TIV for a WTP threshold of $50 000 per quality-adjusted life-year. Future studies should include new and existing vaccine options for broad age ranges and use more robust methodologies-such as real-world evaluations or modeling studies accounting for methodological, structural, and parameter uncertainty.

The incidence of type 1 diabetes mellitus is increasing every year requiring substantial expenditure on treatment and complications. A systematic review was conducted on the cost-effectiveness of insulin formulations, including ultralong-, long-, or intermediate-acting insulin, and their biosimilar insulin equivalents.MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, HTA, and NHS EED were searched from inception to June 11, 2021. Cost-effectiveness and cost-utility analyses were included if insulin formulations in adults (≥ 16 years) with type 1 diabetes mellitus were evaluated. Two reviewers independently screened titles, abstracts, and full-text articles, extracted study data, and appraised their quality using the Drummond 10-item checklist. Costs were converted to 2020 US dollars adjusting for inflation and purchasing power parity across currencies.A total of 27 studies were included. Incremental cost-effectiveness ratios ranged widely across the studies. All pairwise comparisons (11 of 11, 100%) found that ultralong-acting insulin was cost-effective compared with other long-acting insulins, including a long-acting biosimilar. Most pairwise comparisons (24 of 27, 89%) concluded that long-acting insulin was cost-effective compared with intermediate-acting insulin. Few studies compared long-acting insulins with one another.Long-acting insulin may be cost-effective compared with intermediate-acting insulin. Future studies should directly compare biosimilar options and long-acting insulin options and evaluate the long-term consequences of ultralong-acting insulins.

A ridable ballbot, a personal robot, is an underactuated system. The four state variables of the ball motion and body motion are controlled by two input signals acting on the ball. Euler–Lagrange equation is applied to obtain the dynamic model of the ridable ballbot. On the basis of this dynamic model, a nonlinear controller is analyzed and designed to control balancing and transferring of the robot. The nonlinear control scheme is proposed based on the combination of two control design techniques: (i) partial feedback linearization, which is designed to maintain the body in the upright position; and (ii) sliding mode control, which provides robust control in ball motion on the floor against model imprecision, uncertainty of system parameters and friction, and external disturbances. These two control mechanisms are successfully merged into a combined controller. Numerical and experimental results indicate the effectiveness of the combined controller and proposed a dynamic model. The control algorithm asymptotically stabilizes all system responses.

Objectives The aim of the article was to identify and summarize studies assessing methodologies for study selection, data abstraction, or quality appraisal in systematic reviews. Study Design and Setting A systematic review was conducted, searching MEDLINE, EMBASE, and the Cochrane Library from inception to September 1, 2016. Quality appraisal of included studies was undertaken using a modified Quality Assessment of Diagnostic Accuracy Studies 2, and key results on accuracy, reliability, efficiency of a methodology, or impact on results and conclusions were extracted. Results After screening 5,600 titles and abstracts and 245 full-text articles, 37 studies were included. For screening, studies supported the involvement of two independent experienced reviewers and the use of Google Translate when screening non-English articles. For data abstraction, studies supported involvement of experienced reviewers (especially for continuous outcomes) and two independent reviewers, use of dual monitors, graphical data extraction software, and contacting authors. For quality appraisal, studies supported intensive training, piloting quality assessment tools, providing decision rules for poorly reported studies, contacting authors, and using structured tools if different study designs are included. Conclusion Few studies exist documenting common systematic review practices. Included studies support several systematic review practices. These results provide an updated evidence-base for current knowledge synthesis guidelines and methods requiring further research.

Objectives To illustrate the use of process mining concepts, techniques, and tools to improve the systematic review process. Study Design and Setting We simulated review activities and step-specific methods in the process for systematic reviews conducted by one research team over 1 year to generate an event log of activities, with start/end dates, reviewer assignment by expertise, and person-hours worked. Process mining techniques were applied to the event log to “discover” process models, which allowed visual display, animation, or replay of the simulated review activities. Summary statistics were calculated for person-time and timelines. We also analyzed the social networks of team interactions. Results The 12 simulated reviews included an average of 3,831 titles/abstracts (range: 1,565–6,368) and 20 studies (6–42). The average review completion time was 463 days (range: 289–629) (881 person-hours [range: 243–1,752]). The average person-hours per activity were study selection 26%, data collection 24%, report preparation 23%, and meta-analysis 17%. Social network analyses showed the organizational interaction of team members, including how they worked together to complete review tasks and to hand over tasks upon completion. Conclusion Event log and process mining can be valuable tools for research teams interested in improving and modernizing the systematic review process.

