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• Menopause HRT gains popularity as more women seek relief from symptoms. • Recommendations for HRT use vary widely among health experts and organizations. • Critical review of HRT CPGs is essential for informed menopause treatment choice. • Patients need the best available evidence to make informed HRT treatment choices. Clinical Practice Guidelines (CPGs) have an indispensable role in guiding the selection of treatments for menopause. Variations in guidelines can impact treatments and health outcomes. The aim of this study was to assess CPGs on hormone replacement therapy (HRT) for menopause, systematically reviewing their quality and compiling recommendations for HRT usage. Embase, Scopus, MedLine, Geneva Foundation for Medical Education and Research databases were searched to identify relevant publications. CPGs published in English language, focusing specifically on HRT for menopause were included in the analysis. Four reviewers assessed the quality of the included CPGs using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and compiled congruent as well as contradictory recommendations. Nine guidelines met the inclusion criteria. The National Institute for Health and Care Excellence (NICE), the Endocrine Society and The Association of the Scientific Medical Societies guidelines were deemed to have the highest quality and are recommended without modifications. Out of 300+ extracted recommendations, merely 17 showed consistency, overlapping in at least two CPGs. The recommendations were categorized into three domains: treatment considerations, impact of HRT on non-reproductive organ systems, and the associations of HRT with cancer. The included CPGs exhibited the highest scores in the "Clarity of presentation" and "Scope and purpose" AGREE II domains. This study found variation in recommendations and quality of CPG on HRT for menopause. Notably, only a small fraction of recommendations showed consistency across guidelines, highlighting the variability in HRT management. Efforts to improve the quality of CPGs in this area are essential to optimize patient care and outcomes in menopausal women receiving HRT. [ABSTRACT FROM AUTHOR]

Fermented chopped chili pepper (FCCP) is the most important fermented and processed chili pepper product, and most pepper varieties can be processed with obvious flavor differences. Many studies have tried to explain these differences using the results of component analysis, processing technology, the microbes involved, etc., but few have examined the characteristics of these varieties along with the flavor of products. We conducted a physiochemical characteristic analysis of 35 kinds of fresh chili peppers with different genotypes and made fermented products from 17 varieties, using principal component analysis (PCA) and cluster analysis (CA) to correlate their components with FCCP products. The results were as follows: (1) Protein, total acids, a* (representation of the object's red and green color), protopectin, and fruit thickness are the five key indexes that affect the quality of fresh chili peppers the most. (2) Protein, total acids, a*, protopectin, and fruit thickness are also the key indexes that affect the quality of FCCP. (3) Suitable ranges of fresh chili pepper to manufacture FCCP are 1.3–2.0 g/100 g for protein, 2.5–4.0 g/kg for total acids, 10–15 g/100 g for protopectin, 30–39 for a*, and 1.2–2.0 mm for fruit thickness. (4) Sensory appraisal shows crispness is the most important mouthfeel sensation and can decrease during the process. The varieties with the top three scores were A12 (21G675), A13 (20Z663), and A14 (21Z698) with scores of 87.92, 74.08, and 74.15, respectively. The varieties in the top three scores are pod peppers. The PCA and CA showed that pod peppers were the most suitable materials for making FCCP. Our results will benefit others in selecting fresh chili peppers for making FCCP and provide data support for directing processable variety breeding. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to examine and evaluate the existing clinical practice guidelines and consensus statements regarding tracheostomy care for non‐mechanically ventilated patients. Methods: A systematic search of databases, and professional organisations was conducted from inception to 19 March 2023. Two appraisers evaluated each guideline using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers. Results: No specific clinical guidelines exist on airway management in non‐mechanically ventilated patients. Of 6318 articles identified, we included 12 clinical practice guidelines, and 9 consensus statements, which were from China, the US, the UK, South Korea, Australia, France and Belgium. The AGREE II scores in six domains are (1) the scope and purpose, 70.30%; (2) stakeholder involvement, 37.61%; (3) rigor of development, 33.97%; (4) clarity of presentation, 68.16%; (5) applicability, 44.23% and (6) editorial independence, 40.06%. The overall quality of evidence was level B. The summarised recommendations for clinical practice encompass the following six areas: airway humidification, management of the trach cuff, management of inner cannula, tracheostoma care, tracheostomy suctioning and management and prevention of common post‐operative complications. Conclusions: The overall quality of the clinical guidelines on non‐ventilated tracheostomy care was moderate, and further improvements are needed in domains of stakeholder involvement, applicability, clarity of presentation and editorial independence. Recommendations on non‐ventilated tracheostomy care are often embedded in the guidelines on ventilated tracheostomy. Specific clinical guidelines are needed to provide a standardised approach to tracheostomy care for non‐ventilated patients. Relevance to clinical practice: Patients with non‐ventilated tracheostomy need specialised airway management. Improving patient outcomes requires standardised protocols, patient involvement, quality evaluation, and interdisciplinary approaches. No patient or public contribution: The study reviewed clinical practice guidelines and consensus statements, therefore patient or public input was not needed. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) enhance health care and aid clinicians' decisions. Aim: To evaluate the quality of clinical guidelines in paediatric dentistry using the AGREE II tool. Design: PubMed, EMBASE, Scopus, LIVIVO, Lilacs, international guidelines websites, scientific societies, and gray literature were searched until September 2021. We included paediatric dental clinical guidelines and excluded drafts or guidelines for patients with special needs. Two independent reviewers performed quality assessment using the APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument. We calculated the mean overall domain scores (95% confidence interval) for each guideline. We used regression analysis to correlate the score of overall assessment and the six domains of AGREE II with guideline characteristics. Results: Forty‐four guidelines were included in this study. Highest mean score was for Domain 4 (Clarity of Presentation; 58%, 95% CI: 50.8–64.9), whereas the lowest was for Domain 5 (Applicability; 16%, 95% CI: 10.8–21.4). The reporting quality was improved in Domains 1–5 with reporting checklists (p <.001), whereas that of Domain 6 was improved by decreasing years since publication (p =.047). Conclusion: Paediatric dental guidelines do not comply with the methodological quality standard, especially in Domain 5 (Applicability). The AGREE reporting checklist should be implemented with a system to evaluate the certainty of evidence for future guidelines. [ABSTRACT FROM AUTHOR]

Abstract Background The unprecedented volume and speed at which COVID-19-related systematic reviews (SRs) may have been produced has raised questions regarding the quality of this evidence. It is feasible that pandemic-related factors may have led to an impairment in quality (reduced internal validity, increased risk of bias [RoB]). This may have serious implications for decision-making related to public health and individual healthcare. Objective The primary objective was to compare the quality of SRs published during the pandemic that were related to COVID-19 with SRs published during the pandemic that were unrelated to COVID-19 (all of which were fully appraised in the KSR Evidence database of SRs in healthcare). Our secondary objective was to compare the quality of SRs published during the pandemic (regardless of research topic), with SRs published pre-pandemic. Methods We compared all SRs related to COVID-19 to all SRs unrelated to COVID-19 that (i) were published during the pandemic (between 1st March 2020 and September 14, 2022), (ii) were included in KSR Evidence, and (iii) had been appraised using the ROBIS tool. We then compared all SRs published during the pandemic (regardless of research topic) with a pre-pandemic sample of SRs. Results For SRs published during the pandemic, we found there was no statistically significant difference in quality between those SRs tagged as being related to COVID-19 and those that were not [relative risk (RR) of low RoB for COVID-19 versus COVID-19-unrelated reviews: 0.94; 95% confidence interval (CI): 0.66 to 1.34]. Generally, COVID-19 SRs and COVID-19-unrelated SRs were both of low quality with only 10% of COVID-19 reviews and 11% of COVID-19-unrelated reviews rated as low RoB. However, SRs (regardless of topic) published during the pandemic were of lower quality than those published pre-pandemic (RR for low RoB for ‘during pandemic’ versus ‘pre-pandemic’: 0.30; 95% CI: 0.26 to 0.34) with 11% of pandemic and 36% of pre-pandemic SRs rated as low RoB. Conclusion These results suggest COVID-19 and COVID-19-unrelated SRs published during the pandemic are equally of low quality. SRs published during the pandemic were generally lower quality compared with SRs published pre-pandemic irrespective of COVID-19 focus. Moreover, SR quality in general is seriously lacking, and considerable efforts need to be made to substantially improve the quality and rigour of the SR process.

