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Conducting high‐quality overviews of reviews (OoR) is time‐consuming. Because the quality of systematic reviews (SRs) varies, it is necessary to critically appraise SRs when conducting an OoR. A well‐established appraisal tool is A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, which takes about 15–32 min per application. To save time, we developed two fast‐and‐frugal decision trees (FFTs) for assessing the methodological quality of SR for OoR either during the full‐text screening stage (Screening FFT) or to the resulting pool of SRs (Rapid Appraisal FFT). To build a data set for developing the FFT, we identified published AMSTAR 2 appraisals. Overall confidence ratings of the AMSTAR 2 were used as a criterion and the 16 items as cues. One thousand five hundred and nineteen appraisals were obtained from 24 publications and divided into training and test data sets. The resulting Screening FFT consists of three items and correctly identifies all non‐critically low‐quality SRs (sensitivity of 100%), but has a positive predictive value of 59%. The three‐item Rapid Appraisal FFT correctly identifies 80% of the high‐quality SRs and correctly identifies 97% of the low‐quality SRs, resulting in an accuracy of 95%. The FFTs require about 10% of the 16 AMSTAR 2 items. The Screening FFT may be applied during full‐text screening to exclude SRs with critically low quality. The Rapid Appraisal FFT may be applied to the final SR pool to identify SR that might be of high methodological quality. [ABSTRACT FROM AUTHOR]

Introduction: Evidence‐based practice supports clinical decision‐making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence‐based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. Methods: A 42‐item questionnaire was developed to address the study aims. It consisted of a 7‐point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. Results: Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. Conclusion: Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision‐making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose. [ABSTRACT FROM AUTHOR]

A literature review with an evaluation of existing evidence is often the first step in designing a research project. This article provides a systematic framework and guide for clinicians, researchers, and clinician‐scientists to appraise the available literature to inform a clinical research project. The three‐step approach outlined in this article starts with defining your research question using the Population Intervention Comparator Outcome‐Design framework, followed by evaluation of the existing evidence and identification of gaps that could be addressed by a research project, and ends with guidance to refine the research question and start preparing a protocol. [ABSTRACT FROM AUTHOR]

Background: To appraise the quality of clinical practice guidelines for glaucoma suspects, and to assess their consistency for how a 'glaucoma suspect' is defined and their recommendations for treatment initiation for such individuals. Methods: This study included all documents that self‐identified as a 'guideline' and provided recommendation(s) for the clinical care of glaucoma suspects. The quality of eligible guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: From 1196 records retrieved from comprehensive searches and two records manually included, 20 clinical practice guidelines were deemed eligible. Based on an appraisal using the AGREE II instrument, 16 (80%) guidelines had ≤2 domains with scores >66%. Overall, the lowest scoring domains were for applicability, editorial independence and stakeholder involvement. There was relatively poor agreement across the guidelines for what defines a 'glaucoma suspect' or 'primary open angle glaucoma [POAG] suspect', as well as the recommendations and criteria for treatment initiation in these populations. There was better agreement for the definition and recommendations for treatment initiation for 'primary angle closure suspects'. Conclusions: There is substantial room to improve the methodological quality of most current international clinical guidelines for glaucoma suspects. Clinicians should consider this finding when using such guidelines to inform their care of glaucoma suspects. Substantial variation in the definition of a POAG suspect and recommendations for treatment initiation underscores important gaps in the current evidence for the accurate prediction of glaucoma development and treatment effectiveness in these individuals. [ABSTRACT FROM AUTHOR]

Systematic reviews (SRs) have an important role in the healthcare decision-making practice. Assessing the overall confidence in the results of SRs using quality assessment tools, such as “A MeaSurement Tool to Assess Systematic Reviews 2” (AMSTAR 2), is crucial since not all SRs are conducted using the most rigorous methods. In this article, we introduce a free, open-source R package called “amstar2Vis” (https://github.com/bougioukas/amstar2Vis) that provides easy-to-use functions for presenting the critical appraisal of SRs, based on the items of AMSTAR 2 checklist. An illustrative example is outlined, describing the steps involved in creating a detailed table with the item ratings and the overall confidence ratings, generating a stacked bar plot that shows the distribution of ratings as percentages of SRs for each AMSTAR 2 item, and creating a “ggplot2” graph that shows the distribution of overall confidence ratings (“Critically Low,” “Low,” “Moderate,” or “High”). We expect “amstar2Vis” to be useful for overview authors and methodologists who assess the quality of SRs with AMSTAR 2 checklist and facilitate the production of pertinent publication-ready tables and figures. Future research and applications could further investigate the functionality or potential improvements of our package. [ABSTRACT FROM AUTHOR]

This article discusses the importance of critical appraisal in evidence-based medicine, specifically focusing on the statistical analysis of research findings. The authors argue that existing critical appraisal tools do not adequately address statistical validity, and they provide guidance on how to review and assess the appropriateness of statistical methods used in research studies. The article outlines five key items to consider when reviewing statistical approaches, including independence of observations, operationalization of the outcome and exposure variables, assumptions of the statistical methods, and correspondence of results with study objectives. The authors also provide a visual guide that summarizes these key considerations and their relations for common statistical methods. The article concludes by emphasizing the need for further information from authors or consultation with statisticians when necessary, and it acknowledges that their suggestions do not replace formal statistical review processes. [Extracted from the article]

Background: Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) is actively participating in the Magnet4Europe® research study, which aims to advance nursing excellence and promote evidence‐based practice. Objectives: As part of this initiative, the Nursing, Allied Health Professional and Midwifery Research Council at GHNHSFT has been actively engaging colleagues in evidence‐based practice and research. Methods: This has been achieved through the development of sessions using the Critically Appraised Topics (CATs) framework, where clinical questions and relevant research articles are discussed. Results and Discussion: This article describes the collaborative approach between the Lead Nurse for Continual Professional Development and the Deputy Manager of the Library and Knowledge Services to develop and run the sessions. Conclusion: Collaboration between clinical staff and library and knowledge teams can be useful in encouraging healthcare professionals' engagement with the evidence base in order to consider changes to practice. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based decision‐making and practice recommendations are commonly based on findings from quantitative studies or reviews. In the present study, we provide an overview of how to incorporate findings from qualitative research into the evidence‐based decision‐making process. Methods: To illustrate how qualitative evidence can be integrated into the decision‐making process, we have outlined a clinical nutrition scenario and the process for sourcing credible evidence to inform decision‐making. A qualitative health research study was selected and appraised using the Critical Appraisal Skill Programme (CASP) appraisal tool for qualitative research. Based on the results of the critical appraisal, the study quality is considered, and we discuss whether the qualitative evidence can be applied to practice. Results: A detailed description of how the qualitative findings can be used conceptually and instrumentally in practice to address the clinical nutrition scenario is provided. Conclusions: Developing skills in critically appraising findings from qualitative studies will increase awareness and utilisation of this type of evidence in practice and policy, with a goal to ensure that patient/client perceptions are considered, leading to enhanced person‐centred care or systems. Key points: Evidence‐based decision‐making and practice is a vital component of dietetics, emphasising the integration of research evidence, patient values, clinical judgement and system processes.Qualitative health research plays a critical role in evidence‐based dietetic decision‐making and practice by providing insights into patient perspectives, experiences and context. Dietitians need to be skilled at appraising qualitative research for quality and applicability.To support the application of evidence in nutrition and dietetic decision‐making and practice, a clinical scenario is presented with practical considerations provided for asking searchable questions, conducting the literature search and completing a critical appraisal of qualitative evidence. [ABSTRACT FROM AUTHOR]