Background Patients who undergo prolonged surgical procedures are at risk of developing pressure ulcers. Recent systematic reviews suggest that pressure redistribution overlays on operating tables significantly decrease the associated risk. Little is known about the cost effectiveness of using these overlays in a prevention program for surgical patients. Methods Using a Markov cohort model, we evaluated the cost effectiveness of an intraoperative prevention strategy with operating table overlays made of dry, viscoelastic polymer from the perspective of a health care payer over a 1-year period. We simulated patients undergoing scheduled surgical procedures lasting ≥90 min in the supine or lithotomy position. Results Compared with the current practice of using standard mattresses on operating tables, the intraoperative prevention strategy decreased the estimated intraoperative incidence of pressure ulcers by 0.51%, corresponding to a number-needed-to-treat of 196 patients. The average cost of using the operating table overlay was $1.66 per patient. Compared with current practice, this intraoperative prevention strategy would increase slightly the quality-adjusted life days of patients and by decreasing the incidence of pressure ulcers, this strategy would decrease both hospital and home care costs for treating fewer pressure ulcers originated intraoperatively. The cost savings was $46 per patient, which ranged from $13 to $116 by different surgical populations. Intraoperative prevention was 99% likely to be more cost effective than the current practice. Conclusion In patients who undergo scheduled surgical procedures lasting ≥90 min, this intraoperative prevention strategy could improve patients’ health and save hospital costs. The clinical and economic evidence support the implementation of this prevention strategy in settings where it has yet to become current practice.

Objective To compare the quality of reporting of reports randomized controlled trials (RCTs) published in English and in languages other than English (LOE), and to determine whether there were differences between conventional medicine (CM) and complementary and alternative medicine (CAM) reports. Study Design and Setting We examined more than 600 RCTs associated with 125 systematic reviews. We extracted characteristics of each RCT using a standardized data collection form. We assessed quality using the Jadad scale and the adequacy of allocation concealment. Results There were only minor differences in the quality of reports of RCTs published in English compared with other languages (median quality score of 3 vs. 2, P = .10), and the quality of reports of CAM RCTs was similar to the CM reports (median score of 3 vs. 2, P = .14). There was no effect of language of publication on quality of reporting for CM trials (median score of 2 vs. 2, P = .12). Among CAM trials, however, overall quality scores were higher for reports in English than for reports in other languages (median score of 3 vs. 2, P = .04). Conclusion The overall quality of reports published in languages other than English is similar to that of English-language reports. Moreover, the overall quality of reporting of RCTs of CAM interventions is as good as that for CM interventions.

It is widely accepted that meta-analysts should search multiple databases. The selection of databases is ideally based on the potential contribution of each database to the project or on the potential for bias if a database is excluded, as supported by research evidence. We explore whether searching Embase yields additional trials that influence a meta-analysis. We identified meta-analyses that searched Medline and Embase. A random-effects weighted mean method was used to estimate the intervention effect in articles indexed only in Embase compared with those indexed elsewhere. On average, Embase-unique trials yielded significantly smaller estimates by 29% (ratio of odds ratio [ROR] 0.71, 95% confidence interval [CI] 0.56-0.90) but influenced the pooled estimate by an average of only 6% (ROR 0.94, 95% CI 0.88-0.99). Searching Medline but not Embase risks biasing a meta-analysis by finding studies that show larger estimates, but their prevalence seems low enough that the risk may be slight, provided the rest of the search is comprehensive.

Objectives: We prospectively evaluated the effects of head position during cardiac deairing on the Doppler ultrasonography–detected cerebral microemboli in children and the association between the embolic counts and the clinical assessment of deairing. Methods: Children requiring exposure of the systemic ventricle under cardiopulmonary bypass were randomized to Trendelenburg (–15°) and horizontal (0°) head positions during and after standard surgical deairing. Complexity of repair was categorized as follows: group I consisted of single simple lesions, and group II consisted of multiple complex lesions. Transcranial Doppler ultrasonography identified high-intensity transient signals in the right middle cerebral artery within the first 5 minutes after aortic declamping (release) and from this ending period until cardiopulmonary bypass termination (residual). Electrocardiographic alterations after deairing were documented. A predefined 5-point scale was used by the surgeon for blinded assessment of deairing. Results: High-intensity transient signals were identified in 97% of 128 patients (aged 5 days to 17 years). The median total high-intensity transient signal count was 60 (25th-75th quartiles, 14-189). Head position or surgeon did not affect the rate of high-intensity transient signals (P > .20). During the residual interval, occurrence of HITS in group I was less than that in group II (P < .05), but there was no difference at release. The incidence of high-intensity transient signals and electrocardiographic alterations correlated with the clinical assessment of deairing (P < .01). Conclusions: Trendelenburg head position as a complement of cardiac deairing in children does not decrease the cerebral microembolic load compared with the horizontal head position. The cerebral microembolic count and the occurrence of electrocardiographic alterations usually increases when the surgeon is less confident in the efficacy of deairing. (J Thorac Cardiovasc Surg 2001;121:3-9)