Supporting the decision-making process for the production of a 3D-printed hand exoskeleton within the Industry 4.0 and Industry 5.0 paradigms brings new concepts of manufacturing procedures for 3D-printed medical devices, including hand exoskeletons for clinical applications. The article focuses on current developments in the design and manufacturing of hand exoskeletons and their future directions from the point of view of implementation within the Industry 4.0 and Industry 5.0 paradigms and applications in practice. Despite numerous publications on the subject of hand exoskeletons, many have not yet entered production and clinical application. The results of research on hand exoskeletons to date indicate that they achieve good therapeutic effects not only in terms of motor control, but also in a broader context: ensuring independence and preventing secondary motor changes. This makes interdisciplinary research on hand exoskeletons a key study influencing the future lives of patients with hand function deficits and the further work of physiotherapists. The main aim of this article is to check in what direction hand exoskeletons can be developed from a modern economic perspective and how decision support systems can accelerate these processes based on a literature review, expert opinions, and a case study. [ABSTRACT FROM AUTHOR]

Introduction: Reporting of aromatherapy-focused research often lacks sufficient quality and detail for replication and subsequent application of results. To our knowledge currently, no quality appraisal tool exists for aromatherapy research reporting. To address this gap, the Aromatic Research Quality Appraisal Taskforce (ARQAT) composed of aromatherapy professionals with varied expert backgrounds came together. Presented here is the Transparent Reporting for Essential oil and Aroma Therapeutic Studies (TREATS) checklist, which is a result of this collaborative effort. Methods: Creation of TREATS followed a three-stage process, including determination of interest/need, development, and dissemination. The shortcomings of existing aromatherapy research reporting quality were evaluated and responses to address these shortcomings were used to create checklist items that were then grouped into sections. Items for each section were brain-stormed with reference to the aromatherapy literature and ARQAT's expert knowledge, and the development of each section followed an iterative process until agreement was reached. An explanatory document was also created to assist more accurate use of the tool; it and the checklist were reviewed by a group of aromatherapy experts. Results: The TREATS checklist with 38 items in four sections was developed along with the explanatory document. The ARQAT and a global group of aromatherapy experts reviewed the TREATS. Their results and comments assisted development of the current version. The TREATS identifies key components of research involving essential oils, their application, and olfactory considerations that ARQAT considers the minimum necessary for high-quality aromatherapy research. Conclusion: The TREATS, explanatory document, and associated website (www.arqat.org) contribute to thorough aromatherapy research critique. The TREATS checklist aids appraisal of quality and can be used with any study design. It lays the foundation for the future development of aromatic research reporting guidelines. [ABSTRACT FROM AUTHOR]

Purpose: The world population is ageing, along with an increasing possibility of functional limitations that affect independent living. Assistive technologies such as exoskeletons for rehabilitative purposes and daily activities assistance maintaining the independence of people with disabilities, especially older adults who wish to ageing-in-place. The purpose of this systematic integrative review was threefold: to explore the development team compositions and involvement, to understand the recruitment and engagement of stakeholders, and to synthesise reported or anticipated consequences of multidisciplinary collaboration. Methods: Databases searched included PubMed, CINAHL Plus, PsycINFO, Web of Science, Scopus, and IEEE Xplore. A total of 34 studies that reported the development of exoskeleton adopting user-centered design (UCD) method in healthcare or community settings that were published in English from 2000 to July 2022 were included. Results: Three major trends emerged from the analysis of included studies. First, there is a need to redefine multidisciplinary collaboration, from within-discipline collaboration to cross-discipline collaboration. Second, the level of engagement of stakeholders during the exoskeleton development remained low. Third, there was no standardised measurement to quantify knowledge production currently. Conclusion: As suggested by the synthesised results in this review, exoskeleton development has been increasing to improve the functioning of people with disabilities. Exoskeleton development often required expertise from different disciplines and the involvement of stakeholders to increase acceptance, thus we propose the Multidisciplinary Collaboration Appraisal Tool to assess multidisciplinary collaboration using the UCD approach. Future research is required to understand the effectiveness of multidisciplinary collaboration on exoskeleton development using the UCD approach. Global trend of population ageing causes a higher risk of disability in older adults who require rehabilitation and assistance in daily living. Assistive technologies such as exoskeletons have the potential to contribute to rehabilitation training and daily activity assistance demand closer multidisciplinary collaboration. A Multidisciplinary Collaboration Appraisal Tool using user-centered design approach (MCAT) is proposed to understand the effectiveness as well as limitations and barriers associated with multidisciplinary collaboration in developing exoskeletons. [ABSTRACT FROM AUTHOR]

Abstract Background and objective Clinical practice guidelines (CPGs) are evaluated for quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool, and this is increasingly done for different countries and regional groupings. This scoping review aimed to describe, map, and compare these geographical synthesis studies, that assessed CPG quality using the AGREE tool. This allowed a global interpretation of the current landscape of these country-wide or regional synthesis studies, and a closer look at its methodology and results. Study design and methods A scoping review was conducted searching databases Medline, Embase, Epistemonikos, and grey literature on 5 October 2021 for synthesis studies using the later versions of AGREE (AGREE II, AGREE-REX and AGREE GRS) to evaluate country-wide or regional CPG quality. Country-wide or regional synthesis studies were the units of analysis, and simple descriptive statistics was used to conduct the analysis. AGREE scores were analysed across subgroups into one of the seven Sustainable Development Goal regions, to allow for meaningful interpretation. Results Fifty-seven studies fulfilled our eligibility criteria, which had included a total of 2918 CPGs. Regions of the Global North, and Eastern and South-Eastern Asia were most represented. Studies were consistent in reporting and presenting their AGREE domain and overall results, but only 18% (n = 10) reported development methods, and 19% (n = 11) reported use of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall scores for domains Rigor of development and Editorial independence were low, notably in middle-income countries. Editorial Independence scores, especially, were low across all regions with a maximum domain score of 46%. There were no studies from low-income countries. Conclusion There is an increasing tendency to appraise country-wide and regionally grouped CPGs, using quality appraisal tools. The AGREE tool, evaluated in this scoping review, was used well and consistently across studies. Findings of low report rates of development of CPGs and of use of GRADE is concerning, as is low domain scores globally for Editorial Independence. Transparent reporting of funding and competing interests, as well as highlighting evidence-to-decision processes, should assist in further improving CPG quality as clinicians are in dire need of high-quality guidelines.

Fermented chopped chili pepper (FCCP) is the most important fermented and processed chili pepper product, and most pepper varieties can be processed with obvious flavor differences. Many studies have tried to explain these differences using the results of component analysis, processing technology, the microbes involved, etc., but few have examined the characteristics of these varieties along with the flavor of products. We conducted a physiochemical characteristic analysis of 35 kinds of fresh chili peppers with different genotypes and made fermented products from 17 varieties, using principal component analysis (PCA) and cluster analysis (CA) to correlate their components with FCCP products. The results were as follows: (1) Protein, total acids, a* (representation of the object’s red and green color), protopectin, and fruit thickness are the five key indexes that affect the quality of fresh chili peppers the most. (2) Protein, total acids, a*, protopectin, and fruit thickness are also the key indexes that affect the quality of FCCP. (3) Suitable ranges of fresh chili pepper to manufacture FCCP are 1.3–2.0 g/100 g for protein, 2.5–4.0 g/kg for total acids, 10–15 g/100 g for protopectin, 30–39 for a*, and 1.2–2.0 mm for fruit thickness. (4) Sensory appraisal shows crispness is the most important mouthfeel sensation and can decrease during the process. The varieties with the top three scores were A12 (21G675), A13 (20Z663), and A14 (21Z698) with scores of 87.92, 74.08, and 74.15, respectively. The varieties in the top three scores are pod peppers. The PCA and CA showed that pod peppers were the most suitable materials for making FCCP. Our results will benefit others in selecting fresh chili peppers for making FCCP and provide data support for directing processable variety breeding.

