Supporting the applicability and transferability of the “Sortir Ensemble & Se Respecter” program in France

INTRODUCTION

The prevention of intimate partner violence (IPV) among young people is a major challenge for public policies. Nevertheless, there are a few prevention programs that have proven effective in France. “Sortir Ensemble & Se Respecter” (SE&SR) is a Swiss adaptation of “Safe Dates,” an American intervention program that has reduced violent behavior by young perpetrators and victims of IPV alike. The aim of this article is to analyze the applicability and “potential transferability” of SE&SR in France.

METHODS

We described the SE&SR intervention by explaining the intervention theory, the key functions (i.e., the “ingredients” allowing the SE&SR program to work), and we commented on its applicability from a perspective of adapting and transferring it to the French context. We used the ASTAIRE tool and the FIC (key functions, implementation, context) approach.

RESULTS

The intervention theory highlighted various factors, acting at the individual level (i.e., beliefs/representations, knowledge, life skills) and at the level of the living environment (i.e., facilities welcoming young people; families; public policies; networks of actors), that can prevent IPV among young people. Ten key functions have been identified, revealing the “skeleton” of the Swiss intervention. We drew on these results to comment on the intervention’s applicability, with a view to transferability, specifying the contextual elements to consider before implementing SE&SR in France.

CONCLUSION

This study aims to make the process of evaluating applicability, with a view to transferring an evidence-based program to the French context, more accessible.

A comparative study of various drought indices at different timescales and over different record lengths in the arid area of northwest China

Although many drought indices have been developed to monitor drought conditions, their applicability differs across climatic regions, which results in different characteristics of drought index assessments at different timescales and over different record lengths. Therefore, the applicability of precipitation-based and precipitation-evapotranspiration/temperature-based drought indices was examined in this study using the Generalized Extreme Value Index (GEVI), Homogeneity Index (HI) of precipitation and temperature, K index (K), precipitation anomaly percentage (Pa), Standardized Precipitation Evapotranspiration Index (SPEI), Standardized Precipitation Index (SPI), and China-Z Index (CZI) over different record lengths and at a timescale range of 1-24 months. In addition, the results that were obtained using these indices were compared with the Self-Calibrating Palmer Drought Severity Index (scPDSI). The stability, accuracy, and consistency of the different drought indices were evaluated using precipitation and evapotranspiration/temperature data (1-24 months) collected from different climatic regions in the arid area of northwest China in the 1961-2017 period. The results indicated that the Pa, CZI, K, and SPEI were more stable; the SPI, SPEI, and HI were more accurate; and the GEVI, SPI, HI, and SPEI were more consistent with the scPDSI. In addition, the results indicated that it is more appropriate to select a long record length (> 35 years) to monitor drought when sufficient data are available. However, defining constant drought classes may not be appropriate for all drought timescales. In fact, precipitation and evapotranspiration data from different timescales had different optimal distribution functions. The drought indices also demonstrated that they were applicable to a temperate arid area in the study region. In addition, the HI and SPEI better captured the precipitation and evapotranspiration/temperature characteristics, while the CZI, K, and Pa overestimated or underestimated the frequency of different drought classes at different timescales to some extent in the study region. The results of this study suggest that greater priority should be given to the precipitation-evapotranspiration-based indices. In addition, it is suggested to change the drought index class thresholds in future related studies on drought event recognition at different timescales to ensure more accurate drought monitoring.

A two-stage Fe(VI) oxidation process enhances the removal of bisphenol A for potential application

Ferrate (Fe(VI)) has been extensively studied as a green oxidant to treat wastewater. But Fe(VI) oxidation still faces several challenges for application, such as the sensitivity of Fe(VI) to pH and the restrictions on the Fe(VI) utilization efficiency for pollutant elimination at low concentration levels. This study proposed a two-stage Fe(VI) oxidation process to enhance the bisphenol A (BPA) removal for potential applicability, consisting of the adsorption by CNTs of stage I and the degradation by Fe(VI) of stage II. The Fe(VI) utilization efficiency in the two-stage process (0.848) was higher than that in one-stage processes (0.727) and Fe(VI) alone system (0.504) at pH 9. In stage I, the adsorption process had good compliance with the Langmuir isotherm model and pseudo-second-order kinetic model. In stage II, the effective utilization of low-concentration Fe(VI) was 2.45 times more than Fe(VI) alone, and the reduction of reaction volume was beneficial to further enhance utilization. The probe experiments (sulfoxide) and the degradation experiments of other electron-donating/withdrawing pollutants (e.g., atrazine, benzoic acid) demonstrated that Fe(IV) and Fe(V) were major oxidizing species in the two-stage process. The regeneration experiments showed that CNTs still had acceptable adsorption and catalytic capabilities after five cycles. Finally, the intermediate products in the two-stage process were detected and four possible degradation pathways of BPA were proposed. These findings were meaningful for the practical application of Fe(VI) oxidation to overcome the conditional limitation and improve the utilization.

Risk of bias assessments in individual participant data meta-analyses of test accuracy and prediction models: a review shows improvements are needed

OBJECTIVES

Risk of bias assessments are important in meta-analyses of both aggregate and individual participant data (IPD). There is limited evidence on whether and how risk of bias of included studies or datasets in IPD meta-analyses (IPDMAs) is assessed. We review how risk of bias is currently assessed, reported, and incorporated in IPDMAs of test accuracy and clinical prediction model studies and provide recommendations for improvement.

STUDY DESIGN AND SETTING

We searched PubMed (January 2018-May 2020) to identify IPDMAs of test accuracy and prediction models, then elicited whether each IPDMA assessed risk of bias of included studies and, if so, how assessments were reported and subsequently incorporated into the IPDMAs.

RESULTS

Forty-nine IPDMAs were included. Nineteen of 27 (70%) test accuracy IPDMAs assessed risk of bias, compared to 5 of 22 (23%) prediction model IPDMAs. Seventeen of 19 (89%) test accuracy IPDMAs used Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), but no tool was used consistently among prediction model IPDMAs. Of IPDMAs assessing risk of bias, 7 (37%) test accuracy IPDMAs and 1 (20%) prediction model IPDMA provided details on the information sources (e.g., the original manuscript, IPD, primary investigators) used to inform judgments, and 4 (21%) test accuracy IPDMAs and 1 (20%) prediction model IPDMA provided information or whether assessments were done before or after obtaining the IPD of the included studies or datasets. Of all included IPDMAs, only seven test accuracy IPDMAs (26%) and one prediction model IPDMA (5%) incorporated risk of bias assessments into their meta-analyses. For future IPDMA projects, we provide guidance on how to adapt tools such as Prediction model Risk Of Bias ASsessment Tool (for prediction models) and QUADAS-2 (for test accuracy) to assess risk of bias of included primary studies and their IPD.

CONCLUSION

Risk of bias assessments and their reporting need to be improved in IPDMAs of test accuracy and, especially, prediction model studies. Using recommended tools, both before and after IPD are obtained, will address this.

Investigation of the applicability of the zebrafish model for the evaluation of aristolochic acid-related nephrotoxicity

BACKGROUND

The risk of compounds/drugs, including aristolochic acid-induced nephrotoxicity remains high and is a significant public health concern. Therefore, it is particularly important to select reasonable animal models for rapid screening and evaluation of different samples with complex chemical systems. The zebrafish (Danio rerio) has been used to study chemical-induced renal toxicity. However, most of the published literature was performed on individual components or drugs, and the key evidence confirming the applicability of zebrafish larvae for the evaluation of aristolochic acid-related nephrotoxicity in complex chemical systems, such as in traditional Chinese medicine (TCM), was insufficient.

