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Background: Virtual journal clubs (VJCs) are innovative technologies with the potential to foster collaboration, facilitate multilingual communication, improve cultural competencies, and expand global professional networks. This allowed participants to be exposed to critical appraisal of the articles. However, its long-term impact on competency development has been debated. This study aimed to investigate the impact of implementing VJCs on developing competencies for critical appraisal among postgraduate nursing students. Methods: A quasi-experimental (pretest/posttest one-group) research design was used with a convenience sample of 40 participants from the community health nursing department, Faculty of Nursing, Mansoura University, Egypt who agreed to participate. The participants received an online self-administered knowledge and attitude data collection tool through Google Forms. However, critical appraisal skills were evaluated by an observational checklist with a rubric through synchronized mode. Eleven VJC sessions were conducted for each participant. Descriptive analysis served as the primary method for analyzing participants' responses. Students' t-test and one-way analysis of variance (ANOVA) were used to measure differences between the pretest and post-test. The study also used a correlation test to assess the relationship of variables. Results: The findings indicated a highly statistically significant difference among the participants regarding knowledge, critical appraisal skills, and attitudes toward VJC before, immediately, and six months after VJC session implementation. In addition, a positive significant correlation with a highly statistically significant difference between the participants' total knowledge score levels, total practice score levels, and total attitude score levels in the immediate post and after six months of VJC session implementation (p < 0.001). Conclusion: The findings indicate this intervention has the potential to enhance critical appraisal competencies among postgraduate students. Therefore, VJCs should be included regularly to enhance critical appraisal competencies in academic settings for continued professional development. [ABSTRACT FROM AUTHOR]

To support the development of appraisal tools for assessing the quality of in vitro studies, we developed a method for literature-based discovery of study assessment criteria, used the method to create an item bank of assessment criteria of potential relevance to in vitro studies, and analyzed the item bank to discern and critique current approaches for appraisal of in vitro studies. We searched four research indexes and included any document that identified itself as an appraisal tool for in vitro studies, was a systematic review that included a critical appraisal step, or was a reporting checklist for in vitro studies. We abstracted, normalized, and categorized all criteria applied by the included appraisal tools to create an "item bank" database of issues relevant to the assessment of in vitro studies. The resulting item bank consists of 676 unique appraisal concepts from 67 appraisal tools. We believe this item bank is the single most comprehensive resource of its type to date, should be of high utility for future tool development exercises, and provides a robust methodology for grounding tool development in the existing literature. Although we set out to develop an item bank specifically targeting in vitro studies, we found that many of the assessment concepts we discovered are readily applicable to other study designs. Item banks can be of significant value as a resource; however, there are important challenges in developing, maintaining, and extending them of which researchers should be aware. [ABSTRACT FROM AUTHOR]

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]

Background: In current clinical practice, pharmaceutical companies use drug promotional literatures (DPLs) as a promotional tool to introduce new products entering into the market to medical practitioners. DPLs play a major role in providing important information about the drug to the health-care professionals and to convince them to prescribe the same. Aims and Objectives: The aims and objectives of the study are to evaluate the appropriateness of DPLs as per the World Health Organization (WHO) criteria for rational drug promotion and for other information such as the pictures given and the presence of self-boasting words, if any. Materials and Methods: A cross-sectional observational study was conducted from December 2022 to May 2023 at a tertiary care teaching institute in southern Rajasthan, India. 330 DPLs, using convenient sampling, were collected in the form of hard and soft copies of flyers, leaflets, brochures, and pamphlets from various registered medical practitioners from a variety of departments and were evaluated based on the WHO guidelines. Results: A total of 330 DPLs were evaluated. Generic name was present in 98.2%, brand name in 97.9%, amount of active ingredient in 90%, name of manufacturer in 100%, and reference to scientific literature in 57.6%. About 75.5% of DPLs depicted photographs and 53% mentioned self-boasting words or phrases. Conclusion: Only few DPLs fulfilled all eleven criteria laid down by the WHO. Hence, doctors should not rely solely on promotional literature and appropriate policies must be made for vigilance of the DPLs. [ABSTRACT FROM AUTHOR]