Objectives: Dysphagia is a common complication in stroke patients, widely affecting recovery and quality of life after stroke. The objective of this systematic review is to identify the gaps that between evidence and practice by critically assessing the quality of clinical practice guidelines (CPGs) for management of dysphagia in stroke. Methods: We systematically searched academic databases and guideline repositories between January 1, 2014, and August 1, 2023. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used by two authors to independently assess CPG quality. Results: In a total of 14 CPGs included, we identified that three CPGs obtained a final evaluation of “high quality,” nine CPGs achieved “moderate quality” and two CPGs received “low quality.” The domain of “scope and purpose” achieved the highest mean score (91.1%) and the highest median (IQR) of 91.7% (86.1, 94.4%), while the domain of “applicability” received the lowest mean score (55.8%) and the lowest median (IQR) of 55.4% (43.2, 75.5%). Conclusion: The CPG development group should pay more attention to improving the methodological quality according to the AGREE II instrument, especially in the domain of “applicability” and “stakeholder involvement;” and each item should be refined as much as possible. [ABSTRACT FROM AUTHOR]

Background and objective: Clinical practice guidelines (CPGs) are evaluated for quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool, and this is increasingly done for different countries and regional groupings. This scoping review aimed to describe, map, and compare these geographical synthesis studies, that assessed CPG quality using the AGREE tool. This allowed a global interpretation of the current landscape of these country-wide or regional synthesis studies, and a closer look at its methodology and results. Study design and methods: A scoping review was conducted searching databases Medline, Embase, Epistemonikos, and grey literature on 5 October 2021 for synthesis studies using the later versions of AGREE (AGREE II, AGREE-REX and AGREE GRS) to evaluate country-wide or regional CPG quality. Country-wide or regional synthesis studies were the units of analysis, and simple descriptive statistics was used to conduct the analysis. AGREE scores were analysed across subgroups into one of the seven Sustainable Development Goal regions, to allow for meaningful interpretation. Results: Fifty-seven studies fulfilled our eligibility criteria, which had included a total of 2918 CPGs. Regions of the Global North, and Eastern and South-Eastern Asia were most represented. Studies were consistent in reporting and presenting their AGREE domain and overall results, but only 18% (n = 10) reported development methods, and 19% (n = 11) reported use of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall scores for domains Rigor of development and Editorial independence were low, notably in middle-income countries. Editorial Independence scores, especially, were low across all regions with a maximum domain score of 46%. There were no studies from low-income countries. Conclusion: There is an increasing tendency to appraise country-wide and regionally grouped CPGs, using quality appraisal tools. The AGREE tool, evaluated in this scoping review, was used well and consistently across studies. Findings of low report rates of development of CPGs and of use of GRADE is concerning, as is low domain scores globally for Editorial Independence. Transparent reporting of funding and competing interests, as well as highlighting evidence-to-decision processes, should assist in further improving CPG quality as clinicians are in dire need of high-quality guidelines. [ABSTRACT FROM AUTHOR]

Background Reverse shoulder arthroplasty (RSA) has evolved continuously over recent years, with expanded indications and better outcomes. YouTube is one of the most popular sources for health-related information available to patients. Evaluating the quality of YouTube videos concerning RSA is important to ensure proper patient education. Methods YouTube was queried for the term “reverse shoulder replacement.” The first 50 videos were evaluated using three different scores: Journal of the American Medical Association (JAMA) benchmark criteria, the global quality score (GQS), and the reverse shoulder arthroplasty-specific score (RSAS). Multivariate linear regression analyses were conducted to determine the presence of a relationship between video characteristics and quality scores. Results The average number of views was 64,645.78±264,160.9 per video, and the average number of likes was 414 per video. Mean JAMA, GQS, and RSAS scores were 2.32±0.64, 2.31±0.82, and 5.53±2.43, respectively. Academic centers uploaded the highest number of videos, and surgical techniques/approach videos was the most common video content. Videos with lecture content predicted higher JAMA scores whereas videos uploaded by industry predicted lower RSAS scores. Conclusions Despite its massive popularity, YouTube videos provide a low quality of information on RSA. Introducing a new editorial review process or developing a new platform for patients’ medical education may be necessary. Level of evidenceNot applicable.

Aims and Objectives: To assess the methodological quality of current clinical practice guidelines related to post‐stroke dysphagia and develop an algorithm using nursing process as a framework for clinical nursing. Background: Dysphagia is a serious complication of stroke. Yet the recommendations related to nursing in guidelines have not been systematically sorted out, so they are difficult for nurses to use to guide clinical nursing practice. Design: Systematic review. Methods: A systematic review of literature was performed using the PRISMA Checklist. A systematic search for relevant guidelines published between 2017 and 2022 was conducted. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations related to nursing practice from high‐quality guidelines were summarised and developed into an algorithm to provide reference for the standardised construction of nursing practice scheme. Results: 991 records were initially identified from database searches and other sources. Finally, 10 guidelines were included, of which 5 were rated as high quality. A total of 27 recommendations from the 5 highest‐scoring guidelines were summarised and used to develop an algorithm. Conclusions: This study indicated deficiencies and variability in current available guidelines. Based on five high‐quality guidelines, we developed an algorithm to facilitate nurses' adherence to guidelines and contribute to evidence‐based nursing. In the future, high‐quality guidelines, together with large‐sample and multi‐centre clinical researches are suggested to give more scientific and convincing evidence to nursing of post‐stroke dysphagia. Relevance to Clinical Practice: The findings indicate that nursing process may provide a unified framework for standardised nursing of different diseases. Nursing leaders are recommended to adopt this algorithm in their units. In addition, nursing administrators and educators should promote the application of nursing diagnosis to help nurses foster nursing thinking mode. Patient or Public Contribution: No patient or public involvement in this review. [ABSTRACT FROM AUTHOR]

A comprehensive evaluation of clinical practice guidelines (CPGs) is essential to measure their quality. This study introduces the function and meaning of the systematic review of CPGs and combs the development and current status of guideline appraisal tools. On this basis, we expound the content and characteristics of the Scientific, Transparent, and Applicable Rankings Tool (STAR) for Guidelines in depth, with the hope of providing reference for the improvement of the compressive guideline assessment system and the development of high-quality guidelines in the future.

The rapid growth in medical research has popularized systematic reviews as comprehensive, accurate, reliable, and concise summaries of the best available information on a particular topic.

Abstract Background Health state utility values (HSUVs) are an essential input parameter to cost-utility analysis (CUA). Systematic literature reviews (SLRs) provide summarized information for selecting utility values from an increasing number of primary studies eliciting HSUVs. Quality appraisal (QA) of such SLRs is an important process towards the credibility of HSUVs estimates; yet, authors often overlook this crucial process. A scientifically developed and widely accepted QA tool for this purpose is lacking and warranted. Objectives To comprehensively describe the nature of QA in published SRLs of studies eliciting HSUVs and generate a list of commonly used items. Methods A comprehensive literature search was conducted in PubMed and Embase from 01.01.2015 to 15.05.2021. SLRs of empirical studies eliciting HSUVs that were published in English were included. We extracted descriptive data, which included QA tools checklists or good practice recommendations used or cited, items used, and the methods of incorporating QA results into study findings. Descriptive statistics (frequencies of use and occurrences of items, acceptance and counterfactual acceptance rates) were computed and a comprehensive list of QA items was generated. Results A total of 73 SLRs were included, comprising 93 items and 35 QA tools and good recommendation practices. The prevalence of QA was 55% (40/73). Recommendations by NICE and ISPOR guidelines appeared in 42% (16/40) of the SLRs that appraised quality. The most commonly used QA items in SLRs were response rates (27/40), statistical analysis (22/40), sample size (21/40) and loss of follow up (21/40). Yet, the most commonly featured items in QA tools and GPRs were statistical analysis (23/35), confounding or baseline equivalency (20/35), and blinding (14/35). Only 5% of the SLRS used QA to inform the data analysis, with acceptance rates of 100% (in two studies) 67%, 53% and 33%. The mean counterfactual acceptance rate was 55% (median 53% and IQR 56%). Conclusions There is a considerably low prevalence of QA in the SLRs of HSUVs. Also, there is a wide variation in the QA dimensions and items included in both SLRs and extracted tools. This underscores the need for a scientifically developed QA tool for multi-variable primary studies of HSUVs.