METHODS

High-performance liquid chromatography (HPLC) was used to determine the content of aristolochic acid (AA) in herbs and Chinese patent medicines. The zebrafish larvae at 4 days post-fertilization (dpf) were used to evaluate the nephrotoxicity of various samples, respectively, based on the phenotype of the kidney and histological, and biochemical. Transcriptome technology was used to investigate the related signaling pathways and potential mechanisms after treatment with AA, which was verified by RT-PCR technology.

RESULTS

The results showed that the total amounts of AAI, AAII, and ALI ranged from 0.0004 to 0.1858 g·g-1( %) from different samples, including Aristolochia debilis, Fibraurea recisa, Asarum, Wantongjingu tablets, Jiuweiqianghuo granules, and Xiaoqinglong granules in descending order. Moreover, compared with the negative/blank control, substantial changes in phenotype, histomorphology and biochemical parameters of renal function were observed in the groups challenged with the sublethal concentration of drugs. The transcriptomics results showed the upregulation of most genes in PERK/ATF4/CHOP, ATM/Chk2/p53, Caspase/Bax/Bcl-2a, TGF/Smad/ERK, PI3K/Akt, induced by aristolochic acid analogues, which were essentially consistent with those of the q-RT-PCR experiments, highlighting the similar toxicity response to the previously published article with the other traditional evaluation model.

CONCLUSION

The stability, accuracy and feasibility of the zebrafish larval model in screening and evaluating the nephrotoxicity of TCM were validated for the first time on the AAs-related drugs in a unified manner, confirming and promoting the applicability of zebrafish in assessing nephrotoxicity of samples with complex chemical character.

Mismatch of populations between randomised controlled trials of perioperative interventions in major abdominal surgery and current clinical practice

BACKGROUND

Demographics of patients undergoing major abdominal surgery are changing. External validity of relevant RCTs may be limited by participants not resembling patients encountered in clinical practice. We aimed to characterise differences in age, weight, BMI, and ASA grade between participants in perioperative trials in major abdominal surgery and patients in a reference real-world clinical practice sample. The secondary aim was to investigate whether time since trial publication was associated with increasing mismatch between these groups.

METHODS

MEDLINE and Embase were searched for multicentre RCTs from inception to September 2022. Studies of perioperative interventions in adults were included. Studies that limited enrolment based on age, weight, BMI, or ASA status were excluded. We compared trial cohort age, weight, BMI, and ASA distribution to those of patients undergoing major abdominal surgery at our tertiary referral hospital during September 2021 to September 2022. We used a local, single-institution reference sample to reflect the reality of clinical practice (i.e. patients treated by a clinician in their own hospital, rather than averaged nationally). Mismatch was defined using comparison of summary characteristics and ad hoc criteria based on differences relevant to predicted mortality risk after surgery.

RESULTS

One-hundred and six trials (44,499 participants) were compared to a reference cohort of 2792 clinical practice patients. Trials were published a median (IQR [range]) 13.4 (5-20 [0-35]) years ago. A total of 94.3% of trials were mismatched on at least one characteristic (age, weight, BMI, ASA). Recruitment of ASA 3 + participants in trials increased over time, and recruitment of ASA 1 participants decreased over time (Spearman's Rho 0.58 and - 0.44, respectively).

CONCLUSIONS

Patients encountered in our current local clinical practice are significantly different from those in our defined set of perioperative RCTs. Older trials recruit more low-risk than high-risk participants-trials may thus 'expire' over time. These trials may not be generalisable to current patients undergoing major abdominal surgery, and meta-analyses or guidelines incorporating these trials may therefore be similarly non-applicable. Comparison to local, rather than national cohorts, is important for meaningful on-the-ground evidence-based decision-making.

Applicability and limitations of quality indicator-based assessment of appropriateness in antimicrobial use: a comparison with expert opinion

BACKGROUND

The effective implementation of antimicrobial stewardship requires an a-priori assessment of the appropriateness of antimicrobial prescriptions.

AIM

To evaluate the effectiveness of quality indicators (QIs) in determining the appropriateness of antimicrobial prescriptions compared to that of expert opinions.

METHODS

The study assessed antimicrobial use in 20 hospitals in Korea, with infectious disease specialists rating the appropriateness based on QIs and expert opinions. The selected QIs were (1) taking two blood cultures, (2) taking cultures from suspected sites of infection, (3) prescribing empirical antimicrobials according to guidelines, and (4) changing from empirical to pathogen-directed therapy for hospitalized patients and (2, 3, and 4) for ambulatory patients. Applicability, compliance with QIs, and agreement between QIs and expert opinions were investigated.

FINDINGS

Overall, 7999 therapeutic uses of antimicrobials were investigated at the study hospitals. The experts rated 20.5% (1636/7999) as inappropriate use. For hospitalized patients, antimicrobial use was assessed based on all four QIs in 28.8% (1798/6234) of the cases. For ambulatory care patients, only 7.5% (102/1351) of the antimicrobial use cases were assessed using all three QIs. The agreement between expert opinions and all four QIs for hospitalized patients was minimal (κ = 0.332), whereas that between expert opinions and all three QIs for ambulatory patients was weak (κ = 0.598).

CONCLUSION

QIs have limitations in determining the appropriateness of antimicrobial use, and the degree of agreement with expert opinions was low. Therefore, these QI limitations should be considered when determining the appropriateness of antimicrobial use.

Underreporting contextual factors preclude the applicability appraisal in primary care randomized controlled trials

OBJECTIVES

To assess applicability reporting in randomized controlled trials (RCTs) conducted in primary care (PC).

STUDY DESIGN AND SETTING

We used a random sample of PC RCTs published between 2000 and 2020 to assess applicability. We extracted data related to setting, population, intervention (including implementation), comparator, outcomes, and context. Based on data availability, we assessed whether the five predefined applicability questions were adequately addressed by each PC RCT.

RESULTS

Adequately described elements that were reported frequently (>50%) included the responsible organization for intervention provision (97, 93.3%), study population characteristics (94, 90.4%), intervention implementation including monitoring and evaluation (92, 88.5%), intervention components (89, 85.6%), time frame (82, 78.8%), baseline prevalence (58, 55.8%), and the type of setting and location (53, 51%). Elements that were often underreported included contextual factors, that is, evidence of differential effects across sociodemographic or other groupings (2, 1.9%), intervention components tailored for specific settings (7, 6.7%), health system structure (32, 30.8%), factors affecting implementation (40, 38.5%) and organization structure (50, 48.1%). The proportion of trials that adequately addressed each applicability question ranged between 1% and 20.2%, while none RCT could address all of them.

CONCLUSION

Underreporting contextual factors jeopardize the appraisal of applicability in PC RCTs.

GRADE concept 4: rating the certainty of evidence when study interventions or comparators differ from PICO targets

OBJECTIVES

This Grading of Recommendations Assessment, Development and Evaluation (GRADE) concept article offers systematic reviewers, guideline authors, and other users of evidence assistance in addressing randomized trial situations in which interventions or comparators differ from those in the target people, interventions, comparators, and outcomes. To clarify what GRADE considers under indirectness of interventions and comparators, we focus on a particular example: when comparator arm participants receive some or all aspects of the intervention management strategy (treatment switching).

STUDY DESIGN AND SETTING

An interdisciplinary panel of the GRADE working group members developed this concept article through an iterative review of examples in multiple teleconferences, small group sessions, and e-mail correspondence. After presentation at a GRADE working group meeting in November 2022, attendees approved the final concept paper, which we support with examples from systematic reviews and individual trials.