Abstract Background Virtual journal clubs (VJCs) are innovative technologies with the potential to foster collaboration, facilitate multilingual communication, improve cultural competencies, and expand global professional networks. This allowed participants to be exposed to critical appraisal of the articles. However, its long-term impact on competency development has been debated. This study aimed to investigate the impact of implementing VJCs on developing competencies for critical appraisal among postgraduate nursing students. Methods A quasi-experimental (pretest/posttest one-group) research design was used with a convenience sample of 40 participants from the community health nursing department, Faculty of Nursing, Mansoura University, Egypt who agreed to participate. The participants received an online self-administered knowledge and attitude data collection tool through Google Forms. However, critical appraisal skills were evaluated by an observational checklist with a rubric through synchronized mode. Eleven VJC sessions were conducted for each participant. Descriptive analysis served as the primary method for analyzing participants’ responses. Students’ t-test and one-way analysis of variance (ANOVA) were used to measure differences between the pretest and post-test. The study also used a correlation test to assess the relationship of variables. Results The findings indicated a highly statistically significant difference among the participants regarding knowledge, critical appraisal skills, and attitudes toward VJC before, immediately, and six months after VJC session implementation. In addition, a positive significant correlation with a highly statistically significant difference between the participants’ total knowledge score levels, total practice score levels, and total attitude score levels in the immediate post and after six months of VJC session implementation (p

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]

This is the twelfth in a series of articles to help readers increase their knowledge - and, in the process, enhance their skill and confidence in appraising, synthesizing, interpreting, and ultimately deciding if a given piece of evidence should be incorporated into practice. This article discusses "validity" as it relates to a measurement instrument. [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]

Purpose: The efficacy of factor Xa inhibitors in patients with atrial fibrillation (AF) and rheumatic heart disease (RHD) is unknown. Methods/Results: The objective of this article was to conduct a comprehensive evaluation of the INVICTUS trial, an open-label randomized controlled study that compared vitamin K antagonists (VKA) to rivaroxaban in patients with AF and RHD while also considering the existing evidence from literature in this particular area of research. Conclusion: The findings of the INVICTUS trial indicated that rivaroxaban was found to be inferior in efficacy to VKA. However, it is important to note that the primary outcome of the trial was driven by sudden death and death caused by mechanical pump failure. As a result, it is necessary to approach the data from this study with caution, and it would be inappropriate to draw parallel conclusions for other causes of valvular AF. Particularly, the perplexing issue of how rivaroxaban could have contributed to both pump failure and sudden cardiac death requires further explanation. Additional data regarding changes in heart failure medication and ventricular function would be essential for proper interpretation. [ABSTRACT FROM AUTHOR]

Abstract Background The fragility index is a statistical measure of the robustness or “stability” of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant. The purpose of this study is to assess the fragility index of randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder. This will provide an indication as to the robustness of trials in the field and the confidence that should be placed in the trials’ outcomes, potentially identifying ways to improve clinical research in the field. This is especially important as opioid use disorder has become a global epidemic, and the incidence of opioid related fatalities have climbed 500% in the past two decades. Methods Six databases were searched from inception to September 25, 2021, for randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder, and meeting the necessary requirements for fragility index calculation. Specifically, we included all parallel arm or two-by-two factorial design RCTs that assessed the effectiveness of any opioid substitution and antagonist therapies using a binary primary outcome and reported a statistically significant result. The fragility index of each study was calculated using methods described by Walsh and colleagues. The risk of bias of included studies was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. Results Ten studies with a median sample size of 82.5 (interquartile range (IQR) 58, 179, range 52–226) were eligible for inclusion. Overall risk of bias was deemed to be low in seven studies, have some concerns in two studies, and be high in one study. The median fragility index was 7.5 (IQR 4, 12, range 1–26). Conclusions Our results suggest that approximately eight participants are needed to overturn the conclusions of the majority of trials in opioid use disorder. Future work should focus on maximizing transparency in reporting of study results, by reporting confidence intervals, fragility indexes, and emphasizing the clinical relevance of findings. Trial registration PROSPERO CRD42013006507. Registered on November 25, 2013.