Background: Reverse shoulder arthroplasty (RSA) has evolved continuously over recent years, with expanded indications and better outcomes. YouTube is one of the most popular sources globally for health-related information available to patients. Evaluating the reliability of YouTube videos concerning RSA is important to ensure proper patient education. Methods: YouTube was queried for the term "reverse shoulder replacement." The first 50 videos were evaluated using three different scores: Journal of the American Medical Association (JAMA) benchmark criteria, the global quality score (GQS), and the reverse shoulder arthroplasty-specific score (RSAS). Multivariate linear regression analyses were conducted to determine the presence of a relationship between video characteristics and quality scores. Results: The average number of views was 64,645.78±264,160.9 per video, and the average number of likes was 414 per video. Mean JAMA, GQS, and RSAS scores were 2.32±0.64, 2.31±0.82, and 5.53±2.43, respectively. Academic centers uploaded the highest number of videos, and surgical techniques/approach videos was the most common video content. Videos with lecture content predicted higher JAMA scores whereas videos uploaded by industry predicted lower RSAS scores. Conclusions: Despite its massive popularity, YouTube videos provide a low quality of information on RSA. Introducing a new editorial review process or developing a new platform for patients' medical education may be necessary. [ABSTRACT FROM AUTHOR]

The realist review/synthesis has become an increasingly prominent methodological approach to evidence synthesis that can inform policy and practice. While there are publication standards and guidelines for the conduct of realist reviews, published reviews often provide minimal detail regarding how they have conducted some methodological steps. This includes selecting and appraising evidence sources, which are often considered for their 'relevance, richness and rigour.' In contrast to other review approaches, for example, narrative reviews and meta‐analyses, the inclusion criteria and appraisal of evidence within realist reviews depend less on the study's methodological quality and more on its contribution to our understanding of generative causation, uncovered through the process of retroductive theorising. This research brief aims to discuss the current challenges and practices for appraising documents' relevance, richness and rigour and to provide pragmatic suggestions for how realist reviewers can put this into practice. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials (RCTs) stand atop the evidence-based hierarchy of study designs for their ability to arrive at results with the lowest risk of bias. Even for RCTs, however, critical appraisal is essential before applying results to clinical practice. Purpose: To analyze the quality of reporting of RCTs published in The American Journal of Sports Medicine (AJSM) from 1990 to 2020 and to identify trends over time and areas of improvement for future trials. Study Design: Systematic review; Level of evidence, 1. Methods: We queried the AJSM database for RCTs published between January 1990 and December 2020. Data pertaining to study characteristics were recorded. Quality assessments were conducted using the Detsky quality-of-reporting index and the modified Cochrane risk-of-bias (mROB) tool. Univariate and multivariable models were generated to establish factors with associations to study quality. The Fragility Index was calculated for eligible studies. Results: A total of 277 RCTs were identified with a median sample size of 70 patients. A total of 19 RCTs were published between 1990 and 2000 (t1); 82 RCTs between 2001 and 2010 (t2); and 176 RCTs between 2011 and 2020 (t3). From t1 to t3, significant increases were observed in the overall mean-transformed Detsky score (from 68.2% ± 9.8% to 87.4% ± 10.2%, respectively; P <.001) and mROB score (from 4.7 ± 1.6 to 6.9 ± 1.6, respectively; P <.001). Multivariable regression analysis revealed that trials with follow-up periods of <5 years clearly stated primary outcomes, and a focus on the elbow, shoulder, or knee were associated with higher mean-transformed Detsky and mROB scores. The median Fragility Index was 2 (interquartile range, 0-5) for trials with statistically significant. Studies with small sample sizes (<100 patients) were more likely to have low Fragility Index scores and less likely to have a statistically significant finding in any outcome. Conclusion: The quantity and quality of published RCTs published in AJSM increased over the past 3 decades. However, single-center trials with small sample sizes were prone to fragile results. [ABSTRACT FROM AUTHOR]

Jiamin Li,1 Qiuwen Zhang,2 Xinjuan Wu,1 Dong Pang2 1Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2School of Nursing, Health Science Center for Evidence-Based Nursing, Peking University, Beijing, People’s Republic of ChinaCorrespondence: Xinjuan Wu; Dong Pang, Email wuxinjuan@sina.com; pangdong@bjmu.edu.cnAim: To systematically search ostomy clinical practice guidelines, critically assess their quality and clinical applicability of recommendations, and summarize the recommendations.Design: Systematic review.Data Sources: The PubMed, ProQuest and CINAHL databases, eight guideline databases, and three ostomy institution websites were searched on September 3, 2021.Review Methods: Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation EXcellence (AGREE-REX) were used to assess the guideline.Results: The initial search identified 1475 documents. Of these, 27 full-text documents were reviewed. Finally, 10 guidelines were included. Among these, the 2019 Registered Nurses’ Association of Ontario (RNAO) guidelines had the highest total scores using AGREE II and AGREE-REX. The 2019 National Institute for Health and Care Excellence (NICE) and 2018 European Hernia Society (EHS) were also ranked as high-quality and evaluated as “recommended.” The median of the “applicability” domain was the lowest (45%) among the six AGREE II domains. The median of the “values and preferences” domain was the lowest (38%) among the three AGREE-REX domains. In total, 172 recommendations were summarized and parastomal hernia received the most attention among the recommendations.Conclusion: The quality of the 10 clinical practice guidelines varied widely. The three identified high-quality guidelines might be appropriate first choices in daily ostomy care and management practice and can be tailored to the local context. Ostomy guidelines require further improvement in the “applicability” and “values and preferences” domains.No Patient or Public Contribution: This review only searched and evaluated relevant documents, so such details do not apply to this review.Keywords: clinical practice guidelines, ostomy, quality appraisal, clinical applicability, systematic review

Context: Goal Attainment Scaling (GAS) is a person-centered and collaborative approach, allowing to assess the effectiveness of an intervention on personally relevant goals. However, GAS is not a “scale” but a heterogeneous group of methodologies, including many variations and lack of consensus on high quality GAS. Objective: The aim of this communication is to: 1. provide updated didactical information on GAS use in PRM practice and research; 2. increase awareness of GAS methodological challenges; 3. guide use of GAS as an integrated process of rehabilitation after goal setting and; 4. provide updated resources for self-directed learning and extensive supplemental material to increase knowledge and practical skills in GAS use. Methods: Educational literature review about current GAS applications relevant to PRM fields. Results: Practical advice is provided regarding clinical challenges in GAS: definition of 0 level, time-frame and means employed to attain the goal, dealing with unforeseen pattern of improvement, synthesizing the numerous significations of “SMART” goal acronym to guide best use of GAS, and thinking flexibility on the type of relevant goals that can be set. Challenges with GAS in rehabilitation research are presented in order to promote researcher’s and reviewer’s awareness on reliable use of GAS and encouraging best-use of GAS. LAY ABSTRACT The goal attainment scaling methodology is a relevant way of measuring the effectiveness of a treatment, by creating scales to measure whether the goals previously identified with the person have been achieved through the treatment. There are many goal attainment scaling methodological variants, with a significant impact on results, of which users are not always aware. The aims of this review of the literature regarding current applications of goal attainment scaling in Physical and Rehabilitation Medicine fields, are to (i) provide up-to-date didactic information on the use of goal attainment scaling in Physical and Rehabilitation Medicine practice and research; (ii) raise awareness of the methodological challenges of goal attainment scaling; (iii) guide the use of goal attainment scaling to support the rehabilitation process after goal setting; and (iv) provide up-to-date resources for self-directed training. Practical guidelines are provided for the use of goal attainment scaling in clinical practice, and the challenges of use of this methodology in rehabilitation research are presented in order to educate researchers and evaluators on the reliable use of goal attainment scaling.