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well‐documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in‐depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field. [ABSTRACT FROM AUTHOR]

A diversity of approaches for critically appraising qualitative and quantitative evidence exist and emphasize different aspects. These approaches lack clear processes to facilitate rating the overall quality of the evidence for aggregated findings that combine qualitative and quantitative evidence. We draw on a meta‐aggregation of implementation and process evaluations to illustrate a method for critically appraising empirical findings generated from qualitative and quantitative studies. This method includes a rubric for standardizing assessments of the overall quality of evidence in an evidence synthesis or mixed‐method systematic review. The method first assesses the credibility of each finding extracted from a study. These individual assessments then feed into an overall score for any synthesized finding generated from the meta‐aggregation. We argue that this approach provides a balanced and inclusive method of critical appraisal by first assessing individual findings, rather than studies, using flexible criteria applicable to a range of primary study methods to derive an overall assessment of synthesized findings. [ABSTRACT FROM AUTHOR]

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well‐documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in‐depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field. [ABSTRACT FROM AUTHOR]

The Cochrane Tobacco Addiction Group has created risk of bias tools, which are topic‐agnostic. In 2012 the Cochrane Tobacco Addiction Group created guidance specific to considerations for reviews of randomized controlled trials of tobacco cessation interventions, building on existing Cochrane tools. The guidance covers issues relating to selection bias, performance bias, detection bias, attrition bias and selective reporting. In this paper, we set out to make this guidance publicly available, so that others can use and cite it. We provide advice for using this tool to appraise trials critically as a systematic reviewer. We also provide guidance for triallists on ways to use this tool to improve trial design and reporting. [ABSTRACT FROM AUTHOR]

Aim: To critically evaluate the reporting quality of a random sample of animal studies within the field of endodontics against the Preferred Reporting Items for Animal Studies in Endodontics (PRIASE) 2021 checklist and to investigate the association between the quality of reporting and several characteristics of the selected studies. Methodology: Fifty animal studies related to endodontics were randomly selected from the PubMed database with publication dates from January 2017 to December 2021. For each study, a score of '1' was given when the item of the PRIASE 2021 checklist was fully reported, whereas a score of '0' was given when an item was not reported; when the item was inadequately or partially reported, a score of '0.5' was given. Based on the overall scores allocated to each manuscript, they were allocated into three categories of reporting quality: low, moderate and high. Associations between study characteristics and reporting quality scores were also analysed. Descriptive statistics and Fisher's exact tests were used to describe the data and determine associations. The probability value of.05 was selected as the level of statistical significance. Results: Based on the overall scores, four (8%) and 46 (92%) of the animal studies evaluated were categorized as 'High' and 'Moderate' reporting quality, respectively. A number of items were adequately reported in all studies related to background (Item 4a), relevance of methods/results (7a) and interpretation of images (11e), whereas only one item related to changes in protocol (6d) was not reported in any. No associations were confirmed between reporting quality scores and number of authors, origin of the corresponding author, journal of publication (endodontic specialty vs. non‐ specialty), impact factor or year of publication. Conclusions: Animal studies published in the specialty of endodontics were mostly of 'moderate' quality in terms of the quality of reporting. Adherence to the PRIASE 2021 guidelines will enhance the reporting of animal studies in the expectation that all future publications will be high quality. [ABSTRACT FROM AUTHOR]

Background and Objectives: A critical appraisal of the literature helps to assess the strength and weakness of the research and suggests ways to improve future research. Our aim was to critically appraise the knowledge, attitude, and practice (KAP) studies conducted in India for blood donation. Materials and Methods: Of 70 articles identified in our search on PubMed, Scopus and Google Scholar, 32 were assessed for quality using an appraisal tool for cross‐sectional studies (AXIS) and questionnaire items. Results: Quality assessment revealed that only 6 of 32 studies had acceptable reporting (≥80% score on the AXIS tool). The most frequently identified shortcomings were failure to address the non‐responders, lack of justification for sample size, assessment of outcome variables and demographic results for the survey. Our evaluation of questionnaires revealed that knowledge for need for blood donation, its benefits and site/place for blood donation were assessed by very few studies. With this, issues such as parental/family consent, religious beliefs, and indifference to blood donation process were amongst the common reasons for non‐donation. Many studies also failed to ask questions related to procedural information/instructions, which are necessary for promoting voluntary blood donations. Conclusion: Most published KAP studies for blood donation in India were not appropriately described, especially the methodology and result section. These deficiencies could have led to suboptimal interpretation of the prevalent issues. Use of an open‐ended and validated KAP questionnaire with a problem‐based approach and inclusion of participants from various socio‐cultural backgrounds is required for good quality of evidence. [ABSTRACT FROM AUTHOR]

Aim: To describe factors affecting critical appraisal of research articles in evidence‐based practice by certified nurse specialists who were advanced practice nurses in Japan. Design: A descriptive qualitative study. Methods: Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi‐structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence‐based practice and learning about critical appraisal. Results: The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence‐based practices—individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence‐based practice. Patient or Public Contribution: If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health‐related outcome for patients or populations. [ABSTRACT FROM AUTHOR]

Risk of bias (RoB) assessments are a core element of evidence synthesis but can be time consuming and subjective. We aimed to develop a decision rule‐based algorithm for RoB assessment of seroprevalence studies. We developed the SeroTracker‐RoB algorithm. The algorithm derives seven objective and two subjective critical appraisal items from the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence studies and implements decision rules that determine study risk of bias based on the items. Decision rules were validated using the SeroTracker seroprevalence study database, which included non‐algorithmic RoB judgments from two reviewers. We quantified efficiency as the mean difference in time for the algorithmic and non‐algorithmic assessments of 80 randomly selected articles, coverage as the proportion of studies where the decision rules yielded an assessment, and reliability using intraclass correlations comparing algorithmic and non‐algorithmic assessments for 2070 articles. A set of decision rules with 61 branches was developed using responses to the nine critical appraisal items. The algorithmic approach was faster than non‐algorithmic assessment (mean reduction 2.32 min [SD 1.09] per article), classified 100% (n = 2070) of studies, and had good reliability compared to non‐algorithmic assessment (ICC 0.77, 95% CI 0.74–0.80). We built the SeroTracker‐RoB Excel Tool, which embeds this algorithm for use by other researchers. The SeroTracker‐RoB decision‐rule based algorithm was faster than non‐algorithmic assessment with complete coverage and good reliability. This algorithm enabled rapid, transparent, and reproducible RoB evaluations of seroprevalence studies and may support evidence synthesis efforts during future disease outbreaks. This decision rule‐based approach could be applied to other types of prevalence studies. [ABSTRACT FROM AUTHOR]