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]

Purpose: As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster. Methods: We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale. Results: Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement. Conclusion: Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration. [ABSTRACT FROM AUTHOR]

Background: The fragility index is a statistical measure of the robustness or "stability" of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant. The purpose of this study is to assess the fragility index of randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder. This will provide an indication as to the robustness of trials in the field and the confidence that should be placed in the trials' outcomes, potentially identifying ways to improve clinical research in the field. This is especially important as opioid use disorder has become a global epidemic, and the incidence of opioid related fatalities have climbed 500% in the past two decades. Methods: Six databases were searched from inception to September 25, 2021, for randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder, and meeting the necessary requirements for fragility index calculation. Specifically, we included all parallel arm or two-by-two factorial design RCTs that assessed the effectiveness of any opioid substitution and antagonist therapies using a binary primary outcome and reported a statistically significant result. The fragility index of each study was calculated using methods described by Walsh and colleagues. The risk of bias of included studies was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. Results: Ten studies with a median sample size of 82.5 (interquartile range (IQR) 58, 179, range 52–226) were eligible for inclusion. Overall risk of bias was deemed to be low in seven studies, have some concerns in two studies, and be high in one study. The median fragility index was 7.5 (IQR 4, 12, range 1–26). Conclusions: Our results suggest that approximately eight participants are needed to overturn the conclusions of the majority of trials in opioid use disorder. Future work should focus on maximizing transparency in reporting of study results, by reporting confidence intervals, fragility indexes, and emphasizing the clinical relevance of findings. Trial registration: PROSPERO CRD42013006507. Registered on November 25, 2013. [ABSTRACT FROM AUTHOR]

Qualitative researchers can benefit from using generative artificial intelligence (GenAI), such as different versions of ChatGPT--GPT-3.5 or GPT-4, Google Bard--now renamed as a Gemini, and Bing Chat--now renamed as a Copilot, in their studies. The scientific community has used artificial intelligence (AI) tools in various ways. However, using GenAI has generated concerns regarding potential research unreliability, bias, and unethical outcomes in GenAIgenerated research results. Considering these concerns, the purpose of this commentary is to review the current use of GenAI in qualitative research, including its strengths, limitations, and ethical dilemmas from the perspective of critical appraisal from South Asia, Nepal. I explore the controversy surrounding the proper acknowledgment of GenAI or AI use in qualitative studies and how GenAI can support or challenge qualitative studies. First, I discuss what qualitative researchers need to know about GenAI in their research. Second, I examine how GenAI can be a valuable tool in qualitative research as a co-author, a conversational platform, and a research assistant for enhancing and hindering qualitative studies. Third, I address the ethical issues of using GenAI in qualitative studies. Fourth, I share my perspectives on the future of GenAI in qualitative research. I would like to recognize and record the utilization of GenAI and/or AI alongside my cognitive and evaluative abilities in constructing this critical appraisal. I offer ethical guidance on when and how to appropriately recognize the use of GenAI in qualitative studies. Finally, I offer some remarks on the implications of using GenAI in qualitative studies. [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]

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Abstract To inform environmental policy and practice, researchers estimate effects of interventions/exposures by conducting primary research (e.g., impact evaluations) or secondary research (e.g., evidence reviews). If these estimates are derived from poorly conducted/reported research, then they could misinform policy and practice by providing biased estimates. Many types of bias have been described, especially in health and medical sciences. We aimed to map all types of bias from the literature that are relevant to estimating causal effects in the environmental sector. All the types of bias were initially identified by using the Catalogue of Bias (catalogofbias.org) and reviewing key publications (n = 11) that previously collated and described biases. We identified 121 (out of 206) types of bias that were relevant to estimating causal effects in the environmental sector. We provide a general interpretation of every relevant type of bias covered by seven risk-of-bias domains for primary research: risk of confounding biases; risk of post-intervention/exposure selection biases; risk of misclassified/mismeasured comparison biases; risk of performance biases; risk of detection biases; risk of outcome reporting biases; risk of outcome assessment biases, and four domains for secondary research: risk of searching biases; risk of screening biases; risk of study appraisal and data coding/extraction biases; risk of data synthesis biases. Our collation should help scientists and decision makers in the environmental sector be better aware of the nature of bias in estimation of causal effects. Future research is needed to formalise the definitions of the collated types of bias such as through decomposition using mathematical formulae.