IntroductionIncreasing attention on workplace wellbeing and growth in workplace wellbeing interventions has highlighted the need to measure workers' wellbeing. This systematic review sought to identify the most valid and reliable published measure/s of wellbeing for workers developed between 2010 to 2020.MethodsElectronic databases Health and Psychosocial Instruments, APA PsycInfo, and Scopus were searched. Key search terms included variations of [wellbeing OR “well-being”] AND [employee*OR worker*OR staff OR personnel]. Studies and properties of wellbeing measures were then appraised using Consensus-based Standards for the selection of health Measurement Instruments.ResultsEighteen articles reported development of new wellbeing instruments and eleven undertook a psychometric validation of an existing wellbeing instrument in a specific country, language, or context. Generation and pilot testing of items for the 18 newly developed instruments were largely rated 'Inadequate'; only two were rated as 'Very Good'. None of the studies reported measurement properties of responsiveness, criterion validity, or content validity. The three instruments with the greatest number of positively rated measurement properties were the Personal Growth and Development Scale, The University of Tokyo Occupational Mental Health well-being 24 scale, and the Employee Well-being scale. However, none of these newly developed worker wellbeing instruments met the criteria for adequate instrument design.DiscussionThis review provides researchers and clinicians a synthesis of information to help inform appropriate instrument selection in measurement of workers' wellbeing.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79044, identifier: PROSPERO, CRD42018079044.

Background: Health state utility values (HSUVs) are an essential input parameter to cost-utility analysis (CUA). Systematic literature reviews (SLRs) provide summarized information for selecting utility values from an increasing number of primary studies eliciting HSUVs. Quality appraisal (QA) of such SLRs is an important process towards the credibility of HSUVs estimates; yet, authors often overlook this crucial process. A scientifically developed and widely accepted QA tool for this purpose is lacking and warranted.Objectives: To comprehensively describe the nature of QA in published SRLs of studies eliciting HSUVs and generate a list of commonly used items.Methods: A comprehensive literature search was conducted in PubMed and Embase from 01.01.2015 to 15.05.2021. SLRs of empirical studies eliciting HSUVs that were published in English were included. We extracted descriptive data, which included QA tools checklists or good practice recommendations used or cited, items used, and the methods of incorporating QA results into study findings. Descriptive statistics (frequencies of use and occurrences of items, acceptance and counterfactual acceptance rates) were computed and a comprehensive list of QA items was generated.Results: A total of 73 SLRs were included, comprising 93 items and 35 QA tools and good recommendation practices. The prevalence of QA was 55% (40/73). Recommendations by NICE and ISPOR guidelines appeared in 42% (16/40) of the SLRs that appraised quality. The most commonly used QA items in SLRs were response rates (27/40), statistical analysis (22/40), sample size (21/40) and loss of follow up (21/40). Yet, the most commonly featured items in QA tools and GPRs were statistical analysis (23/35), confounding or baseline equivalency (20/35), and blinding (14/35). Only 5% of the SLRS used QA to inform the data analysis, with acceptance rates of 100% (in two studies) 67%, 53% and 33%. The mean counterfactual acceptance rate was 55% (median 53% and IQR 56%).Conclusions: There is a considerably low prevalence of QA in the SLRs of HSUVs. Also, there is a wide variation in the QA dimensions and items included in both SLRs and extracted tools. This underscores the need for a scientifically developed QA tool for multi-variable primary studies of HSUVs. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population. A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria. There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1–10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion. High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4–6 weeks. The reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures. A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs. Our systematic review concluded that a 12-week PT program starting with immobilization for 4–6 weeks, followed by 3–4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA. Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation. [ABSTRACT FROM AUTHOR]

Topicality. Soups are an integral part of a person’s daily diet. Therefore, they are a required menu component of most public catering establishments. Nowadays, there are approximately 150 types of soups in the world, which are divided into more than 1000 types, each having several variations. Soups are nutritious, but, at the same time, they are light. Soups are absorbed fast, they warm well, and help to improve digestion. Compared to frying, boiling vegetables, mushrooms, meat and poultry, much more nutrients are preserved in soups. In addition, soups are usually lower in calories than full-fledged second courses. Still, at the same time, they are not inferior to them in terms of nutrients. The aim of the study is to research the quality indicators of soups with the use of beans, namely physico-chemical, organoleptic and biological. Comparison and evaluation of experimental samples (soups with the use of soy, lentil and beans) has been conducted. When writing this article, the following research methods have been used: standard methods of organoleptic profile analysis, calculation, mathematical and statistical methods. Results. Recipes of soups have been substantiated and elaborated, their organoleptic evaluation and physico-chemical quality indicators have been studied. The analysis of the chemical composition and energy value of soups has been made. The indicators of carbohydrate load and amino acid content of soups have been calculated. The exponents of soup biological value have been given. Conclusions and suggestions. This research allows to found the methods of chemical composition and organoleptic indicators improvement for pureed soups with beans use.

This study aimed to evaluate and analyze the methodological quality of the published clinical practice guidelines (CPGs) for perinatal bereavement care and provide a reference for implementing best clinical practices. We performed a systematic and comprehensive search in five electronic databases (PubMed, The Cochrane Library, Web of Science, CNKI, Wan Fang Database), eight guideline databases, and six websites of professional organizations from March 2021 to June 2021. Four researchers used the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument to appraise the selected CPGs independently. The inter-rater reliability of AGREE II domains was calculated using the intraclass correlation coefficient with 95% CI. We included a total of 8 CPGs. The mean scores of six domains ranged from the lowest score of 46.61% (editorial independence) to the highest score of 87.85% (clarity of presentation). Subgroup analysis showed no statistical difference. Each domain achieved "good" and "very good" intraclass reliability. Two CPGs were deemed as grade A (strongly recommended), five were rated as grade B (recommended with modifications), and one was evaluated as grade C (not recommended). Healthcare professionals in obstetrics and neonatology play an important role in helping bereaved parents and families to cope with perinatal loss. High-quality CPGs for perinatal bereavement care can serve as useful resources to improve the quality and outcomes of clinical practice. More efforts should be made to disseminate the best practices for perinatal bereavement care. When implementing GCPs in countries or regions with different backgrounds, professional translations, strict validations, and cultural adaptations should be taken into account. • Perinatal loss is a global health issue with profound psychosocial effects on parents and their families. • Current perinatal bereavement care provided by healthcare professionals does not adequately meet the needs of patients. • High-quality CPGs can provide reliable evidence about perinatal bereavement care. • Our manuscript appraised the methodological quality of the existing CPGs, hoping to improve clinical practice. [ABSTRACT FROM AUTHOR]

Background: The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was developed to evaluate the quality of clinical practice guidelines. Evidence suggests that development, reporting, and appraisal of guidelines on surgical interventions may be better informed by modification of the instrument. Objective: We aimed to develop an AGREE II extension specifically designed for appraisal of guidelines of surgical interventions. Methods: In a three-part project funded by the United European Gastroenterology and the European Association for Endoscopic Surgery, (i) we identified factors that were associated with higher quality of surgical guidelines, (ii) we statistically calibrated the AGREE II instrument in the context of surgical guidelines using correlation, reliability, and factor analysis, and (iii) we undertook a Delphi consensus process of stakeholders to inform the development of an AGREE II extension instrument for surgical interventions. Results: Several features were prioritized by stakeholders as of particular importance for guidelines of surgical interventions, including development of a guideline protocol, consideration of practice variability and surgical expertise in different settings, and specification of infrastructures required to implement the recommendations. The AGREE-S—AGREE II extension instrument for surgical interventions has 25 items, compared to the 23 items of the original AGREE II instrument, organized into the following 6 domains: Scope and purpose, Stakeholders, Evidence synthesis, Development of recommendations, Editorial independence, and Implementation and update. As the original instrument, it concludes with an overall appraisal of the quality of the guideline and a judgement on whether the guideline is recommended for use. Several items were amended and rearranged among domains, and an item was deleted. The Rigor of Development domain of the original AGREE II was divided into Evidence Synthesis and Development of Recommendations. Items of the AGREE II domain Clarity of Presentation were incorporated in the new domain Development of Recommendations. Three new items were introduced, addressing the development of a guideline protocol, support by a guideline methodologist, and consideration of surgical experience/expertise. Conclusion: The AGREE-S appraisal instrument has been developed to be used for assessment of the methodological and reporting quality of guidelines on surgical interventions. [ABSTRACT FROM AUTHOR]