Many reviews referred to as 'systematic reviews' in ecology are not consistent with best practice in that they generally lack appropriate critical appraisal of included studies. This limitation is particularly important in applied ecology, where there have been increasing calls for more systematic reviews to guide decision making. To identify the available critical appraisal tools (CATs) and hierarchies of evidence available for ecology studies, we systematically searched for: studies that described the development and/or examination of tools to assess the potential methodological bias in studies of ecology; and the tools used to assess potential methodological bias of included studies in ecological systematic reviews. We identified 680 reviews labelled as 'systematic reviews' in ecology, however only 4.0% performed critical appraisal of the included studies. Three hierarchies of evidence and 23 CATs were identified, and assessed as lacking independent development, validity and reliability testing, and/or completeness. The authors of the reviews that included critical appraisal have appropriately identified the need to move reviews in ecology in the direction of this higher level of evidence, and have taken applied ecology further in the direction of evidence‐based practice. However, we identified shortcomings in these approaches when compared with best practice, and conclude that new tools are needed that reflect a range of questions posed in ecology. Through increasing the availability of such tools, the strength of evidence provided by systematic reviews in ecology would improve. [ABSTRACT FROM AUTHOR]

This report is the outcome of an EFSA procurement (NP/EFSA/PREV/2020/01) which aims at contributing to the development of adverse outcome pathways (AOPs) to be integrated in a network addressing uterine adenocarcinoma in mammals. The outcome is intended to support the identification of substances with endocrine disruptor mode of action. For this specific purpose, an evidence‐based approach methodology was adopted. Available evidence was systematically mapped from the literature to identify Molecular Initiating Events (MIEs) and Key Events (KEs) linked to adverse outcome (AO) "uterine endometrioid adenocarcinoma" independently from prototypical stressors, by means of: 1. a priori defined search strategies initially addressing the AO and biologically plausible MIEs, 2. application of machine learning technique (Topic modelling) that automatically analyzes text data to identify biologically plausible KERs, 3. systematic literature review and critical appraisal of prioritized evidence, taking into account human, in vivo and in vitro studies. Estradiol and tamoxifen, two recognized human risk factors for endometrioid adenocarcinoma, were used as tool chemical compounds to empirically support the response and temporal concordance of the identified key event relationships (KERs). All evidence has been then integrated by means of the AOP conceptual network. An evidence‐based AOP starting from activation of uterine estrogen receptor‐alfa leading to endometrial adenocarcinoma via epigenetic modulation was postulated. This publication is linked to the following EFSA Journal article: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2023.7744/full [ABSTRACT FROM AUTHOR]

AMSTAR‐2 is a critical appraisal instrument for systematic reviews and may have a role in editorial processes. This study explored whether associations exist between AMSTAR‐2 assessments and editorial decisions. A retrospective, cross‐sectional study of manuscripts submitted to a single journal between 2015 and 2017 was undertaken. All submissions that reported an eligible systematic review were assessed using AMSTAR‐2 by two assessors. Inter‐rater agreement (IRR) was calculated for all AMSTAR‐2 items. Associations between AMSTAR‐2 assessments and the editorial decision, final publication status in any journal, and measures of impact were explored. One hundred and twenty‐two manuscripts were included. Across all AMSTAR‐2 items, the IRR varied from 0.03 (slight agreement) to 0.82 (substantial agreement). All submissions contained at least two critical methodological weaknesses. There was no difference in the number of weaknesses (median: 4; IQR: 3–5 vs. median: 4; IQR: 3.5–4.5; p = 0.482) between accepted and rejected submissions. Neither was there a difference between rejected submissions published elsewhere and those which remained unpublished (median: 4; IQR: 3.5–4.5 vs. median: 4; IQR: 4.5–5; p = 0.103). The number of weaknesses was not associated with academic impact. There was no association with AMSTAR‐2 assessments and editorial outcomes. Further work is required to explore whether the instrument can be prospectively operationalized for use during editorial processes. [ABSTRACT FROM AUTHOR]

The knowledge‐action gap in conservation science and practice occurs when research outputs do not result in actions to protect or restore biodiversity. Among the diverse and complex reasons for this gap, three barriers are fundamental: knowledge is often unavailable to practitioners and challenging to interpret or difficult to use or both. Problems of availability, interpretability, and useability are solvable with open science practices. We considered the benefits and challenges of three open science practices for use by conservation scientists and practitioners. First, open access publishing makes the scientific literature available to all. Second, open materials (detailed methods, data, code, and software) increase the transparency and use of research findings. Third, open education resources allow conservation scientists and practitioners to acquire the skills needed to use research outputs. The long‐term adoption of open science practices would help researchers and practitioners achieve conservation goals more quickly and efficiently and reduce inequities in information sharing. However, short‐term costs for individual researchers (insufficient institutional incentives to engage in open science and knowledge mobilization) remain a challenge. We caution against a passive approach to sharing that simply involves making information available. We advocate a proactive stance toward transparency, communication, collaboration, and capacity building that involves seeking out and engaging with potential users to maximize the environmental and societal impact of conservation science. [ABSTRACT FROM AUTHOR]

Background: While information evaluation is an essential component of evidence based practice, it remains unclear how nurses perceive their own source evaluation skills and what evaluation criteria they typically apply. Objectives: This study aims to determine nurses' self‐reported confidence in their evaluation skills and their actual source evaluation ability. The findings will guide information literacy instruction. Methods: A questionnaire asked recently graduated nurses from four institutions in the Intermountain West (USA) to rate their confidence in evaluating information and to provide examples of evaluation criteria they typically applied. The quality of these criteria was rated by nursing librarians, then compared with reported confidence in evaluation, years employed as a nurse and highest degree level. Results: While nurses' self‐reported confidence levels about source evaluation largely matched their ability, their evaluation criteria showed a low level of sophistication and did not match the recommended criteria by professional organizations. Graduate education, not years of work experience, was predictive of the quality of criteria used by nurses, suggesting the importance of more instruction on source evaluation for nursing students. Conclusions: Nursing educators, including librarians, need to teach evaluation skills at the undergraduate level. Further investigation into building evaluation skills in nurses is warranted. [ABSTRACT FROM AUTHOR]