RESULTS

In the presence of safeguards against risk of bias, trials provide unbiased estimates of the effect of an intervention on the people as enrolled, the interventions as implemented, the comparators as implemented, and the outcomes as measured. Within the GRADE framework, differences in the people, interventions, comparators, and outcomes elements between the review or guideline recommendation targets and the trials as implemented constitute issues of indirectness. The intervention or comparator group management strategy as implemented, when it differs from the target comparator, constitutes one potential source of indirectness: Indirectness of interventions and comparators-comparator group receipt of the intervention constitutes a specific subcategory of said indirectness. The proportion of comparator arm participants that received the intervention and the apparent magnitude of effect bear on whether one should rate down, and if one does, to what extent.

CONCLUSION

Treatment switching and other differences between review or guideline recommendation target interventions and comparators vs. interventions and comparators as implemented in otherwise relevant trials are best considered issues of indirectness.

Reverse homodigital artery versus reverse dorsal homodigital island flaps for fingertip defect repair: A meta-analysis

PURPOSE

This review aimed to systematically and comprehensively compare the effectiveness and applicability of reverse homodigital artery island flaps (RHAIF) and reverse dorsal homodigital island flaps (RDHIF) to treat fingertip defects.

METHODS

A comprehensive search was conducted in multiple databases for studies that compared RHAIF versus RDHIF for treating fingertip defects with no language restrictions from inception until July 31, 2022. A meta-analysis was performed using RevMan 5.4 software.

RESULTS

A total of 14 articles were retrieved, comprising 484 patients (509 fingers) in the RHAIF group and 453 patients (484 fingers) in the RDHIF group. The pooled estimates suggested that patients treated with RHAIF experienced more donor-side complications and less postoperative venous crisis than patients in the RDHIF group. On the other hand, no significant differences were found in operative time, flap necrosis, static 2-point discrimination, moving two-point discrimination, total active motion, satisfaction rates and sensory recovery grade (S3+ to S4) between the RHAIF and RDHIF groups.

CONCLUSIONS

No difference in effectiveness was found between the two surgical procedures for treating fingertip defects. Accordingly, the selection of the optimal approach should be based on the functional requirements of the patient and the surgeon's expertize.

A systematic review of quality and consistency of clinical practice guidelines on the primary prevention of food allergy and atopic dermatitis

Background and aims

With an increasing number of Clinical Practice Guidelines (CPGs) addressing primary prevention of food allergy and atopic dermatitis, it is timely to undertake a comprehensive assessment of the quality and consistency of recommendations and evaluation of their implementability in different geographical settings.

Methods

We systematically reviewed CPGs from 8 international databases and extensive website searches. Seven reviewers screened records in any language and then used the AGREE II and AGREE REX instruments to critically appraise CPGs published between January 2011 and April 2022.

Results

Our search identified 2138 relevant articles, of which 30 CPGs were eventually included. Eight (27%) CPGs were shortlisted based on our predefined quality criteria of achieving scores >70% in the "Scope and Purpose" and "Rigour of Development" domains of the AGREE II instrument. Among the shortlisted CPGs, scores on the "Applicability" domain were generally low, and only 3 CPGs rated highly in the "Implementability" domain of AGREE-REX, suggesting that the majority of CPGs fared poorly on global applicability. Recommendations on maternal diet and complementary feeding in infants were mostly consistent, but recommendations on use of hydrolysed formula and supplements varied considerably.

Conclusion

The overall quality of a CPG for Food Allergy and Atopic Dermatitis prevention did not correlate well with its global applicability. It is imperative that CPG developers consider stakeholders' preferences, local applicability, and adapt existing recommendations to each individual population and healthcare system to ensure successful implementation. There is a need for development of high-quality CPGs for allergy prevention outside of North America and Europe.

PROSPERO registration number

CRD42021265689.

McKern-Stewart method as a technique for analysing age related pubic symphyseal changes: A systematic review and meta-analysis

Age estimation is one of the essential criteria in the identification process. The method of age estimation employed depends on the availability of skeletal material brought for forensic examination. McKern and Stewart's method constitutes one of the principal approaches towards pubic symphyseal age estimation. The method entails evaluating morphological changes within the pubic symphysis and subsequently allotting a specific score corresponding to the observed changes. Based on the obtained scores, an age range is then assigned to the remains presenting for examination. The present systematic review was undertaken to ascertain the applicability of the McKern-Stewart method for age estimation. Studies pertaining to the use of the McKern-Stewart method for age estimation in skeletal remains were retrieved by keying in a combination of MeSH terms and other free terms from four databases. The retrieved articles were subjected to a stringent inclusion and exclusion criteria, following which the risk of bias was assessed and the overall quality of evidence was established. Once the final tally of relevant articles was obtained, data specific to the mean age corresponding to each score was extracted. Non-parametric tests and boxplots were employed to compare the mean ages reported across multiple studies. The present systematic review concludes that the McKern-Stewart method can be applied for the purpose of age estimation in skeletal remains. Broader age cohorts for higher scores, as well as, overlapping values for age ranges in relation to the cumulative scores, however, can be considered a limitation for its applicability in forensic case work.

[Systematic reviews in five steps: V. Interpreting the findings]

The last step in a systematic review is the interpretation of the findings. The important findings need to be explicitly identified. A level of strength of evidence should be assigned to support each key finding, based on factors such as study design, methodological quality and risk of publication bias. Variations in the magnitude of associations observed also need to be explored. The aim of this analysis is to determine in which clinical groups the intervention is more or less effective, the impact of exposure is greater or lesser, or a diagnostic test is more useful. At this stage, for better interpretation of the findings, the magnitude of the association can be estimated either globally or stratified according to the characteristics of the participants. All this is helpful in formulating recommendations for clinical practice and policy.

Evaluation of the acceptability of point of care diagnostic test for prenatal toxoplasmosis (translational research phase III)

BACKGROUND

A new point of care test (POC) was developed that is promising as a tool to enhance impact of prenatal care programs for toxoplasmosis, however, no reports exist about its use or acceptability for healthcare personnel and mothers in Colombia.

METHODS

This was a translational research - phase III study of the acceptability of a new POC test (Toxoplasma ICT IgG-IgM, LDBio) for qualitative diagnosis of toxoplasmosis in 783 pregnant women and 30 health personnel in primary health care sites in the city of Armenia, Quindío (Colombia). Along with collection of the results of diagnostic POC and confirmatory test and demographic information, we evaluated acceptability through measure of the willingness, credibility, and satisfaction by using questionnaires with a Likert scale during routine prenatal care visits.

RESULTS

POC positivity was 46.5% among pregnant participants and was significantly related to socioeconomic factors, including education level (p = 0.00000000) and insurance status (p = 0.00000015). A total of 93-97% of healthcare personnel indicated agreement to positive statements regarding total satisfaction and total credibility of the LDBio test, but qualitative questions identified "Difficulty in the test procedure" as the most common response about barriers to apply the test. Greater than 90% of pregnant participants agree that POC test should be routine for all pregnant woman and permanently implemented.

CONCLUSIONS

The test had near complete acceptability. In future studies it is necessary to examine the effect of non-differentiation between IgG and IgM isotypes.

Measuring continuity of ambulatory cardiovascular care: a cross-sectional study on the applicability of the Nijmegen Continuity Questionnaire in Germany

Background

Chronic cardiovascular diseases demand continuous care from general practitioners and medical specialists. Especially in fragmented healthcare systems, such as in Germany, a large body of research is devoted to the improvement of care continuity. Meanwhile, measuring continuity of care itself has been a challenge due to the absence of validated instruments. In 2011, the Dutch Nijmegen Continuity Questionnaire (NCQ) was developed and validated to measure continuity of care across care settings from the patients’ perspectives in the Netherlands. Its applicability in other countries and health systems, however, has rarely been tested. We therefore aimed at assessing the applicability of the Nijmegen Continuity Questionnaire to the German health care context. 