When evidence from randomized controlled trials about the effectiveness and safety of an intervention is unclear, researchers may choose to review the nonrandomized evidence. All systematic reviews pose considerable challenges, and the level of methodological expertise required to undertake a useful review of nonrandomized intervention studies is both high and often severely underestimated. Using the example of the endometrial receptivity array, we review some common, critical flaws in systematic reviews of this nature, including errors in critical appraisal and meta-analysis. [ABSTRACT FROM AUTHOR]

An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the 'gift of life' are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care. [ABSTRACT FROM AUTHOR]

To inform environmental policy and practice, researchers estimate effects of interventions/exposures by conducting primary research (e.g., impact evaluations) or secondary research (e.g., evidence reviews). If these estimates are derived from poorly conducted/reported research, then they could misinform policy and practice by providing biased estimates. Many types of bias have been described, especially in health and medical sciences. We aimed to map all types of bias from the literature that are relevant to estimating causal effects in the environmental sector. All the types of bias were initially identified by using the Catalogue of Bias (catalogofbias.org) and reviewing key publications (n = 11) that previously collated and described biases. We identified 121 (out of 206) types of bias that were relevant to estimating causal effects in the environmental sector. We provide a general interpretation of every relevant type of bias covered by seven risk-of-bias domains for primary research: risk of confounding biases; risk of post-intervention/exposure selection biases; risk of misclassified/mismeasured comparison biases; risk of performance biases; risk of detection biases; risk of outcome reporting biases; risk of outcome assessment biases, and four domains for secondary research: risk of searching biases; risk of screening biases; risk of study appraisal and data coding/extraction biases; risk of data synthesis biases. Our collation should help scientists and decision makers in the environmental sector be better aware of the nature of bias in estimation of causal effects. Future research is needed to formalise the definitions of the collated types of bias such as through decomposition using mathematical formulae. [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]

This article examines the issue of overadjustment bias in systematic reviews and meta-analyses of observational studies. It emphasizes the need to address biases, such as selection, measurement, and confounding biases, in order to obtain accurate estimates. The authors find that while guidelines and tools for conducting and reporting these reviews often address confounding bias, they rarely consider overadjustment bias. The authors argue that guidelines and tools should explicitly address overadjustment bias to enhance the quality of these reviews. They recommend including overadjustment bias in guidelines and standards, promoting recent tools that address both overadjustment and confounding, and implementing strategies to improve adherence to guidelines. [Extracted from the article]

Introduction: Network meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of the comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs. Methods and analysis: We included papers that present items related to bias, reporting or methodological quality, papers assessing the quality of NMAs, or method papers. We searched MEDLINE, the Cochrane Library and unpublished literature (up to July 2020). We extracted items related to bias in NMAs. An item was excluded if it related to general systematic review quality or bias and was included in currently available tools such as ROBIS or AMSTAR 2. We reworded items, typically structured as questions, into concepts (i.e. general notions). Results: One hundred eighty-one articles were assessed in full text and 58 were included. Of these articles, 12 were tools, checklists or journal standards; 13 were guidance documents for NMAs; 27 were studies related to bias or NMA methods; and 6 were papers assessing the quality of NMAs. These studies yielded 99 items of which the majority related to general systematic review quality and biases and were therefore excluded. The 22 items we included were reworded into concepts specific to bias in NMAs. Conclusions: A list of 22 concepts was included. This list is not intended to be used to assess biases in NMAs, but to inform the development of items to be included in our tool. [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]