In Christie et al. (2019), we used simulations to quantitatively compare the bias of commonly used study designs in ecology and conservation. Based on these simulations, we proposed 'accuracy weights' as a potential way to account for study design validity in meta‐analytic weighting methods. Pescott and Stewart (2022) raised concerns that these weights may not be generalisable and still lead to biased meta‐estimates. Here we respond to their concerns and demonstrate why developing alternative weighting methods is key to the future of evidence synthesis.We acknowledge that our simple simulation unfairly penalised randomised controlled trial (RCT) relative to before‐after control‐impact (BACI) designs as we considered that the parallel trends assumption held for BACI designs. We point to an empirical follow‐up study in which we more fairly quantify differences in biases between different study designs. However, we stand by our main findings that before‐after (BA), control‐impact (CI) and after designs are quantifiably more biased than BACI and RCT designs. We also emphasise that our 'accuracy weighting' method was preliminary and welcome future research to incorporate more dimensions of study quality.We further show that over a decade of advances in quality effect modelling, which Pescott and Stewart (2022) omit, highlights the importance of research such as ours in better understanding how to quantitatively integrate data on study quality directly into meta‐analyses. We further argue that the traditional methods advocated for by Pescott and Stewart (2022; e.g. manual risk‐of‐bias assessments and inverse‐variance weighting) are subjective, wasteful and potentially biased themselves. They also lack scalability for use in large syntheses that keep up‐to‐date with the rapidly growing scientific literature.Synthesis and applications. We suggest, contrary to Pescott and Stewart's narrative, that moving towards alternative weighting methods is key to future‐proofing evidence synthesis through greater automation, flexibility and updating to respond to decision‐makers' needs—particularly in crisis disciplines in conservation science where problematic biases and variability exist in study designs, contexts and metrics used. While we must be cautious to avoid misinforming decision‐makers, this should not stop us investigating alternative weighting methods that integrate study quality data directly into meta‐analyses. To reliably and pragmatically inform decision‐makers with science, we need efficient, scalable, readily automated and feasible methods to appraise and weight studies to produce large‐scale living syntheses of the future. [ABSTRACT FROM AUTHOR]

Network meta‐analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta‐analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care. [ABSTRACT FROM AUTHOR]

Background: Evidence‐based practice (EBP) requires integration of research evidence with clinical expertise and patient preferences. It is endorsed by many regulatory bodies, using the approach is challenging for many busy clinicians. Objectives: To explore mental health practitioners' perceptions of the factors which help, and which hinder, EBP and their views of two formats for presenting research findings – a systematic review and a one‐page summary of that review. (written by a clinical librarian) Methods: Qualitative semi‐structured interviews with a multi‐professional sample of mental health clinicians. (n=7) Results: Participants worked under varying time constraints, with some participants perceiving a conflict between research activities such as reading the evidence and their clinical duties one‐page research summary would help some participienrs to identify potentially valuable evidence quickly. However, participants agreed that they would need to read full systematic review to assess whether and how their practice could or should change. Discussion: A one‐page research summary can perform useful functions for clinicians; however, they require more detailed research reports such as systematic reviews to judge research's external validity. Conclusion: This exploratory study indicates that writing evidence summaries is a useful role for clinical librarians, as part of training and support for EBP. [ABSTRACT FROM AUTHOR]

Since the early 1990s, ecologists and evolutionary biologists have aggregated primary research using meta‐analytic methods to understand ecological and evolutionary phenomena. Meta‐analyses can resolve long‐standing disputes, dispel spurious claims, and generate new research questions. At their worst, however, meta‐analysis publications are wolves in sheep's clothing: subjective with biased conclusions, hidden under coats of objective authority. Conclusions can be rendered unreliable by inappropriate statistical methods, problems with the methods used to select primary research, or problems within the primary research itself. Because of these risks, meta‐analyses are increasingly conducted as part of systematic reviews, which use structured, transparent, and reproducible methods to collate and summarise evidence. For readers to determine whether the conclusions from a systematic review or meta‐analysis should be trusted – and to be able to build upon the review – authors need to report what they did, why they did it, and what they found. Complete, transparent, and reproducible reporting is measured by 'reporting quality'. To assess perceptions and standards of reporting quality of systematic reviews and meta‐analyses published in ecology and evolutionary biology, we surveyed 208 researchers with relevant experience (as authors, reviewers, or editors), and conducted detailed evaluations of 102 systematic review and meta‐analysis papers published between 2010 and 2019. Reporting quality was far below optimal and approximately normally distributed. Measured reporting quality was lower than what the community perceived, particularly for the systematic review methods required to measure trustworthiness. The minority of assessed papers that referenced a guideline (~16%) showed substantially higher reporting quality than average, and surveyed researchers showed interest in using a reporting guideline to improve reporting quality. The leading guideline for improving reporting quality of systematic reviews is the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) statement. Here we unveil an extension of PRISMA to serve the meta‐analysis community in ecology and evolutionary biology: PRISMA‐EcoEvo (version 1.0). PRISMA‐EcoEvo is a checklist of 27 main items that, when applicable, should be reported in systematic review and meta‐analysis publications summarising primary research in ecology and evolutionary biology. In this explanation and elaboration document, we provide guidance for authors, reviewers, and editors, with explanations for each item on the checklist, including supplementary examples from published papers. Authors can consult this PRISMA‐EcoEvo guideline both in the planning and writing stages of a systematic review and meta‐analysis, to increase reporting quality of submitted manuscripts. Reviewers and editors can use the checklist to assess reporting quality in the manuscripts they review. Overall, PRISMA‐EcoEvo is a resource for the ecology and evolutionary biology community to facilitate transparent and comprehensively reported systematic reviews and meta‐analyses. [ABSTRACT FROM AUTHOR]

Background and objective: Clinical Practice Guidelines (CPGs) provide evidence‐based recommendations to healthcare professionals, policy makers, patients and other stakeholders. Mexico is the biggest producer of CPGs in Latin America and Caribbean countries. The National Healthcare Technology Excellence Center (acronym in Spanish: CENETEC) is responsible for the CPG development, adaptation and update. The aim of this study was to assess the adherence to the GRADE framework and to critically appraise the Mexican CPGs with the AGREE‐II tool. Study design: We conducted a descriptive cross‐sectional study with a random sample of 86 CPGs produced by CENETEC between 2015 and 2017 and published in an online database called "Catalogo Maestro". We assessed the adherence to the GRADE framework and performed a critical appraisal with the AGREE II tool. Results: Of the 86 CPGs, 34 were published in 2015, 21 in 2016 and 31 in 2017. Of the 86 CPGs, 25 (29%) used the GRADE framework; adherence to GRADE standards was, however, inconsistent and generally poor. The overall methodological quality by AGREE II proved a median of 16.6% (Min 16.6%, Max 50%). Conclusion: CPGs produced by CENETEC during this period had a poor adherence to the GRADE framework and low score by AGREE II standards. A concerted initiative could rapidly improve CENETEC guidelines. [ABSTRACT FROM AUTHOR]