Methods

We translated and applied the original NCQ to an ambulatory cardiovascular care setting in Germany. Qualitative interview data and quantitative survey data on our adaptation were collected from patients in 27 general practices within the German states of Baden-Wuerttemberg and Rhineland-Palatinate. Qualitative data on understandability and clearness of the questionnaire was obtained using semi-structured telephone interviews and think aloud-protocols. Quantitative data was obtained through an anonymous written questionnaire containing the translated NCQ items to assess applicability of our translation. We performed confirmatory and exploratory factor analyses based on the original NCQ-structure mapped to general practitioners and an aggregated analysis of general practitioners and cardiologists combined.

Results

A total of 6 patients participated in the interviews and a total of 435 patients participated in the written survey. The interviews showed that, overall, patients had little difficulties comprehending and answering to our translation of the NCQ. The confirmatory factor analyses then showed that the structure of the original NCQ with 12 items and 3 latent factors can also be found in the German context. However, a simpler 2-factor-structure would also fit well with the data.

Conclusion

A German translation of the NCQ yielded a factor structure comparable to the original version and proved to be understandable for patients.

Trial registration

The project underlying the study was registered on November 7, 2019 in the German Clinical Trials Register (www.drks.de) under ID: DRKS00019219.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08612-z.

Applicability of the interventions recommended for patients at risk or with delirium in medical and post-acute settings: a systematic review and a Nominal Group Technique study

BACKGROUND

Delirium is a common condition during hospitalisation that should be prevented and treated. Several recommendations have been established to date, whereas few studies have investigated their applicability in daily practice for medical and post-acute settings.

AIM

The aim of this research exercise was to emerge the applicability of the interventions recommended by studies in the daily care of patients at risk or with delirium cared in medical and post-acute settings.

METHODS

The study was organised in three phases. A systematic literature review according to Centre for Reviews and Dissemination was conducted (January-February 2021). Cochrane Library, Pubmed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Psychological Information Database, and the Joanna Briggs Institute databases were searched. Primary and secondary studies were evaluated in their methodological quality with the Standard Quality Assessment Criteria, the Critical Appraisal Skills Programme, and the Appraisal of Guidelines for Research & Evaluation. Then, the interventions identified were assessed in their applicability using the Nominal Group Technique who ranked their judgement on a four-point Likert scale from 1 (totally inapplicable) to 4 (totally applicable). Qualitative feedbacks were also considered, and a validation of the final list was performed by the Nominal Group.

RESULTS

A total of 12 studies were included producing a list of 96 interventions categorised into four macro-areas (prevention, non-pharmacological, communication and pharmacological management). The Nominal Group identified 51 interventions (average score > 3.5) as applicable in medical and post-acute settings. Then, through a process of re-reading, and revising according to the comments provided by the Nominal Group, a list of 35 interventions out of the initial 96 were judged as applicable.

CONCLUSION

Applicability should be assessed with experts in the field to understand the involved factors. One-third of interventions have been judged as applicable in the Italian context; the nurses' expertise, the work environment features, and the time required for each intervention in a high workload setting may prevent the full applicability of the interventions recommended by the literature.

Evaluation of the applicability of organic amendments from microbially driven carbon and nitrogen transformations

Pig manure (PM), wheat straw (WS), compost product (CP) and improved compost product (IC) are very important agricultural organic resources. In this study, their applicability as soil organic fertilizations (OFs) in terms of their properties and influence on soil properties through an incubation experiment and a field verification were evaluated. The property differences indicated that wheat straw has the highest C/N ratio, and compost products contain more aromatic compounds compared with pig manure and wheat straw. The results of incubation experiment showed that OFs promoted the carbon and nitrogen transformation driven by related microorganisms and their functional metabolisms. The PM treatment had the highest proportion of Labile organic carbon to soil organic carbon (LOC/SOC) and ratio of dissolved organic carbon to soil organic carbon (DOC/SOC), while WS treatment had the lowest values. The highest net N mineralization rate and nitrification rate was observed in the WS treatment, but the lowest amounts were under the PM treatment. Additionally, the similar findings were also obtained from the field examination. Therefore, compost products were more applicable in agricultural soil as OF insight from changes in carbon, nitrogen and microbial community. Furthermore, the result of UV-vision showed that the largest amount of aromatic structure was observed in IC relative to CP. It can be concluded that CP was more conducive to fix carbon and provide available nitrogen for crops among four OFs.

Identification of tools used to assess the external validity of randomized controlled trials in reviews: a systematic review of measurement properties

Background

Internal and external validity are the most relevant components when critically appraising randomized controlled trials (RCTs) for systematic reviews. However, there is no gold standard to assess external validity. This might be related to the heterogeneity of the terminology as well as to unclear evidence of the measurement properties of available tools. The aim of this review was to identify tools to assess the external validity of RCTs. It was further, to evaluate the quality of identified tools and to recommend the use of individual tools to assess the external validity of RCTs in future systematic reviews.

Methods

A two-phase systematic literature search was performed in four databases: PubMed, Scopus, PsycINFO via OVID, and CINAHL via EBSCO. First, tools to assess the external validity of RCTs were identified. Second, studies investigating the measurement properties of these tools were selected. The measurement properties of each included tool were appraised using an adapted version of the COnsensus based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

Results

38 publications reporting on the development or validation of 28 included tools were included. For 61% (17/28) of the included tools, there was no evidence for measurement properties. For the remaining tools, reliability was the most frequently assessed property. Reliability was judged as “sufficient” for three tools (very low certainty of evidence). Content validity was rated as “sufficient” for one tool (moderate certainty of evidence).

Conclusions

Based on these results, no available tool can be fully recommended to assess the external validity of RCTs in systematic reviews. Several steps are required to overcome the identified difficulties to either adapt and validate available tools or to develop a better suitable tool.

Trial registration

Prospective registration at Open Science Framework (OSF): 10.17605/OSF.IO/PTG4D.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01561-5.

Comparing the Diagnostic Criteria of MAFLD and NAFLD in the Chinese Population: A Population-based Prospective Cohort Study

BACKGROUND AND AIMS

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new concept, proposed in 2020; however, its applicability in Asia populations has yet to be evaluated. Therefore, we aimed to compare the difference in epidemiological and clinical characteristics between MAFLD and non-alcoholic fatty liver disease (NAFLD) among Asian populations.

METHODS

Based on the Jinchang cohort, 30,633 participants were collected. The prevalence and incidence of MAFLD and NAFLD were used to analyze the epidemic characteristics and its overlapping effects. In addition, the corresponding clinical characteristics of the two diagnostic criteria populations were compared.

RESULTS

The prevalence rates of MAFLD and NAFLD were 21.03% and 18.83%, respectively. After an average 2.28-year follow-up, the incidence densities of MAFLD and NAFLD were 41.58 per 1,000 person-years and 37.69 per 1,000 person-years, respectively. With the increase of baseline age, body mass index (BMI), and waist circumference (WC) levels, the prevalence and incidence of MAFLD and NAFLD were on the rise (all p _trend<0.05). Among the total patients diagnosed at baseline or follow-up, most patients had both MAFLD and NAFLD, accounting for 78.84% and 82.88%, respectively. Compared with NAFLD, MAFLD patients had greater proportions of males and metabolic diseases (diabetes, dyslipidemia), and had higher BMI, WC, liver enzymes, blood glucose, and lipid levels in the baseline diagnosis patients (p<0.05). Additionally, lean MAFLD patients had higher metabolic disorders than lean NAFLD patients (p<0.05).