Abstract Background An assessment of the validity of individual diagnostic accuracy studies in systematic reviews is necessary to guide the analysis and the interpretation of results. Such an assessment is performed for each included study and typically reported at the study level. As studies may differ in sample size and disease prevalence, with larger studies contributing more to the meta-analysis, such a study-level report does not always reflect the risk of bias in the total body of evidence. We aimed to develop improved methods of presenting the risk of bias in the available evidence on diagnostic accuracy of medical tests in systematic reviews, reflecting the relative contribution of the study to the body of evidence in the review. Methods We applied alternative methods to represent evaluations with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), weighting studies according to their relative contribution to the total sample size or their relative effective sample size. We used these methods in four existing systematic reviews of diagnostic accuracy studies, including 9, 13, 22, and 32 studies, respectively. Results The risk-of-bias summaries for each domain of the QUADAS-2 checklist changed in all four sets of studies after replacing unit weights for the studies with relative sample sizes or with the relative effective sample size. As an example, the risk of bias was high in the patient selection domain in 31% of the studies in one review, unclear in 23% and low in 46% of studies. Weighting studies according to the relative sample size changed the corresponding proportions to 4%, 4%, and 92%, respectively. The difference between the two weighting methods was small and more noticeable when the reviews included a smaller number of studies with wider range of sample size. Conclusions We present an alternative way of presenting the results of risk-of-bias assessments in systematic reviews of diagnostic accuracy studies. Weighting studies according to their relative sample size or their relative effective sample size can be used as more informative summaries of the risk of bias in the total body of available evidence. Systematic review registrations Not applicable

Critical appraisal of evidence is performed to assess its validity, trustworthiness and usefulness in evidence-based practice. There currently exists a large number and variety of critical appraisal tools (also named risk of bias tools and quality assessment instruments), which makes it challenging to identify and choose an appropriate tool to use. We sought to develop an online inventory to inform librarians, practitioners, graduate students, and researchers about critical appraisal tools. This online inventory was developed from a literature review on critical appraisal tools and is kept up to date using a crowdsourcing collaborative web tool (eSRAP-DIY). To date, 40 tools have been added to the inventory (www.catevaluation.ca), and grouped according to five general categories: (a) quantitative studies, (b) qualitative studies, (c) mixed methods studies, (d) systematic reviews and (e) others. For each tool, a summary is provided with the following information: tool name, study designs, number of items, rating scale, validity, reliability, other information (such as existing websites or previous versions), and main references. Further studies are needed to test and improve the usability of the online inventory, and to find solutions to reduce to monitoring and update workload. [ABSTRACT FROM AUTHOR]

Abstract Background In the context of the volume of mixed- and multi-methods studies in health services research, the present study sought to develop an appraisal tool to determine the methodological and reporting quality of such studies when included in systematic reviews. Evaluative evidence regarding the design and use of our existing Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was synthesised to enhance and refine it for application across health services research. Methods Secondary data were collected through a literature review of all articles identified using Google Scholar that had cited the QATSDD tool from its inception in 2012 to December 2019. First authors of all papers that had cited the QATSDD (n=197) were also invited to provide further evaluative data via a qualitative online survey. Evaluative findings from the survey and literature review were synthesised narratively and these data used to identify areas requiring refinement. The refined tool was subject to inter-rater reliability, face and content validity analyses. Results Key limitations of the QATSDD tool identified related to a lack of clarity regarding scope of use of the tool and in the ease of application of criteria beyond experimental psychological research. The Quality Appraisal for Diverse Studies (QuADS) tool emerged as a revised tool to address the limitations of the QATSDD. The QuADS tool demonstrated substantial inter-rater reliability (k=0.66), face and content validity for application in systematic reviews with mixed, or multi-methods health services research. Conclusion Our findings highlight the perceived value of appraisal tools to determine the methodological and reporting quality of studies in reviews that include heterogeneous studies. The QuADS tool demonstrates strong reliability and ease of use for application to multi or mixed-methods health services research.

Abstract Background The clinical landscape of pulmonary arterial hypertension (PAH) has evolved in terms of disease definition and classification, trial designs, available therapies and treatment strategies as well as clinical guidelines. This study critically appraises published evidence synthesis studies, i.e. meta-analyses (MA) and network-meta-analyses (NMA), to better understand their quality, validity and discuss the impact of the findings from these studies on current decision-making in PAH. Methods A systematic literature review to identify MA/NMA studies considering approved and available therapies for treatment of PAH was conducted. Embase, Medline and the Cochrane’s Database of Systematic Reviews were searched from database inception to April 22, 2020, supplemented by searches in health technology assessment websites. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist covering six domains (relevance, credibility, analysis, reporting quality and transparency, interpretation and conflict of interest) was selected for appraisal of the included MA/NMA studies. Results Fifty-two full publications (36 MAs, 15 NMAs, and 1 MA/NMA) in PAH met the inclusion criteria. The majority of studies were of low quality, with none of the studies being scored as ‘strong’ across all checklist domains. Key limitations included the lack of a clearly defined, relevant decision problem, shortcomings in assessing and addressing between-study heterogeneity, and an incomplete or misleading interpretation of results. Conclusions This is the first critical appraisal of published MA/NMA studies in PAH, suggesting low quality and validity of published evidence synthesis studies in this therapeutic area. Besides the need for direct treatment comparisons assessed in long-term randomized controlled trials, future efforts in evidence synthesis in PAH should improve analysis quality and scrutiny in order to meaningfully address challenges arising from an evolving therapeutic landscape.

This paper systematically and critically reviewed all published economic evaluations of drugs for the treatment of postmenopausal osteoporosis. A systematic search was conducted using relevant databases for economic evaluations to include all relevant English articles published between January 2008 to January 2020. After extracting the key study characteristics, methods and outcomes, we evaluated each article using the Quality of Health Economic Studies (QHES) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) instruments. A total of 49 studies met the inclusion criteria. Majority of studies were funded by the industry and reported favorable cost-effectiveness. Based on the QHES total scores, studies (n = 35) were found to be industry-funded with higher QHES mean 82.44 ± 8.69 as compared with nonindustry funding studies (n = 11) with mean 72.22 ± 17.67. The overall mean QHES scores were found to be higher 79.06 ± 11.84, representing high quality (75–100) compared to CHEERS scores (%) 75.03 ± 11.21. The statistical pairwise comparison between CHEERS mean (75.03 ± 11.21) and QHES mean (79.06 ± 11.84) were not statistically significant (P = 0.10) whereas, QHES score showed higher means as compared to CHEERS. This study suggests the overall quality of the published literatures was relatively few high-quality health economic evaluation demonstrating the cost-effectiveness of drugs for postmenopausal osteoporosis, and the majority of the literature highlights that methodological shortcoming.