Hospital librarians receive invites to teach thinking and searching in an evidence-based way and critical appraisal of the literature to nurses. With these invitations, the hospital librarians play a central role in establishing an evidence-based culture in the hospital and contribute to the nursing staff feeling competent and confident in fulfilling evidence-based competencies. This author just prepared a 17-minute online talk as part of an international nursing webinar on "searching nursing literature in an evidence-based way." Using this experience, remembering other teaching and presentation experiences, and some "help" from AI tools, this experienced hospital librarian suggests decision points for colleagues to create a meaningful, practical information session for nurses and introduce to some AI tools along the way. [ABSTRACT FROM AUTHOR]

Abstract Background Different network meta-analyses (NMAs) on the same topic result in differences in findings. In this review, we investigated NMAs comparing aflibercept with ranibizumab for diabetic macular oedema (DME) in the hope of illuminating why the differences in findings occurred. Methods Studies were searched for in English and Chinese electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP; see detailed search strategy in the main body). Two independent reviewers systematically screened to identify target NMAs that included a comparison of aflibercept and ranibizumab in patients with DME. The key outcome of interest in this review is the change in best-corrected visual acuity (BCVA), including various ways of reporting (such as the proportion of participants who gain ≥ 10 ETDRS letters at 12 months; average change in BCVA at 12 months). Results For the binary outcome of BCVA, different NMAs all agreed that there is no clear difference between the two treatments, while continuous outcomes all favour aflibercept over ranibizumab. We discussed four points of particular concern that are illustrated by five similar NMAs, including network differences, PICO (participants, interventions, comparators, outcomes) differences, different data from the same measures of effect, and differences in what is truly significant. Conclusions A closer inspection of each of these trials shows how the methods, including the searches and analyses, all differ, but the findings, although presented differently and sometimes interpreted differently, were similar.

Abstract Background The most effective method of teaching critical appraisal concepts remains unclear. We used simulation scenarios in a Risk-of-Bias (RoB) 2.0 framework to teach the various biases that may affect randomized controlled trials and assessed whether including this interactive session in an evidence-based medicine (EBM) course for third-year preclinical medical students can optimize their understanding of critical appraisal concepts. Methods The session had 13 modules, each corresponding to a particular risk of bias in RoB 2.0. Each module included a simulated scenario, followed by data presentation and a generalized conclusion. The students were subsequently asked to use colored vote cards to indicate whether they agreed, had some concern, or disagreed with the conclusion and to justify their answers. On the basis of the students’ answers, the facilitator debriefed the scenario and addressed the specific bias. In each module, the students were required to demonstrate critical thinking in analyzing the claims and quality of the supporting evidence and in justifying their decisions, thus conceptualizing their understanding of research biases. Results We included 306 students across two pilot sessions in spring 2020 and 2021, and the response rate was 97.4%. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging. Conclusion Preclinical medical students generally appreciated the inclusion of simulation scenarios and vote cards in an EBM course. The use of vote cards facilitated medical students’ understanding of critical appraisal concepts, uncovered areas that they found challenging to understand, and encouraged their active participation. Such interactive sessions should be increasingly included in medical education.

Abstract Objective To explore and critically appraise the evidence supporting the role of estrogen withdrawal in menstrual migraine. Main body Menstrual migraine, impacting about 6% of reproductive-age women, manifests as migraine attacks closely related to the menstrual cycle. The estrogen withdrawal hypothesis posits that the premenstrual drop in estrogen levels serves as a trigger of migraine attacks. Despite its wide acceptance, the current body of evidence supporting this hypothesis remains limited, warranting further validation. Estrogen is believed to exert a modulatory effect on pain, particularly within the trigeminovascular system – the anatomic and physiologic substrate of migraine pathogenesis. Nevertheless, existing studies are limited by methodologic inconsistencies, small sample sizes, and variable case definitions, precluding definitive conclusions. To improve our understanding of menstrual migraine, future research should concentrate on untangling the intricate interplay between estrogen, the trigeminovascular system, and migraine itself. This necessitates the use of robust methods, larger sample sizes, and standardized case definitions to surmount the limitations encountered in previous investigations. Conclusion Further research is thus needed to ascertain the involvement of estrogen withdrawal in menstrual migraine and advance the development of effective management strategies to address unmet treatment needs.