CONCLUSIONS

Compared with NAFLD, the newly proposed definition of MAFLD is more practical and accurate, and it can help identify more fatty liver patients with high-risk diseases.

State-of-the-art of situation recognition systems for intraoperative procedures

One of the key challenges for automatic assistance is the support of actors in the operating room depending on the status of the procedure. Therefore, context information collected in the operating room is used to gain knowledge about the current situation. In literature, solutions already exist for specific use cases, but it is doubtful to what extent these approaches can be transferred to other conditions. We conducted a comprehensive literature research on existing situation recognition systems for the intraoperative area, covering 274 articles and 95 cross-references published between 2010 and 2019. We contrasted and compared 58 identified approaches based on defined aspects such as used sensor data or application area. In addition, we discussed applicability and transferability. Most of the papers focus on video data for recognizing situations within laparoscopic and cataract surgeries. Not all of the approaches can be used online for real-time recognition. Using different methods, good results with recognition accuracies above 90% could be achieved. Overall, transferability is less addressed. The applicability of approaches to other circumstances seems to be possible to a limited extent. Future research should place a stronger focus on adaptability. The literature review shows differences within existing approaches for situation recognition and outlines research trends. Applicability and transferability to other conditions are less addressed in current work.

Absence of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis is a valid strategy

BACKGROUND

Management of abdominal drainage after surgery for secondary lower gastrointestinal tract peritonitis (LGTP) is not a standardized procedure. A monocentric study was carried out in 2016 in our centre. (PI study) to evaluate the interest of drainage. Our objective was to revaluate, our actual use of abdominal drainage after peritonitis (PII study).

STUDY DESIGN

We examined retrospectively patients who underwent surgery for secondary sub-mesocolic community-acquired peritonitis (January 2016-December 2019). Study exclusion criteria were primary peritonitis, peritoneal dialysis, nosocomial peritonitis, postoperative peritonitis, upper gastrointestinal tract peritonitis, peritonitis due to appendicitis, peritonitis requiring the implementation of Mikulicz's drain, and peritonitis in which the peritoneum was not described in the surgical report (i.e., the same criteria that the PI study which included 141 patients from January 2009 to January 2012). The primary endpoint was the rate of abdominal drainage. The secondary endpoints were the patient rate without a peritoneum description, major complications rate (Clavien ≥III), abscess rate, mortality rate and the length of stay in the non-drain group (D - ) and in the drain group (D + ) in PII study. Primary and secondary endpoints were also compared between PI and PII studies. Risk factors for post-operative abscess were also research.

RESULTS

Of the 150 patients included 33% were drained vs 84% of the 141 patients included in PI study (p < 0.001). In PII study peritoneum was described in 80.3% of patients vs 69% in PI study (NS, p = 0.06). Comparing the two groups D -  and D + , no significant differences were found in major complications (respectively 45% vs 32%, p = 0.1), reoperation rate (respectively 25% vs 22%, p = 0.7), death rate (respectively 25% vs 14%; p = 0.1) and mean length of stay (respectively 12 days vs 13 days, p = 0.9). The abscess rate was significantly lower in the D -  group (10% vs 30%, p = 0.002). Comparing PI and PII studies, there was no difference about major complications (35% vs 35%, p = 0.1), reoperation (16% vs 17.5%, p = 0.5), abscess rate (15% vs 8.5%, p = 0.1) and mortality (14.5% vs 17.5%, p = 0.7). The length of stay was longer in PI study than in P II (14 days vs 9 days, p = 0.03). Drainage (p = 0.005; OR = 4.357; CI [1.559-12.173]) and peritonitis type (p = 0.032; OR = 3.264; CI [1.106-9.630]) were abscess risk factors.

CONCLUSION

This study therefore showed that drainage after surgery for LGTP may not be necessary and that, at least at the local level, surgeons seem to be inclined to discontinue it systematically. It may therefore be worthwhile to conduct a randomised control trial to establish recommendations on drainage after surgery for LGTP.

Shear-Wave Dispersion Slope of the Liver: Effect of Study Protocol and Ascites on the Measurement Applicability

This study aimed to evaluate the shear-wave dispersion (SWD) scanning protocol including the minimum number of measurements and better size of the region of interest (ROI), as well as the influence of ascites on the measurement applicability. Patients who had undergone serial SWD examinations between July 2019 and December 2020 were included. In patients with chronic liver disease (group A), two different ROI sizes were applied, and at least 10 measurements were repeated to determine the minimum number of measurements and better ROI size. In patients with liver failure (group B), failure and unreliable results were compared between patients with and without ascites. A minimum of five measurements when using a 20-mm ROI and six measurements when using a 10-mm ROI were required. Compared with using a 20-mm ROI, a 10-mm ROI showed a higher unreliable rate. The failure and unreliable rates of SWD in patients with ascites were significantly higher than those in patients without ascites. SWD examination required at least five measurements when using a 20-mm ROI and six measurements when using a 10-mm ROI. A larger ROI was associated with higher reliability, and ascites influenced the failure and reliability of the SWD measurement.

Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting

BACKGROUND

Delirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection.

METHOD

This diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients' and the health care professionals' experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted.

RESULTS

By reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51-0.84) and specificity 0.92 (95% CI 0.87-0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50-0.93), specificity 0.93 (95% CI 0.87-0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct.

CONCLUSION

The Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden.

External applicability of SGLT2 inhibitor cardiovascular outcome trials to patients with type 2 diabetes and cardiovascular disease

Background

Recent treatment guidelines support the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes and cardiovascular disease based on the results of cardiovascular outcome trials (CVOTs). Applicability of these trials to everyday patients with type 2 diabetes and cardiovascular disease is however unknown. The aim of this study is to assess the external applicability of SGLT2i CVOTs in daily clinical practice type 2 diabetes patients with established cardiovascular disease.

Methods

Trial in- and exclusion criteria from EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI 58 and VERTIS-CV were applied to 1389 type 2 diabetes patients with cardiovascular disease in the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART). To evaluate the difference in cardiovascular risk (MACE) and all-cause mortality between trial eligible and ineligible patients, age and sex-adjusted Cox-regression analyses were performed.

Results

After applying trial in- and exclusion criteria, 48% of UCC-SMART patients with type 2 diabetes and cardiovascular disease would have been eligible for DECLARE-TIMI 58, 35% for CANVAS, 29% for EMPA-REG OUTCOME and 21% for VERTIS-CV. Without the eligibility criteria of HbA_1c, eligibility was 58–88%. For all trials the observed risk for cardiovascular events and all-cause mortality was similar in eligible and ineligible patients after adjustment for age and gender.

Conclusion

A large proportion of patients with type 2 diabetes and cardiovascular disease in daily clinical practice would have been eligible for participation in the SGLT2i CVOTs. Trial eligible and ineligible patients have the same risk for MACE and all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-021-01373-9.

Health technology assessment and economic evaluation: Is it applicable for the traditional medicine?