Abstract Background The lack of attention to Indigenous epistemologies and, more broadly, Indigenous values in primary research, is mirrored in the standardised critical appraisal tools used to guide evidence-based practice and systematic reviews and meta-syntheses. These critical appraisal tools offer no guidance on how validity or contextual relevance should be assessed for Indigenous populations and cultural contexts. Failure to tailor the research questions, design, analysis, dissemination and knowledge translation to capture understandings that are specific to Indigenous peoples results in research of limited acceptability and benefit and potentially harms Indigenous peoples. A specific Aboriginal and Torres Strait Islander Quality Appraisal Tool is needed to address this gap. Method The Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) was developed using a modified Nominal Group and Delphi Techniques and the tool’s validity, reliability, and feasibility were assessed over three stages of independent piloting. National and international research guidelines were used as points of reference. Piloting of the Aboriginal and Torres Strait Islander QAT with Aboriginal and Torres Strait Islander and non-Indigenous experts led to refinement of the tool. Results The Aboriginal and Torres Strait Islander QAT consists of 14 questions that assess the quality of health research from an Aboriginal and Torres Strait Islander perspective. The questions encompass setting appropriate research questions; community engagement and consultation; research leadership and governance; community protocols; intellectual and cultural property rights; the collection and management of research material; Indigenous research paradigms; a strength-based approach to research; the translation of findings into policy and practice; benefits to participants and communities involved; and capacity strengthening and two-way learning. Outcomes from the assessment of the tool’s validity, reliability, and feasibility were overall positive. Conclusion This is the first tool to appraise research quality from the perspective of Indigenous peoples. Through the uptake of the Aboriginal and Torres Strait Islander QAT we hope to improve the quality and transparency of research with Aboriginal and Torres Strait Islander peoples, with the potential for greater improvements in Aboriginal and Torres Strait Islander health and wellbeing.

IntroductionSince its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear.ObjectiveWe aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST).Materials and MethodsA literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared.ResultsAGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50–96); stakeholder involvement, 54% (28–85); rigor of development, 39% (21–63); clarity of presentation, 85% (69–100); applicability, 27% (6–51); and editorial independence, 76% (42–100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG.Conclusion and RelevanceDupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.

What is known and objective: Opioid Use Disorder (OUD) has a high mortality rate and affects millions of people worldwide. Many organizations and societies develop Clinical Practice Guidelines (CPGs) to serve as a framework for healthcare providers to decide and support best practice to manage and treat OUD. However, not all CPGs sufficiently address all the important aspects of optimal care for managing OUD. This study aims to review current CPGs for management of OUD, evaluate their methodological quality and summarize their recommendations. Methods: We conducted this systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). Various databases were searched for CPGs and Appraisal of Guidelines for Research and Evaluation (AGREE‐II) instrument was used to assess the methodological quality. We also summarized the treatments plans of CPGs across continuum of care (diagnosis and assessment, treatment initiation, pharmacotherapy and psychosocial). Results: This review included 28 CPGs of varying qualities. CPGs from high‐income countries and international organizations rated high for their methodological quality. Most CPGs scored high for the scope and purpose domain and scored low for applicability domain. Recommendations for the continuum of care for OUD varied across CPGs. Buprenorphine was recommended in most of the CPGs, followed by methadone. Recommendations for psychosocial interventions also varied, with cognitive behaviour therapies and counselling or education being the common recommendations in many CPGs What is new and conclusion: We found most CPGs have scope and purpose and clarity of presentation. However, the methodological rigour and applicability scored low. CPGs need to frame health questions in a comprehensible manner and provide an update as evidence grows. It is important for CPG developers to consider methodological quality as a factor when developing CPG recommendations. [ABSTRACT FROM AUTHOR]

Stroke represents one of the major causes of death and long-term disability worldwide and, even when new treatment strategies have been identified, there is a need of quality clinical practice guidelines (CPGs) to guide and improve acute stroke care. We aim to describe the characteristics and assess the quality of CPGs in endovascular treatment for acute ischemic stroke due to anterior-circulation large-vessel occlusion. We conducted a scoping review of CPGs that assessed stroke management. We searched the following databases: PubMed, TripDatabase, Scopus, and Google Scholar to identify CPGs published or updated in the last 3 years and used Appraisal of Guidelines Research and Evaluation II to assess the quality of the guidelines. We found a total of 9 CPGs published or updated between 2018 and 2020, from which only one third had adequate methodologic rigor. Guidelines presented pitfalls related to evidence search, assessment, and methods used to reach the recommendations. All the CPGs considered a 24-hour extended window of treatment and the CPGs considered the use of similar imaging techniques to diagnose and explore the extent of the stroke. However, there were variations regarding the selection criteria for thrombectomy. The quality of the CPGs varied widely, which issues around the identification and assessment of the evidence used to reach recommendations. Despite this, the recommendations regarding the use of thrombectomy were similar across the CPGs. Readers need to carefully assess the methodologic rigor of CPGs before applying them to their clinical practice. [ABSTRACT FROM AUTHOR]

Background: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. Methods: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre‐specified characteristics. Results: We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P =.001 and 58.3 vs 37.5; P =.02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P =.034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P =.006). Conclusions: Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations' development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines. [ABSTRACT FROM AUTHOR]

Consumer engagement is emerging as an important trend in a contemporary health care environment. Yet, a universal definition of meaningful consumer engagement has not been determined. This paper presents our systematic literature review findings, which intended to consolidate the definition of consumer engagement (or related terms) in the context of health care to date to arrive at a definition for meaningful consumer engagement in healthcare. Literature searches were performed in MEDLINE, CINAHL, Embase and PsychINFO in June 2021. Using a combination of medical subject headings (MeSH) terms, Emtree search headings and free text words, a total of 82 records were identified. After reviewing in line with PRISMA methodology, 23 articles were considered relevant to the development of the definition of consumer engagement. The methodology of these papers was analysed using the revised Mixed Methods Appraisal Tool (MMAT) (2018). A total of 13 of these papers were then further analysed for a definition of meaningful consumer engagement or characteristics of consumer engagement. None of the definitions found comprehensively defined meaningful consumer engagement but instead, five described meaningful consumer engagement. Therefore, a new definition of meaningful consumer engagement is proposed, which is based upon the synthesis of the characteristics of meaningful consumer engagement and person-centred care. This new definition speaks to what is it means to be consumers of health care rather than patients and acknowledged the importance of the reciprocity of the exchange relationship of 'consumers', the importance of leadership, and the emerging evidence around diversity and inclusion trust and partnership which requires active involvement and participation. [ABSTRACT FROM AUTHOR]

Purpose: On-The-Go (OTG) references are those that clinicians make within a tight deadline at the point of patient care to direct critical decisions. We conducted this study to assess the knowledge level of orthopaedicians on clinical usefulness and quality appraisal of different reference methods along with their attitude towards its utility for practice. Materials and Methods: A web-based survey was administered through Google Forms among the members of the Tamil Nadu Orthopaedic Association (TNOA) by snowball sampling method. The survey was designed by the Quality Appraisal Committee (QAC) of Orthopaedic Research Group (ORG) with 17 items. Association and correlation analysis were done between different responses in the survey to find out ways to improve the reference practices. Results: 177 participants with a mean age of 43.5 years completed the survey. About 45.8% (n = 81) of participants had prior knowledge on the Oxford Levels of Evidence. However, they were not familiar with using them for critical appraisal of evidence. About 86.5% (n = 153) of participants were worried about the quality of the content they seek for reference. Among the reference sources, online research articles were used by 54.2% (n = 96), digital applications by 21.4% (n = 38), digital textbooks by 15.2% (n = 27), and other methods like peer discussion by 5.1% (n = 9). A significant association was noted between the participants who chose level I studies for their reference and their familiarity with the concept of fragility (p = 0.006) and heterogenicity (p = 0.021) and types of bias (p = 0.003). A significant association was noted between participants with active journal subscription and their familiarity with the concept of spin (p = 0.016) and their knowledge of the heterogeneity of study results (p = 0.019). We found a significant association between age (< 40 years of age) and knowledge on various types of bias (p = 0.032), heterogenicity (p = 0.01), and fragility (p = 0.021). Conclusion: This is the first study on the information-seeking behaviour of the orthopaedicians. OTG references remain a part of the orthopaedic practice and are made mostly by accessing online research articles. Imparting knowledge of their quality appraisal should be an active part of the orthopaedic curriculum. This will, in turn, improve the attitude and reference practices leading to better decision-making towards patient care. [ABSTRACT FROM AUTHOR]