This paper explores the work that Shane Godbolt did in Africa in strengthening health information networks. It focuses on th role she played in supporting the Association for Health Information and Libraries in Africa (AHILA) and working with the Information Training Outreach Centre for Africa (ITOCA) to provide capacity building linkages. Some examples of such linkages extending beyond Africa to the United Kingdom are explored. It then concludes with reflections from authors on their own experiences of working with Shane Godbolt. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to: identify the evidence on cost‐effectiveness of school‐based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps. Methods: A scoping review of published literature on the cost‐effectiveness of school‐based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Of the 738 records identified in the initial search, 15 studies met the pre‐specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high‐income countries (n = 12). Nearly 80% of the studies assessed the cost‐effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost‐saving or cost‐effective when compared with usual care. Compliance with the CHEERS checklist differed. Conclusions: There is evidence to suggest that school‐based caries preventive interventions are cost‐effective, and in some cases cost‐saving. Further evidence is required from low‐ to middle‐income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost‐effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required. [ABSTRACT FROM AUTHOR]

This feature describes the tailored information skills programme which was delivered for the second cohort of Trainee Nursing Associates (TNAs) at Barnsley Hospital NHS Foundation Trust and presents the results of the evaluation which was undertaken. Literature searching and critical appraisal were offered to the first cohort. Feedback was collated, and sessions were refined and tailored to better meet the information needs of the second cohort of TNAs. A comparison of confidence ratings before and after the programme ascertained whether the information skills programme had a positive benefit in confidence levels of attendees. D.I. [ABSTRACT FROM AUTHOR]

Summary: Critical appraisal skills enabling assessment of the validity and importance of evidence are essential for clinicians to make informed decisions regarding what new information should be incorporated into their clinical practice. This review highlights key points to consider in a critical review concentrating on common study designs used in the equine literature. [ABSTRACT FROM AUTHOR]

Background: Severe burns are associated with a plethora of profound metabolic, immunologic, and physiologic responses, demanding prompt and adequate management. The objective of the present study was to review, compare, and critically appraise medical nutrition therapy guidelines for adult patients with severe burns, and produce salient points for the future update of relevant guidelines.Methods: A total of 8 clinical practice guidelines developed by the American Burn Association (ABA), the European Burn Association (EBA), the European Society for Parenteral and Enteral Nutrition (ESPEN), the Midlands National Health Service, the Society for Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the Spanish Society of Intensive Care Medicine and Coronary Units and Spanish Society of Parenteral and Enteral Nutrition, the Indian Association for Parenteral and Enteral Nutrition (IAPEN), and the International Society for Burn Injury regarding medical nutrition therapy in burn patients was independently reviewed by a team of 4 multidisciplinary researchers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument.Results: From the appraised guidelines, the SCCM/ASPEN guidelines received the greatest scoring in the majority of AGREE domains compared with ABA, EBA, and IAPEN, which obtained the lowest scores. On the other hand, the ESPEN guidelines provided the majority of information concerning nutrition support and medical nutrition therapy.Conclusion: Our study identified gaps in most nutrition guidelines and emphasized methodologic issues that could improve the quality of future guidelines concerning nutrition support among adult severe burn patients. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide an exhaustive survey of the academic research dedicated to the study of human capital‐intensive firms (HCIFs). We use a bibliometric analysis based on the three widely used databases (Econlit, Science Direct and Wiley) over the period 1992–2015. We are adapting a methodology developed in previous works to our specific object of study, and we generate a bottom‐up clustering on keywords, titles and abstracts. Our examination of the data sheds a light on five main clusters of works that respectively focus on (1) critical human resource management, (2) intellectual capital assessment, (3) funding risk and innovation (4) high‐skilled employees supporting economic development and (5) internal and external valuable social networks. In a critical appraisal of our results, we stress that the bibliometric analysis remains silent on how the different clusters are linked with each other. Based on our own appreciation of the HCIFs literature, we propose a further step in the identification of a central question linking up these clusters: a transversal review of the five clusters reveals that HCIFs appear as a network of specialized agents whose complementary human resources are decisive for the value‐creation process. [ABSTRACT FROM AUTHOR]

Objective: To assess the available scientific evidence regarding the effectiveness and complications associated with using dental implants in patients with neurodegenerative diseases.Materials and Methods: PubMed, EMBASE, Biosis Citation Index, CINAHL, Web of Science and LILACS electronic databases were searched, with the last search performed on 20 May 2013. Reference lists of the included systematic reviews were manually reviewed. No restriction regarding the study design or publication language was applied for study inclusion. Only studies involving human subjects were included. In case randomised or other controlled trials were identified, methodological assessment of included studies was planned.Results: Fifty-eight potential papers were initially retrieved from the electronic databases. Eleven papers were finally included. No randomised controlled trial or other controlled trial was found. Eight papers were case reports and three were case series. The sample included three types of neurodegenerative diseases: dementia, Parkinson's disease and Huntington's disease. Generally, the reports showed improvements in chewing function and quality of life after the placement of implants and prostheses. Nevertheless, the follow-up time was typically short (≤12 months), and the overall sample size was small (N = 22 patients). Inclusion of studies without controls prevented a more robust methodological assessment from being performed.Conclusions: The results of the included reports suggest positive outcomes for dental implant use in patients with neurodegenerative diseases. Nevertheless, more robust studies, with better design and longer follow-ups, are needed to set strategies to prevent and treat potential complications in patients with neurodegenerative disorders treated with dental implants. [ABSTRACT FROM AUTHOR]

Objective This study examines behavioural tracking practices on consumer health websites, contrasting tracking on sites recommended by information professionals with tracking on sites returned by Google. Methods Two lists of consumer health websites were constructed: sites recommended by information professionals and sites returned by Google searches. Sites were divided into three groups according to source (Recommended-Only, Google-Only or both) and type (Government, Not-for-Profit or Commercial). Behavioural tracking practices on each website were documented using a protocol that detected cookies, Web beacons and Flash cookies. The presence and the number of trackers that collect personal information were contrasted across source and type of site; a second set of analyses specifically examined Advertising trackers. Results Recommended-Only sites show lower levels of tracking - especially tracking by advertisers - than do Google-Only sites or sites found through both sources. Government and Not-for-Profit sites have fewer trackers, particularly from advertisers, than do Commercial sites. Conclusions Recommended sites, especially those from Government or Not-for-Profit organisations, present a lower privacy threat than sites returned by Google searches. Nonetheless, most recommended websites include some trackers, and half include at least one Advertising tracker. Implications To protect patron privacy, information professionals should examine the tracking practices of the websites they recommend. [ABSTRACT FROM AUTHOR]