Gaps between limited health resources and expanding health service demands are emerging to be more and more prominent, which extremely generate the cost-effective strategies for scientific policy-making in the context of healthcare. As a systematic approach and solid tool to promote healthcare system more efficient and sustainable, health technology assessment (HTA) could provide multi-dimensional evidences comprising effectiveness, safety, economic implications, ethical, social, cultural and legal issues, in which economic evaluation is an important and unique part for optimizing decision-making. After decades of development, HTA has formulated a set of systematic theories, methods and procedures based on modern medicine. Meanwhile, as an important component of medicine system across the world, traditional medicine (TM) originates from knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different traditional cultures. Yet whether current theory and method system of HTA is applicable for TM is necessary to be explored and investigated. In principle, the general steps and methods of HTA could be basically applicable to TM, except for the PICO structuring, cost measurement, and supportive clinical evidence and information collection in economic evaluation. Therefore, these three challenging problems need to be focused and addressed in future HTA for TM.

A Rapid Review of Interventions to Prevent First Pregnancy among Adolescents and Its Applicability to Latin America

STUDY OBJECTIVE

To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context.

RESULTS

Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable.

CONCLUSION

This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.

Influence of air oxidative and non-oxidative torrefaction on the chemical properties of corn stalk

The non-structural components (extractives and ash) in biomass can affect the torrefaction characteristics. The objective of this study was to investigate the applicability of air oxidative and non-oxidative torrefaction for corn stalk, which has higher organic extractives and lower ash contents. The raw materials were torrefied with air and nitrogen in a fluidized bed reactor at 180℃~235℃ and 200℃~280℃ for 1 h, respectively. The proximate and ultimate analysis results demonstrated that the lower ash content (3.89%) was not favorable for deoxygenation. The organic extractives, extracted materials and mixture were torrefied with nitrogen at 260℃. The results indicated that the addition of organic extractives reduced the deoxidation efficiency of structural components during torrefaction. Compared to raw materials, the moderate and severe removal of hemicellulose can be achieved through torrefaction under air and nitrogen, respectively.

Green synthesis, characterization, application and functionality of nitrogen-doped MgO/graphene nanocomposite

A facile, feasible, and green synthesis via an electrochemical exfoliation process was applied to synthesize nitrogen-doped MgO/graphene nanocomposite (N-MgO/G). The N-MgO/G nanocomposite was characterized by several analytical techniques including X-ray photoelectron spectroscopy, X-ray powder diffraction, transmission electron microscopy, field emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, selected area electron diffraction, and elemental mapping analysis. N-MgO/G nanocomposite was then applied to adsorb lead metal ions (Pb²⁺) from aqueous solutions. The N-MgO/G nanocomposite demonstrated a remarkably high Langmuir maximum adsorption capacity (294.12 mg/g) for Pb²⁺ ions under the optimum experimental conditions at a pH of 5.13, time of 35 min, dose of 0.025 g, the concentration of 400 mg/L, and a temperature of 36 °C. Adsorption kinetics results fitted with a pseudo-second-order model and a thermodynamic study showed that Pb²⁺ adsorption is an endothermic process. The practical application of N-MgO/G was also investigated to test its applicability in real water samples collected from different sources such as deionized water, tap water, wastewater, and river water.

The assessment of buildings and constructions sector of economy proposal: an environmental perspective

Environmental impact assessment methods suffer from an applicability issue which could impede their use and development. The main subject of this article is to present a method to evaluate the applicability of building environmental assessment method in a given country. Here, when we say that a method is applicable in a given country, it means that it could be widely used and that it could produce the expected effects in terms of energy savings, environmental impact minimization, economic gain, etc. So, for this applicability evaluation purpose, the main criteria that affect the building environmental assessment method applicability were identified and were weighted by studying different scenarios. Then, the evaluation method was applied to the Tunisian case. Moreover, in order to contribute to a better understanding of the importance of building environmental assessment method implementation, stakes related thereto are reviewed. It was reported that building environmental assessment method would concur to improve building energy efficiency, enhance social capital, and contribute to environmental, social, and economic stability. In addition, it could be one of the major solutions for the collection of statistical data, which in turn would contribute to the success of projects undertaken as part of the green economy. Eventually, the building environmental assessment could be one of the major green marketing tools and should be taken into account by a company to improve profitability. The developed method and the presented stakes could be a good management and decision making tools and could help legislators and policy-makers for the best implementation of building environmental assessment method.

Applicability of somatic monitoring instructions in clinical practice guidelines on antipsychotic drug use

BACKGROUND

Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use.

METHODS

A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached.

RESULTS

In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0-47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations.

CONCLUSIONS

We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.

Understanding implementability in clinical trials: a pragmatic review and concept map

Background

The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the ‘implementability’ of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability.

Methods

Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials; described factors that increased or decreased the capacity of trials to be implemented; and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019.

Results

Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map.

Conclusions

The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia.

Trial registration

This review did not include health-related outcomes and was therefore not eligible for registration in the PROSPERO register.

Addressing the unique qualities of upper-level biology CUREs through the integration of skill-building

Early exposure to course-based undergraduate research experiences (CUREs) in introductory biology courses can promote positive student outcomes such as increased confidence, critical thinking, and views of applicability in lower-level courses, but it is unknown if these same impacts are achieved by upper-level courses. Upper-level courses differ from introductory courses in several ways, and one difference that could impact these positive student outcomes is the importance of balancing structure with independence in upper-level CUREs where students typically have more autonomy and greater complexity in their research projects. Here we compare and discuss two formats of upper-level biology CUREs (Guided and Autonomous) that vary along a continuum between structure and independence. We share our experiences teaching an upper-level CURE in two different formats and contrast those formats through student reported perceptions of confidence, professional applicability, and CURE format. Results indicate that the Guided Format (i.e., a more even balance between structure and independence) led to more positive impacts on student outcomes than the Autonomous Format (less structure and increased independence). We review the benefits and drawbacks to each approach while considering the unique elements of upper-level courses relative to lower-level courses. We conclude with a discussion of how implementing structured skill-building can assist instructors in adapting CUREs to their courses.

Consistency and applicability of different brief screen instrument of cognitive function in elderly population

BACKGROUND

Screening for cognitive impairment (CI) is often hampered by lack of consensus as to which screening instrument to use. The aim is to assess the consistence and applicability of different CI screening tools.

METHOD

In a cross-sectional study from October 2017 to September 2018 in 7 communities in Shanghai, China, elder (≧60) residential volunteers with no history of major cardiovascular diseases, cancers and other comorbidities known to affect cognitive functions were recruited. The participants underwent tests with 7 cognitive function screening instruments. Multivariate linear regressions were performed to test correlations between demographic characteristics, including gender, age, education, and marital status, with cognitive test scores. Mini-Mental State Examination (MMSE) score adjusted according to the correlation coefficients was used to detect CI with a cutoff of 24. Other cognitive function scores were compared between participants with and without CI. In addition, Pearson's correlation test was used to detect association between different test scores.

RESULTS

172 participants with relatively low education levels were included. Age and education showed significant association with cognitive test scores. Using adjusted MMSE, 39.6% of participants were identified with CI, while the percentage was 87.2% when adjusted Montreal Cognitive Assessment (MoCA) with cutoff of 26 was used. Analysis of "abnormal" test scores showed that MMSE had the highest percentage of valid data (98.8%). MoCA and Isaacs test of Verbal Fluency (VF) score had correlation with most the other scores, while MMSE only significantly associated with VF and MoCA.

CONCLUSIONS

MMSE may still present the most applicable tools for quick screen of cognitive functions, especially when environmental conditions may interfere with participants' attention.

Dynamic meta-analysis: a method of using global evidence for local decision making

Background

Meta-analysis is often used to make generalisations across all available evidence at the global scale. But how can these global generalisations be used for evidence-based decision making at the local scale, if the global evidence is not perceived to be relevant to local decisions? We show how an interactive method of meta-analysis—dynamic meta-analysis—can be used to assess the local relevance of global evidence.