We propose modifications for scoping (and by extension systematic) review methodologies to improve their contribution to horizon scanning exercises. As a means of systematically collecting, coding and synthesising literature, we argue that scoping reviews are ideal for conducting initial environmental scans of a topic of interest, trend analyses and scenario developments. To demonstrate this utility, this paper uses a futures-oriented scoping review of technology-enhanced money laundering and terrorist financing risks as an example. At the forefront of the proposed modifications is a quality assessment framework assessing reviewed publications for their neutrality, evidence, relevance and clarity (NERC). This proposed framework is not only ideal for appraising publications but also as an indication of likelihood, namely whether their discussed insights constitute possible, plausible or probable alternative futures. The validity of the NERC framework in achieving these aims is assessed successfully through statistical correlation tests. The overall aim of this paper is to motivate the proposed modifications, the NERC framework and (modified) scoping reviews more generally as a formidable tool for informing horizon scanning, decision-making and pre-emptive policy development. • With some methodological enhancements, systematic and scoping reviews can become effective initial horizon scanning tools. • This article proposes six such modifications, including study selection, quality appraisal and expert verification. • The NERC framework (neutrality, evidence, relevance, and clarity) is proposed to assess publication quality. • The utility of NERC scores to identify weak signals, possible, plausible and probable future scenarios is demonstrated. • This can have significant impact on informing future studies, policy, prioritisation and understanding of futures issues. [ABSTRACT FROM AUTHOR]

Background: Surviving sepsis campaign (SSC) recommends 6 h-sepsis resuscitation bundle for severe sepsis (now termed “sepsis” after the Sepsis-3 definition) or septic shock. The study was done to assess the guideline compliance in Indian patients before and after the resident physicians' training and their impact on the survival. Subjects and Methods: Prospective interventional study (time series design) was conducted. Resident physicians, who were regularly managing the patients of severe sepsis/septic shock, were trained by providing the education and feedback on the guideline compliance at 6-month intervals for three quality improvement (QI) phases. Case details of preintervention and QI phases' patients were reviewed as per the quality indicators, defined by SSC guideline, and compared. Results: The baseline compliance of composite six components of 6 h-sepsis resuscitation bundle was low and significantly increased on postintervention (baseline 0% to 18% at QI 3 (P for trend = 0.01). The compliance of individual components was improved too: serum lactate measurement (26%, P = 0.002), obtaining blood culture (28%, P = 0.003), antibiotic administration (2%, P = 0.56), provision of fluid bolus (60%, P = 0.02), attainment of target central venous pressure (50%, P = 0.03), and optimization of central venous oxygen saturation (20%, P = 0.21). The hospital mortality showed a decreasing trend (18%, P = 0.06). Patients compliant to composite bundle got the mortality benefit (odds ratios = 0.25, 95% [confidence interval, 0.07–0.9]). The study, however, did not show any benefits of mean hospital/Intensive Care Unit (ICU) length of stay. Conclusions: The study establishes lack of acceptance to the prevailing guideline; however, it has shown a significant improvement in adaptation and mortality benefit without reducing mean hospital/ICU length of stay after physicians' repeated educational programs. The barriers to implementation of the prevalent guideline should be searched out in further trials.

Background: An assessment of the validity of individual diagnostic accuracy studies in systematic reviews is necessary to guide the analysis and the interpretation of results. Such an assessment is performed for each included study and typically reported at the study level. As studies may differ in sample size and disease prevalence, with larger studies contributing more to the meta-analysis, such a study-level report does not always reflect the risk of bias in the total body of evidence. We aimed to develop improved methods of presenting the risk of bias in the available evidence on diagnostic accuracy of medical tests in systematic reviews, reflecting the relative contribution of the study to the body of evidence in the review. Methods: We applied alternative methods to represent evaluations with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2), weighting studies according to their relative contribution to the total sample size or their relative effective sample size. We used these methods in four existing systematic reviews of diagnostic accuracy studies, including 9, 13, 22, and 32 studies, respectively. Results: The risk-of-bias summaries for each domain of the QUADAS-2 checklist changed in all four sets of studies after replacing unit weights for the studies with relative sample sizes or with the relative effective sample size. As an example, the risk of bias was high in the patient selection domain in 31% of the studies in one review, unclear in 23% and low in 46% of studies. Weighting studies according to the relative sample size changed the corresponding proportions to 4%, 4%, and 92%, respectively. The difference between the two weighting methods was small and more noticeable when the reviews included a smaller number of studies with wider range of sample size. Conclusions: We present an alternative way of presenting the results of risk-of-bias assessments in systematic reviews of diagnostic accuracy studies. Weighting studies according to their relative sample size or their relative effective sample size can be used as more informative summaries of the risk of bias in the total body of available evidence. Systematic review registrations: Not applicable [ABSTRACT FROM AUTHOR]

Background: In the context of the volume of mixed- and multi-methods studies in health services research, the present study sought to develop an appraisal tool to determine the methodological and reporting quality of such studies when included in systematic reviews. Evaluative evidence regarding the design and use of our existing Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was synthesised to enhance and refine it for application across health services research.Methods: Secondary data were collected through a literature review of all articles identified using Google Scholar that had cited the QATSDD tool from its inception in 2012 to December 2019. First authors of all papers that had cited the QATSDD (n=197) were also invited to provide further evaluative data via a qualitative online survey. Evaluative findings from the survey and literature review were synthesised narratively and these data used to identify areas requiring refinement. The refined tool was subject to inter-rater reliability, face and content validity analyses.Results: Key limitations of the QATSDD tool identified related to a lack of clarity regarding scope of use of the tool and in the ease of application of criteria beyond experimental psychological research. The Quality Appraisal for Diverse Studies (QuADS) tool emerged as a revised tool to address the limitations of the QATSDD. The QuADS tool demonstrated substantial inter-rater reliability (k=0.66), face and content validity for application in systematic reviews with mixed, or multi-methods health services research.Conclusion: Our findings highlight the perceived value of appraisal tools to determine the methodological and reporting quality of studies in reviews that include heterogeneous studies. The QuADS tool demonstrates strong reliability and ease of use for application to multi or mixed-methods health services research. [ABSTRACT FROM AUTHOR]

BackgroundA wide range of human in vitro methods have been developed and there is considerable interest in the potential of these studies to address questions related to clinical (human) use of drugs, and the pathobiology of tumours. This requires agreement on how to assess the strength of evidence available (i.e., quality and quantity) and the human-relevance of such studies. The SAToRI-BTR (Systematic Approach To Review of in vitro methods in Brain Tumour Research) project seeks to identify relevant appraisal criteria to aid planning and/or evaluation of brain tumour studies using in vitro methods.ObjectivesTo identify criteria for evaluation of quality and human relevance of in vitro brain tumour studies; to assess the general acceptability of such criteria to senior scientists working within the field.MethodsStage one involved identification of potential criteria for evaluation of in vitro studies through: (1) an international survey of brain tumour researchers; (2) interviews with scientists, clinicians, regulators, and journal editors; (3) analysis of relevant reports, documents, and published studies. Through content analysis of findings, an initial list of criteria for quality appraisal of in vitro studies of brain tumours was developed. Stage two involved review of the criteria by an expert panel (Delphi process).ResultsResults of stage one indicated that methods for and quality of review of in vitro studies are highly variable, and that improved reporting standards are needed. 129 preliminary criteria were identified; duplicate and highly context-specific items were removed, resulting in 48 criteria for review by the expert (Delphi) panel. 37 criteria reached agreement, resulting in a provisional checklist for appraisal of in vitro studies in brain tumour research.ConclusionThrough a systematic process of collating assessment criteria and subjecting these to expert review, SAToRI-BTR has resulted in preliminary guidance for appraisal of in vitro brain tumour studies. Further development of this guidance, including investigating strategies for adaptation and dissemination across different sub-fields of brain tumour research, as well as the wider in vitro field, is planned.