Men with prostate cancer are likely to have a long illness and experience psychological distress for which supportive care may be helpful. This systematic review describes the evidence for effectiveness and cost-effectiveness of supportive care for men with prostate cancer, taking into account treatment pathway and components of interventions. MEDLINE, EMBASE, CINAHL, CENTRAL, and Psychinfo were searched from inception--July 2013 for randomized controlled trials and controlled trials. Two authors independently assessed risk of bias and extracted data. Twenty-six studies were included (2740 participants). Interventions were delivered pre and during ( n = 12), short-term ( n = 8), and longer term (18 months) ( n = 5) after primary treatment. No interventions were delivered beyond this time. Few trials recruited ethnic minorities and none recruited men in same sex relationships. Intervention components included information, education, health professional discussion, homework, peer discussion, buddy support, cognitive behavioral therapy, cognitive restructuring, psychoeducation, Reiki and relaxation. Most interventions were delivered for 5-10 weeks. Risk of bias of trials was assessed as unclear for most domains due to lack of information. The majority of trials measuring quality of life and depression found no effect. Relatively few trials measured anxiety, coping skills and self-efficacy, and the majority found no effect. No cost data were available. Trials of supportive care for men with prostate cancer cover a range of interventions but are limited by population diversity, inconsistent measurement and reporting of outcomes, and inability to assess risk of bias . Recommendations on design and conduct of future trials are presented. [ABSTRACT FROM AUTHOR]

The National Comprehensive Cancer Network (NCCN) describes the presence of extracapsular spread and/or positive margins in oropharynx cancer (OPC) as an indication for the addition of chemotherapy to postoperative radiation. The guideline's category 1 consensus is based on what they term high-level evidence. For this study, the authors performed a critical appraisal of the research upon which the NCCN guideline is based and assessed its relevance in the era of human papillomavirus (HPV)/p16-positive OPC. Multiple shortcomings were identified, including patient exclusion after randomization and the use of unplanned subgroup analyses without multivariate adjustment, which undermined internal validity. Indeterminate HPV/p16 status limited external validity. Given the unique biology of HPV/p16-positive tumors and the problems of internal and external validity, the authors concluded that the literature upon which the recommendation for the addition of chemotherapy to adjuvant radiation was based does not generate high-level evidence, and its relevance for the postoperative management of patients with HPV/p16-positive OPC remains unknown. Cancer 2015;121:1747-1754. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

The critical appraisal and quality assessment of primary research are key stages in systematic review and evidence synthesis. These processes are driven by the need to determine how far the primary research evidence, singly and collectively, should inform findings and, potentially, practice recommendations. Quality assessment of primary qualitative research remains a contested area. This article reviews recent developments in the field charting a perceptible shift from whether such quality assessment should be conducted to how it might be performed. It discusses the criteria that are used in the assessment of quality and how the findings of the process are used in synthesis. It argues that recent research indicates that sensitivity analysis offers one potentially useful means for advancing this controversial issue. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Training in evidence-based medicine is most commonly offered to physicians, medical students and health-care decision-makers. Setting and participants We partnered with community organizations to recruit participants and develop trainings for consumers, non-physician health-care providers and journalists in California. Intervention We conducted half-day and one-day workshops in critical appraisal of health evidence. Workshops consisted of didactic presentations, small-group practice sessions and class discussions. Outcome measures We measured knowledge and confidence immediately before and after the workshops and at follow-up 6 months later. We also asked participants to describe their use of health evidence before the workshops and at follow-up. Results At baseline, 41% of the consumers, 45% of the providers and 57% of the journalists correctly answered questions about health evidence. Scores increased by about 20% ( P < 0.05) in all groups at the end of the workshops and remained significantly over baseline at follow-up. At baseline, 26% of the participants were confident in their understanding of critical appraisal concepts, significantly increasing to 54% after the workshops and sustained (53%) at follow-up. During discussions, participants' comments often focused on funding and the potential effects of financial conflicts of interest on study findings. Participants did not use evidence more frequently at follow-up but said that they applied workshop skills in evaluating research, communicating with others and making decisions about health care. Conclusion It is possible to successfully conduct critical appraisal workshops to aid health-related decision making for groups who have previously not had access to this kind of training. [ABSTRACT FROM AUTHOR]

Background: Many dog owners turn to the internet for pet care advice. As internet resources can positively or negatively influence owners' decision making and thus impact dogs' welfare, the identification of trustworthy information online is crucial. Methods: A scoping review was conducted in 2014, and repeated in 2021, to assess the availability and quality indicators of information resources generated from Google searches using empirically derived dog owner internet search terms. Results: A total of 121 unique resources were identified from 300 search hits in 2014, compared to 102 in 2021. On both occasions, the resources identified covered most aspects of dog care and related to all ages and breeds of dog. Flesch Kincaid readability scores indicated the majority to be easily understandable. However, many resources did not offer supporting evidence or a reference list, and the minority of resources stated an author. Of the resources identified in 2014, only 10% (n = 12/121) were dated, compared to 45% in 2021 (n = 46/102). Conclusion: This study found that while a great deal of information on caring for a new dog or puppy is available online, reliable indicators of quality were lacking, posing a barrier to owners' identification of trustworthy information. [ABSTRACT FROM AUTHOR]

To systematically assess published reports on the efficacy of electrophysical therapy in the treatment of diabetic foot ulcers, including electrical stimulation, low-level laser therapy, therapeutic ultrasound and electromagnetic therapy. Databases searched included MEDLINE, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1966 to 2011. Studies reviewed included only randomised controlled trials (RCTs) on treatment with electrophysical modalities compared with sham, conventional treatment or other electrophysical modalities. Information extracted were objective measures of healing and data useful for the calculation of effect size. Eight RCTs were eventually included in the critical appraisal, with a combined total of 325 participants. Five studies were conducted on electrical stimulation, two on phototherapy and one on ultrasound. All studies reported that the experimental group was significantly more favourable than the control or sham group. The pooled estimate of the number of healed ulcers of the three studies on electrical stimulation compared to the control or sham electrical stimulation showed statistical significance [mean difference of 2·8 (95% CI = 1·5-5·5, P = 0·002] in favour of electrical stimulation. The results indicated potential benefit of using electrophysical therapy for managing diabetic foot ulcers. However, due to the small number of trials ever conducted, the possibility of any harmful effects cannot be ruled out, and high-quality trials with larger sample sizes are warranted. [ABSTRACT FROM AUTHOR]