Results

We developed Metadataset (www.metadataset.com) as a proof-of-concept for dynamic meta-analysis. Using Metadataset, we show how evidence can be filtered and weighted, and results can be recalculated, using dynamic methods of subgroup analysis, meta-regression, and recalibration. With an example from agroecology, we show how dynamic meta-analysis could lead to different conclusions for different subsets of the global evidence. Dynamic meta-analysis could also lead to a rebalancing of power and responsibility in evidence synthesis, since evidence users would be able to make decisions that are typically made by systematic reviewers—decisions about which studies to include (e.g. critical appraisal) and how to handle missing or poorly reported data (e.g. sensitivity analysis).

Conclusions

In this study, we show how dynamic meta-analysis can meet an important challenge in evidence-based decision making—the challenge of using global evidence for local decisions. We suggest that dynamic meta-analysis can be used for subject-wide evidence synthesis in several scientific disciplines, including agroecology and conservation biology. Future studies should develop standardised classification systems for the metadata that are used to filter and weight the evidence. Future studies should also develop standardised software packages, so that researchers can efficiently publish dynamic versions of their meta-analyses and keep them up-to-date as living systematic reviews. Metadataset is a proof-of-concept for this type of software, and it is open source. Future studies should improve the user experience, scale the software architecture, agree on standards for data and metadata storage and processing, and develop protocols for responsible evidence use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12915-021-00974-w.

Applicability and reproducibility of the CPAT-grading system for pancreas allograft thrombosis

PURPOSE

Although pancreas allograft thrombosis (PAT) incidence has progressively decreased, it remains the most common cause of early graft failure. Currently, there is no consensus on documentation of PAT, which has resulted in a great variability in reporting. The Cambridge Pancreas Allograft Thrombosis (CPAT) grading system has recently been developed for classification of PAT. In this study we aimed to assess the applicability and validate the reproducibility of the CPAT grading system.

METHODS

This study is a retrospective cohort study. Selected for this study were all 177 pancreas transplantations performed at our center between January 1 st, 2008 and September 1 st, 2018 were included.

RESULTS

A total of 318 Computed Tomography (CT) images was reevaluated according the CPAT system by two local radiologists. Inter-rater agreement expressed in Cohen's kappa was 0.403 for arterial and 0.537 for venous thrombosis. Inter-rater agreement, expressed in the Fleiss' kappa, within clinically relevant thrombosis categories was 0.626 for Grade 2 and 0.781 for Grade 3 venous thrombosis.

CONCLUSIONS

Although not perfect, we believe that implementation of the CPAT system would improve current documentation on PAT. However, it is questionable whether identification of a small Grade 1 thrombosis would be relevant in clinical practice. Furthermore, a good quality CT scan, including adequate phasing, is essential to accurately identify potential thrombus and extend after pancreas transplantation.

A review on hydrodynamic cavitation disinfection: The current state of knowledge

Disinfection, which aims to eliminate pathogenic microorganisms, is an essential step of water treatment. Hydrodynamic cavitation (HC) has emerged as a promising technology for large-scale disinfection without introducing new chemicals. HC, which can effectively induce sonochemistry by mechanical means, creates extraordinary conditions of pressures of ~1000 bar, local hotspots with ~5000 K, and high oxidation (hydroxyl radicals) in room environment. These conditions can produce highly destructive effects on microorganisms in water. In addition, the enhancements of chemical reactions and mass transfers by HC produce the synergism between HC and disinfectants or other physical treatment methods. HC is generated by hydrodynamic cavitation reactors (HCRs), therefore, their performance basically determines the effectiveness, economical efficiency, and applicability of HC disinfection. Therefore, developing high-performance HCRs and revealing the corresponding disinfection mechanisms are the most crucial issues today. In this review, we summarize the fundamental principles of HC and HCRs and recent development in HC disinfection. The energy release from cavitation phenomenon and corresponding mechanisms are elaborated. The performance (effectiveness, treatment ratio, and cost) of various HCRs, effects of treatment conditions on performance, and applicability of HC disinfection are evaluated and discussed. Finally, recommendations are provided for the future progress based on the analysis of previous studies.

American Diabetes Association "Standards of Medical Care-2020 for Gestational Diabetes Mellitus": A Critical Appraisal

INTRODUCTION

Gestational diabetes mellitus (GDM) is a major public health problem, affecting about one in every six pregnancies globally. The guidelines provided by the American Diabetes Association (ADA) on diagnosis and management of hyperglycemia in pregnancy are widely followed. We aim to provide a critical appraisal of the recently published ADA guidance document, highlighting its strength and limitations with regard to the diagnosis of GDM.

METHODS AND RESULTS

We reviewed the recent ADA recommendations for the diagnosis and management of hyperglycemia in pregnancy. A periodic update in keeping with the emerging evidence, an inclusive diagnostic approach which increases generalizability, and a clear proposed approach for prenatal testing and postpartum follow-up are strengths of the ADA guidance document. On the other hand, its limitations are a lack of clarity on the applicability of diagnosis of GDM during early pregnancy, use of scientifically inaccurate terms such as "prediabetes" in the context of pregnancy and "overt diabetes prior to gestation" in the definition of GDM, and inconsistent use of terminology between successive publications. Certain issues which merit attention in future publications include a need for uniform global definition of GDM, demarcation of overt diabetes in pregnancy as a distinct entity, clarity on the diagnosis of GDM during early pregnancy, and clear delineation of timelines and appropriate testing strategy for the first prenatal visit.

CONCLUSIONS

This article provides a critical appraisal of the recently published ADA guidance document with regard to the diagnosis of GDM. We also share our perspective on issues warranting attention in the future publications. Experts from various professional organizations should aim for a consensus document which can resolve existing controversies in this field, and help clinicians and researchers achieve better health for women in their care.

[GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence]

OBJECTIVES

The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process.

STUDY DESIGN AND SETTING

Consensus-based guidance developed by the GRADE working group members and other methodologists. This is a German translation of the original paper published in English.

RESULTS

We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings.

CONCLUSION

The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.

Guidelines in Low and Middle Income Countries Paper 3: Appraisal of Philippine Clinical Practice Guidelines using Appraisal of Guidelines for Research and Evaluation II: improvement needed for rigor, applicability, and editorial independence

BACKGROUND AND OBJECTIVE

High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument.

METHODS

Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of <75.0% on either of the criteria implied that the CPG needed revision.

RESULTS

Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable.

CONCLUSION

AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities.

Learners' Perception of the Applicability of Pre-clinical Subjects to Clinical Training and Experience in Obafemi Awolowo University, Ile-Ife

This article was migrated. The article was marked as recommended. Introduction: This study investigated how Final Year Students and Newly qualified Doctors of Obafemi Awolowo University (OAU) Medical School perceive the applicability of the three pre-clinical subjects (Anatomy, Biochemistry and Physiology) to clinical studies and medical practice with the aim of ascertaining whether or not the students are able to establish a real connect between knowledge acquired in the pre-clinical years and their experience during clinical exposure. Methods: A cross sectional study involving 106 final year medical students and 81 interns was conducted using convenience sampling method. Data was collected using a structured self-administered questionnaire consisting of demographic characteristics and 10 items regarding perception of the relevance of basic medical courses to clinical training experience. Responses were rated using a 5 point Likert scale, which ranged from "strongly disagree" to "strongly agree". Data analysis was carried out using descriptive and inferential statistics and values expressed as mean of scores. Results: Overall mean scores for anatomy, biochemistry and physiology were 26.4 ± 0.32, 25.7 ± 0.29 and 28.1 ± 0.31 respectively. Thus, physiology was rated as having the highest applicability with the highest score in 4 out of 10 items. Biochemistry had the lowest score for the item "I remember most of the content of the course even now". Newly qualified Doctors were found to have a more positive perception of anatomy and biochemistry than final year medical students. All Subjects were scored high (average of 3-0/4.0) on items having to do with introduction of curriculum integration and clinical studies to teaching. Conclusion: Findings from the study suggest that the responses of the subjects were based more on their ability to understand and recall content, rather than how relevant the subjects are to their clinical experience. The study concludes that there is an urgent need to embrace integration of the curriculum and introduce more learner-centered teaching methods.