This is the eleventh in a series of articles to help readers increase their knowledge and, in the process, enhance their skill and confidence in appraising, synthesizing, interpreting, and ultimately deciding if a given piece of evidence should be incorporated into practice. This article defines and describes the term 'reliability' within the context of a research study. [ABSTRACT FROM AUTHOR]

Abstract Introduction Umbrella review is one of the terms used to describe an overview of systematic reviews. During the last years, a rapid increase in the number of umbrella reviews on epidemiological studies has been observed, but there is no systematic assessment of their methodological and reporting characteristics. Our study aims to fill this gap by performing a systematic mapping of umbrella reviews in epidemiological research. Methods We will perform a meta-epidemiological study including a systematic review in MEDLINE and EMBASE to identify all the umbrella reviews that focused on systematic reviews of epidemiological studies and were published from inception until December 31, 2022. We will consider eligible any research article which was designed as an umbrella review and summarized systematic reviews and meta-analyses of epidemiological studies. From each eligible article, we will extract information about the research topic, the methodological characteristics, and the reporting characteristics. We will examine whether the umbrella reviews assessed the strength of the available evidence and the rigor of the included systematic reviews. We will also examine whether these characteristics change across time. Discussion Our study will systematically appraise the methodological and reporting characteristics of published umbrella reviews in epidemiological literature. The findings of our study can be used to improve the design and conduct of future umbrella reviews, to derive a standardized set of reporting and methodological guidelines for umbrella reviews, and to allow further meta-epidemiological work. Systematic review registration osf.io/sxzc6

Randomized Control Trials (RCTs) are the major source of information on the efficacy and safety of new and repurposed therapeutic agents and treatments. Therefore, it becomes essential that RCTs are of good quality and free of any biases. In the ever-evolving field of healthcare, making the correct clinical decision is important. Critical appraisal of new medical findings is therefore of utmost importance since clinical judgments are made based on the evidence provided by the publications and trial reports. In this review, we analyze the process of critically appraising RCTs using various researcher-developed guidelines and The Critical Appraisal Skills Programme (CASP) checklist for RCTs.

Abstract 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 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.

An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the ‘gift of life’ are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.

This article provides a summary and critical appraisal of the systematic review conducted by Alidoust et al. 1 regarding the various effects of housing on both physical and psychological well-being. We aim to discuss the review's findings against existing published evidence to draw out policy and practical implications. Our mini-review illuminates a wide range of housing-related factors which impact on health around which we draw evidence-based policy initiatives and implications, and outline avenues for future research. This mini-review is part of the wider Rapid Conversion of Evidence Summaries (RaCES) program which aims to critically appraise systematic reviews and highlight evidence-based policy and practice implications.

Background: Given current health system trends, clinicians increasingly care for patients with complex care needs. There is a recognized lack of evidence to support clinician decision-making in these situations, as complex or multimorbid patients have been historically excluded from the types of research that inform clinical practice guidelines. However, expert clinicians at sites of excellence (e.g., Stroke Distinction sites) provide measurably excellent care. We sought to review profession-specific competency frameworks to locate information that may be supporting the development of clinician expertise when managing the care of patients with complex care needs. Methods: We conducted a review of the professional competency frameworks for core members of the inpatient stroke rehabilitation team, to determine the degree of guidance and/or preparation for the management of patients with complex care needs. We developed and applied an assessment rubric to locate references to patient complexity, multimorbidity and complexity theory. Results: Across the professional competency frameworks, there are some references to complexity at patient- and team-levels; there are fewer references to system-level complexity. We noted a lack of clear guidance for clinicians regarding the management of patients with complex care needs. Conclusion: Further research is needed to explore how clinicians develop expertise in the management of patients with complex care needs, as we noted minimal guidance in the professional competency frameworks. However, we suggest that integrating complexity-related language into professional competency frameworks could better prime novice clinicians for new learning in the workplace and ease their transition into working in a complex context. [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]