In this paper, we explore the recent emphasis, in various medical contexts, of the term 'critical' or the notion of 'being critical'. We identify various definitions of being critical and note that they differ strikingly. What are these different uses of the term trying to capture that is important in clinical medicine and medical education? We have analysed these qualities as responsibilist, epistemic virtues. We believe that a virtues approach is best able to make sense of the non-cognitive elements of 'being critical', such as the honesty and courage to question claims in the face of persuasion, authority or social pressure. Medical educators and professional bodies seem to agree that being critical is important and desirable. Yet, it is unclear how this quality can be optimally fostered and balanced with the constraints that act upon individual practitioners in the context of institutional medicine including professional standards and the demands of the doctor-patient relationship. Other constraints such as authoritarianism, intimidation and financial pressures may act against the expression of being critical or even the cultivation of critical thinking. The issue of the constraints on critical thinking and the potential hazards it entails will require further consideration by those who encourage being critical in medicine. [ABSTRACT FROM AUTHOR]

Rationale This study focused on factors that most concern specialist societies when choosing an evidence grading system, such as methodological strengths and weaknesses, applicability and ease of use. The grading systems chosen were the Scottish Intercollegiate Guidelines Network (SIGN), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the National Service Framework for long-term neurological conditions critical appraisal tool (NSF-LTC). Methodology Twelve assessors, representing typical members of society-based guideline development groups, graded papers and a recommendation using a key question as a guide. Key questions and recommendations were extracted from existing clinical guidelines representing a variety of research fields. Assessors were given 3 months to grade the papers using the grading systems and to complete a semi-structured qualitative questionnaire. The results were independently assessed for emerging themes. Results Assessors felt all three systems had strengths and weaknesses depending on the type of evidence being graded. GRADE was seen as the most complex but rigorous system, while SIGN and NSF were seen as easier and more flexible to use, but less methodologically rigorous. In grading the evidence, 10% of assessors used GRADE incorrectly, 33% used SIGN incorrectly and 75% used NSF-LTC incorrectly. In grading the recommendations, 60% used GRADE incorrectly, 50% used SIGN incorrectly and 50% used NSF-LTC incorrectly. Implications It is recommended that specialist societies consider the type of evidence they will be evaluating and the research experience of the appraisers before selecting a grading system. Additionally, appraisers should have training in appraising and grading evidence using the system to be employed. [ABSTRACT FROM AUTHOR]

This article reports the validation of an assessment instrument designed to measure the outcomes of training in evidence-based practice (EBP) in the context of dentistry. Four EBP dimensions are measured by this instrument: I) understanding of EBP concepts, 2) attitudes about EBP, 3) evidence-accessing methods, and 4) confidence in critical appraisal. The instrument-the Knowledge, Attitudes, Access, and Confidence Evaluation (KACE)-has four scales, with a total of thirty-five. items: EBP knowledge (ten items), EBP attitudes (ten), accessing evidence (nine), and confidence (six). Four elements of validity were assessed: consistency of items within the KACE scales (extent to which items within a scale measure the same dimension), discrimination (capacity to detect differences between individuals with different training or experience), responsiveness (capacity to detect the effects of education on trainees), and test-retest reliability. Internal consistency of scales was assessed by analyzing responses of second-year dental students, dental residents, and dental faculty members using Cronbach coefficient alpha, statistical measure of reliability. Discriminative validity was assessed by comparing KACE scores for the three groups. Responsiveness was assessed by comparing pre and post-training responses for dental students and residents. To measure test-retest reliability, the full KACE was completed twice by a class of freshman dental students seventeen days apart, and the knowledge scale was completed twice by sixteen faculty members fourteen days apart. Item-to-scale consistency ranged from 0.21 to 0.78 for knowledge, 0.57 to 0.83 for attitude, 0.70 to 0.84 for accessing evidence, and 0.87 to 0.94 for confidence. For discrimination, ANOVA and post hoc testing by the Tukey-Kramer method revealed significant score differences among students, residents, and faculty members consistent with education and experience levels. For responsiveness to training, dental students and residents demonstrated statistically significant changes, in desired directions, from pre - to post-test. For the student test-retest, Pearson correlations for KACE scales were as follows: knowledge 0.66, attitudes 0.66, accessing evidence 0.74, and confidence 0.76. For the knowledge scale test-retest by faculty members, the Pearson correlation was 0.79. The construct validity of the KACE is equivalent to that of instruments that assess similar EBP dimensions in medicine. Item consistency for the knowledge scale was more variable than for other KACE scales, a finding also reported for medically oriented EBP instruments. We conclude that the KACE has good discriminative validity, responsiveness to training effects, and test-retest reliability. [ABSTRACT FROM AUTHOR]

The involvement of service users in the design and conduct of health research has developed significantly in the UK in recent years. Involving service users is now seen as a core component of good research practice for all forms of health research. Given the important role that users have in health research, it is necessary to develop guidelines for their effective involvement. Whilst guidelines are currently being formulated, there remain no criteria with which to assess user involvement in published studies and funding applications. This study offers guidelines for appraising the quality and impact of user involvement in published papers and grant applications. Appraisal guidelines for user involvement have been developed on the basis of available literature and experiences from studies involving cancer patients and carers in the design and conduct of research. Nine appraisal criteria have been developed. Criteria include issues such as 'Is the rationale for involving users clearly demonstrated?', 'Is the level of user involvement appropriate?', 'Is the recruitment strategy appropriate?', and 'Is the nature of training appropriate?' Generating and applying guidelines is vital if the impact of user involvement agenda in health research is to be understood. [ABSTRACT FROM AUTHOR]