Study objective: More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic review of treatments for sudden cardiac arrest was limited by suboptimal data. Since then, debate has increased about whether bystander CPR is effective or whether attention should focus instead on rapid defibrillation. Therefore a cumulative meta-analysis was conducted to determine the relative effectiveness of differences in the defibrillation response time interval, proportion of bystander CPR, and type of EMS system on survival after out-of-hospital cardiac arrest. Methods : A comprehensive literature search was performed by using a priori exclusion criteria. We considered EMS systems that provided BLS-D, ALS, BLS plus ALS, or BLS-D plus ALS care. A generalized linear model was used with dispersion estimation for random effects. Results : Thirty-seven eligible articles described 39 EMS systems and included 33, 124 patients. Median survival for all rhythm groups to hospital discharge was 6.4% (interquartile range, 3.7 to 10.3). Odds of survival were 1.06 (95% confidence interval [Cl], 1.03 to 1.09; P P P =.01); BLS plus ALS, 1.47 (95% Cl, 0.89 to 2.42; P =.07); and BLS with defibrillation plus ALS, 2.31 (95% Cl, 1.47 to 3.62; P Conclusion : We confirm that greater survival after sudden cardiac arrest is associated with provision of bystander CPR, early defibrillation, or ALS. More research is required to evaluate the relative benefit of early defibrillation versus early ALS.

Objective To determine the frequency of unpublished systematic reviews (SRs) and explore factors contributing to their occurrence. Study Design and Setting First or corresponding authors from a sample of SRs published in 2005 were asked to participate in a 26-item survey administered through the Internet, facsimile, and postal mail. Outcomes included median and range of published and unpublished SRs, and barriers, facilitators, and reasons for not publishing SRs. Descriptive analyses were performed. Results 55.7% (348 of 625) of those invited participated, half of which were from Europe and 22.7% were from the United States. Participants reported 1,405 published (median: 2.0, range: 1–150) and 199 unpublished (median: 2.0, range: 1–33) SRs. Lack of time and lack of funding and organizational support were barriers, whereas time availability and self-motivation were facilitators to publishing reviews. For most recent unpublished SRs (n = 52), the reasons for not publishing included lack of time (12 of 52, 23.0%), the manuscript being rejected (10 of 52, 19.0%), and operational issues (six of 52, 11.5%). Conclusion Unpublished SRs do exist. Lack of time, funding, and organizational support were consistent reasons for not publishing SRs. Statistical significance of SR results was not reported as being a major barrier or reason for not publishing. Further research on unpublished SRs is warranted.

To determine which factors predict favorable results and positive conclusions in systematic reviews (SRs) and to assess the level of agreement between SR results and conclusions.A sample of 296 English SRs indexed in MEDLINE (November, 2004) was obtained. Two investigators independently categorized SR characteristics, results, and conclusions. Descriptive analyses and logistic regression predicting favorable results (nonstatistically significant and statistically significant positive) and positive conclusions were conducted. The level of concordance between results and conclusions was assessed using a weighted-kappa statistic.Overall, 36.5% of the SRs had favorable results, increasing to 57.7% for Cochrane and 64.3% for non-Cochrane reviews with a meta-analysis of the primary outcome. Non-Cochrane reviews with a meta-analysis of the primary outcome were twice as likely to have positive conclusions as Cochrane reviews with such an analysis (P-value0.05). The weighted kappa for agreement between SR results and conclusions was 0.55. It was lower for Cochrane (0.41) vs. non-Cochrane (0.67) reviews.SRs including a meta-analysis of the primary outcome may be affected by indirect publication bias in our sample. Differences between the results and conclusions of Cochrane and non-Cochrane reviews were apparent. Further research on publication-related issues of SRs is warranted.