Objective Mixed methods research (MMR) integrates quantitative and qualitative methods throughout the research process to answer complex research questions. MMR designs align with the guiding frameworks of patient-centered care and social determinants of health by effectively examining the role of contextual factors and human experiences in influencing health and rehabilitation outcomes. Reporting standards and critical appraisal tools ensure the quality and transparency of the research process. MMR standards exist; yet, there is a need for reporting guidelines and an appraisal tool that meets field standards, is applicable across rehabilitation fields of study, and can accommodate the range of possibilities for combining research approaches and methods. Methods Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) was developed using a systematic consensus-building process in accordance with published guidance and was preregistered with the Enhancing the Quality and Transparency of Health Research Network. MMR-RHS evolved through a sequence of steps, including extensive literature review, expert consultation, stakeholder feedback, pilot testing, and tool refinement. Results MMR-RHS consists of 20 criteria that align with field standards for rigor and transparency, with an emphasis on integration throughout the research process, a key component of MMR. Conclusions A systematic process was utilized to develop the reporting standards and an appraisal tool for MMR in rehabilitation and health science. The tool is comprehensive, includes a set of criteria grounded in MMR literature, and is flexible for application to a range of MMR designs commonly seen in rehabilitation research. Impact The MMR-RHS may improve the quality and transparency of MMR by supporting investigators, authors, reviewers, and editors during project development, manuscript preparation, and critical review. The tool may assist readers in critical appraisal, knowledge translation, and application of published MMR findings. Ultimately, the MMR-RHS may help legitimize mixed methods in rehabilitation and health research, an important step toward understanding the complexities of health care, patient outcomes, and evolving societal health needs. [ABSTRACT FROM AUTHOR]

Background: Different network meta-analyses (NMAs) on the same topic result in differences in findings. In this review, we investigated NMAs comparing aflibercept with ranibizumab for diabetic macular oedema (DME) in the hope of illuminating why the differences in findings occurred. Methods: Studies were searched for in English and Chinese electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP; see detailed search strategy in the main body). Two independent reviewers systematically screened to identify target NMAs that included a comparison of aflibercept and ranibizumab in patients with DME. The key outcome of interest in this review is the change in best-corrected visual acuity (BCVA), including various ways of reporting (such as the proportion of participants who gain ≥ 10 ETDRS letters at 12 months; average change in BCVA at 12 months). Results: For the binary outcome of BCVA, different NMAs all agreed that there is no clear difference between the two treatments, while continuous outcomes all favour aflibercept over ranibizumab. We discussed four points of particular concern that are illustrated by five similar NMAs, including network differences, PICO (participants, interventions, comparators, outcomes) differences, different data from the same measures of effect, and differences in what is truly significant. Conclusions: A closer inspection of each of these trials shows how the methods, including the searches and analyses, all differ, but the findings, although presented differently and sometimes interpreted differently, were similar. [ABSTRACT FROM AUTHOR]

Background: The most effective method of teaching critical appraisal concepts remains unclear. We used simulation scenarios in a Risk-of-Bias (RoB) 2.0 framework to teach the various biases that may affect randomized controlled trials and assessed whether including this interactive session in an evidence-based medicine (EBM) course for third-year preclinical medical students can optimize their understanding of critical appraisal concepts. Methods: The session had 13 modules, each corresponding to a particular risk of bias in RoB 2.0. Each module included a simulated scenario, followed by data presentation and a generalized conclusion. The students were subsequently asked to use colored vote cards to indicate whether they agreed, had some concern, or disagreed with the conclusion and to justify their answers. On the basis of the students' answers, the facilitator debriefed the scenario and addressed the specific bias. In each module, the students were required to demonstrate critical thinking in analyzing the claims and quality of the supporting evidence and in justifying their decisions, thus conceptualizing their understanding of research biases. Results: We included 306 students across two pilot sessions in spring 2020 and 2021, and the response rate was 97.4%. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging. Conclusion: Preclinical medical students generally appreciated the inclusion of simulation scenarios and vote cards in an EBM course. The use of vote cards facilitated medical students' understanding of critical appraisal concepts, uncovered areas that they found challenging to understand, and encouraged their active participation. Such interactive sessions should be increasingly included in medical education. [ABSTRACT FROM AUTHOR]