Our previous article described the principles of conducting an economic evaluation for evidence-based medical decision making. This article provides some tips for reading, critically appraising and applying the findings of an economic evaluation in clinical practice. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • CYP2C19 polymorphisms may have clinical consequences in relation to drugs extensively metabolized by the enzyme. • Recently a new variant CYP2C19* 17 was discovered. • Unlike other commonly studied variant alleles, notably CYP2C19* 2 and CYP2C19* 3, which are defective, CYP2C19*17 is associated with enhanced enzyme activity and three CYP2C19 phenotypes have been suggested: ultrarapid metabolizers (UM), extensive metabolizers (EM) and poor metabolizers (PM). • There appears to be interethnic variability in the prevalence of the CYP2C19* 17 allele. WHAT THIS STUDY ADDS • We provide the first critical quantitative review of this rapidly developing area of research to serve as a basis for subsequent research and overviews. • We summarize data on population prevalence and functional effects of CYP2C19* 17. • We argue on the basis of current evidence that potentially significant clinical effects are unlikely except for drugs with very narrow therapeutic windows. Of studied substrates, only clopidogrel may fall into this category. Even then, only homozygotes of the variant allele are likely to be at significantly increased risk. • The assignment of CYP2C19* 17 homozygotes as EM, rather than UM, is adequate as the metabolic ratios of all probe drugs studied so far overlap completely the range of values seen in wild-type homozygotes. • The implications of CYP2C19* 17 on the clinical effects of tamoxifen require further study. AIMS Cytochrome P450 2C19 metabolizes many important drugs. In 2006, a variant allele ( CYP2C19* 17) associated with increased activity was discovered, but its likely clinical significance is controversial. Investigators disagree about the phenotype to be assigned to the two CYP2C19* 17 genotypes. The aim of this study was to provide a critical summary, helpful to prescribers. METHODS We searched MEDLINE for papers on the allele from 2006 and then undertook historical searches through the reference lists of papers retrieved. The relevant information was critically assessed and summarized. RESULTS CYP2C19* 17 was associated with increased enzymic activity. Substrates studied were omeprazole, pantoprazole, escitalopram, sertraline, voriconazole, tamoxifen and clopidogrel. Most studies used pharmacokinetic variables as outcome measure. For clopidogrel, activated by CYP2C19, pharmacodynamic consequences focused on platelet aggregation. While for most pharmacokinetic parameters of the substrates studied the average value was altered, the range of values showed mostly complete overlap for CYP2C19* 1/* 17 heterozygotes and wild-type homozygotes. Even for CYP2C19* 17 homozygotes, the absolute effect was modest compared with the effect of previously identified loss-of-function alleles. In Helicobacter pylori eradication CYP2C19* 2 carriage was associated with an altered eradication rate (odds ratio 4.20, 95% confidence interval 1.23, 16.44) relative to the wild-type, but CYP2C19* 17 homozygosity was not. Prevalence of the variant allele was typically <5% in Asians and about four times higher in White and African populations. CONCLUSIONS Assignment of CYP2C19* 17 homozygotes as extensive metabolizers rather than ultrarapid metabolizers is adequate. CYP2C19* 17 genotyping is unlikely to have clinical utility except for drugs with very narrow therapeutic indices. [ABSTRACT FROM AUTHOR]

Objectives The level of evidence-based practice (EBP) and awareness has not been previously assessed among primary care physicians in Kuwait. The objectives of this study were to quantify the level of EBP and awareness in Kuwait and identify the factors related to EBP. Method We used a cross sectional study that enrolled 332 primary care physicians in 57 primary care centres randomly chosen in Kuwait. A self-administered questionnaire was used to collect the data with a response rate of about 93%. Results Although half of the physicians self reported that they use EBP most of the time, further analysis revealed that only about 24% of this group had a reasonable understanding of EBP. Most of the clinical practice in the Kuwaiti primary care system seems to be based on the clinician's own judgment or what they learned in the medical school and traditional text books, rather than evidence-based sources. None of the physicians had an Internet connection at their work place and a vast majority of them had no access to international journals nor were confident about critical appraisal of published evidence. Conclusion Overall level of awareness of evidence-based medicine (EBM) among primary care physicians in Kuwait was considerably low. Training in the areas of EBM as well as making sure the Kuwaiti primary care centres have access to evidence-based sources are critically important if primary care in Kuwait were to become evidence based. [ABSTRACT FROM AUTHOR]

Objective To develop tools for use by teams of point-of-care clinicians to improve access to evidence evaluation. Method A search of the literature was conducted to review available evidence evaluation systems for their applicability to the project. Fourteen systems were reviewed in depth for strengths and limitations of the systems to meet the objective. Using these strengths and addressing the limitations, tools were developed and pilot-tested among an interprofessional team of clinicians. Results Five principles were drawn from the review of the literature and from our experience to guide development of six tools. The tools form a comprehensive evidence evaluation system known as Let Evidence Guide Every New Decision (LEGEND). LEGEND included a glossary, a table of evidence levels, an algorithm, a set of evidence appraisal forms, and worksheets to guide grading a body of evidence and judging the strength of a recommendation. Conclusion LEGEND provides tools for point-of-care clinicians that assist them in synthesizing evidence from published studies. The tools provide a balance between quality processes and simplicity, use terminology friendly to multiple disciplines, assist comprehensively with the evidence evaluation process, incorporate factors familiar to the user, and provide flexibility for a diverse range of evidence evaluation projects and users. [ABSTRACT FROM AUTHOR]

In this article, the Task Force on Student Outcomes Assessment of the American Dental Education Association's Commission on Change and Innovation in Dental Education describes the current status of student outcomes assessment in U.S. dental education. This review is divided into six sections. The first summarizes the literature on assessment of dental students' performance. Section two discusses catalysts, with a focus on problem-based learning, for development of new assessment methods, while the third section presents several resources and guides that can be used to inform selection of assessment techniques for various domains of competence. The fourth section describes the methodology and results of a 2008 survey of current assessment practices in U.S. dental schools. In the fifth Section, findings from this survey are discussed within the context of competencybased education, the educational model for the predoctoral curriculum endorsed by the American Dental Education Association and prescribed by the Commission on Dental Accreditation. The article concludes with a summary of assessments recommended as optimal strategies to measure three components of professional competence based on the triangulation model. The survey of assessment practices in predoctoral education was completed by 931 course directors, representing 45 percent of course directors nationwide, from fifty-three of the fifty-six U.S. dental schools. Survey findings indicate that five traditional mainstays of student performance evaluation-multiple-choice testing, lab practicals, daily grades, clinical competency exams, and procedural requirements-still comprise the primary assessment tools in dental education. The survey revealed that a group of newer assessment techniques, although frequently identified as best practices in the literature and commonly used in other areas of health professions education, are rarely employed in predoctoral dental education. [ABSTRACT FROM AUTHOR]

The capacity to locate, access, and appraise information is an important skill required for success in dental school and beyond. An interdisciplinary course was implemented to teach first-year dental students at the University of Texas Health Science Center at Houston Dental Branch about evidence-based dentistry, search strategies, critical appraisal of the literature, and dental informatics. Students learned to develop a clinical question, conduct a search to find answers to that question, and critically appraise one of the retrieved resources. Over a period of four years, a total of 259 dental students completed a questionnaire that requested their assessment of this course. Seventy-five percent of the respondents agreed or strongly agreed that they learned to effectively search databases such as the Cochrane Collaboration and PubMed and to critically appraise websites and journal articles and that the information on evidence-based dentistry and critical thinking skills was valuable. In response to open-ended questions, approximately 35 percent of the respondents mentioned the importance of learning to search PubMed and Cochrane databases. Approximately 20 percent of the respondents felt the course did not contain new information. These results indicated the effectiveness of the course in familiarizing the students with the capacity of online resources to help them locate, access, and appraise information pertinent to oral health issues and the practice of dentistry. A future goal is to integrate information and skills associated with evidence-based practice into other courses in the dental curriculum. [ABSTRACT FROM AUTHOR]