Monitoring the spatiotemporal terrestrial water storage changes in the Yarlung Zangbo River Basin by applying the P-LSA and EOF methods to GRACE data

The Yarlung Zangbo River Basin is a regulator of water vapor changes in China and even Asia. To avoid the shortcomings of traditional water resource monitoring methods, this study used Gravity Recovery and Climate Experiment (GRACE) data to monitor the terrestrial water storage anomaly (TWSA) in this river from 2002 to 2015 with the help of the polynomial-least squares approach (P-LSA) and the empirical orthogonal function (EOF). The obtained TWSA was compared with hydrometeorological data from several sources to discuss the applicability, uniqueness and response relationship. The results showed that (1) the combination of P-LSA and EOF had strong applicability to explore the TWSA in the study area, with R² = 0.75 and 0.80, respectively, and could indirectly reflect dry and wet conditions in southwestern China. (2) The TWSA revealed significant cyclical and seasonal fluctuations of approximately 12 months and increased from upstream to downstream and from north to south, which was discussed for the first time in the research area. (3) The EOF method can effectively identify the TWSA principal component and structure (EOF1 contribution = 91.08%) by removing noise and redundancy, which is beneficial for revealing the laws essential for TWSA changes. (4) The TWSA in the studied watershed was unique (i.e., the clearest periodic changes with the best fitting effect (R = 0.90); peak, low and peak-low difference values that were 1.82, 1.19 and 1.52 times larger than those of the 8 other rivers; and the largest downward trend of 4.13 mm·a^-1). (5) Rainfall was the decisive factor influencing the TWSA, with correlation coefficients (R) >0.60. This study enhances our overall understanding of the TWSA in this plateau watershed and provides a scientific basis for optimal water resource management.

Possession and Applicability of Signature Character Strengths: What Is Essential for Well-Being, Work Engagement, and Burnout?

Signature character strengths can foster health-related outcomes in work and private life, thus being particularly important for endangered occupational groups like physicians. However, situational circumstances need to allow character strengths demonstration (applicability) first to enable their application. Therefore, this study addresses the role of (1) applicability of signature character strengths in work and private life beyond their possession and (2) relationships with well-being, work engagement, and burnout dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment). Hospital physicians (N = 274) completed an online survey examining their signature character strengths and applicability, well-being, work engagement, and burnout dimensions. The top-five individual signature character strengths were fairness, honesty, judgment, kindness, and love. Hierarchical multiple linear regressions revealed that the possession as well as the applicability of signature character strengths was important in work and private life, but to different degrees. Possessing fairness, honesty, or kindness indicated significant positive relations with subjective well-being, whereas judgment and kindness seemed to negatively interact with reduced personal accomplishment. Hospital physicians' applicability of fairness, honesty, judgment, and love was particularly essential for their psychological well-being and work engagement, whereas the applicability of fairness (reduced personal accomplishment) and judgment (emotional exhaustion, depersonalization) at work interacted negatively with the respective outcomes. Therefore, creating awareness for individual signature character strengths as well as providing applicability in hospitals and private life could be a promising approach to improve physicians' well-being and consequently patient care as well as the performance of the health-care system in general.

Glucocorticoid-trials in rheumatoid arthritis mostly study representative real-world patients: A systematic review and meta-analysis

OBJECTIVE

Randomized controlled trials (RCTs) are considered the gold standard in clinical research due to credible causality. Their results, however, may not be generalizable to real-world populations. While glucocorticoids (GCs) remain a mainstay of rheumatoid arthritis (RA) treatment, it is unclear whether the results of GC-RCTs are generalizable to current real-world RA patients.

METHODS

MEDLINE was searched for RCTs and, as comparators, cohort studies (CSs) in RA evaluating systemic GCs. Random-effects meta-analyses were performed for descriptive baseline characteristics (including general demographics, comorbidities, and disease activity) that have been shown to be able to modify the benefit-risk-ratio of various RA therapeutics. These meta-analyses were stratified by study type (RCT and CS). Stratified estimates were subsequently compared. Further sensitivity analyses were performed stratifying by disease duration.

RESULTS

56 RCTs (7053 participants) and 10 CSs (14,688 participants) were included. 12 characteristics were reported frequently enough to allow for comparative analysis. In 10/12 characteristics (83%), RCT estimates did not appear to differ from CS estimates. However, RCT participants were younger (-4.7 years [95% CI -7.2 to -2.1]; p < 0.001) and had higher erythrocyte sedimentation rates (11.8 mm/h [5.7 to 17.8]; p < 0.001) than CS participants. Comorbidities could not be assessed due to insufficient reporting.

CONCLUSION

Our findings suggest that evidence from GC trials in RA is of acceptable generalizability to current real-world patients - especially compared to findings from biologic agents in RA. However, RCT participants were younger than real-world patients, potentially limiting the generalizability of trial results to elderly patients.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42019134675).

When assessing generalisability, focusing on differences in population or setting alone is insufficient

Generalisability is typically only briefly mentioned in discussion sections of evaluation articles, which are unhelpful in judging whether an intervention could be implemented elsewhere, with similar effects. Several tools to assess generalisability exist, but they are difficult to operationalise and are rarely used. We believe a different approach is needed. Instead of focusing on similarities (or more likely, differences) in generic population and setting characteristics, generalisability assessments should focus on understanding an intervention’s mechanism of action - why or how an intervention was effective. We believe changes are needed to four types of research. First, outcome evaluations should draw on programme theory. Second, process evaluations should aim to understand interventions’ mechanism of action, rather than simply ‘what happened’. Third, small scoping studies should be conducted in new settings, to explore how to enact identified mechanisms. Finally, innovative synthesis methods are required, in order to identify mechanisms of action where there is a lack of existing process evaluations.

Application of adult reference intervals in children

The aim of this study was to evaluate to which extend adult reference intervals (RIs) could be applied in children. A local paediatric population (aged 1 to < 20 years), based on first draw samples from general practitioners (GPs), was established. Children with samples taken at a hospital or > 3 samples from GPs were excluded. Analytes evaluated included haematological, liver and pancreatic function, kidney function, electrolytes, and metabolism parameters. Applicability of adult RIs in children aged 1-17 years was evaluated using individuals aged 18-19 years as reference groups for the adult RIs. The local population consisted of 31,024 children with 282,721 analyses in total. For each analyte, 17 age strata and two gender strata were established. Partitioning was not warranted in 51% of the male strata and in 69% of the female strata. Adult RIs could be applied in 42% for children aged 1-< 10 years, 57% for children aged 10-< 15 years, and 85% for children aged 15-<18 years.Conclusion: for certain analytes, there is no need to partition between adult and paediatric RIs, but a need for age- and gender-specific RIs remains for several clinical laboratory tests.What is Known:• Establishing paediatric reference intervals (RIs) is time consuming, costly, and not feasible for many laboratories. Transference of RIs established elsewhere often leads to misclassification of paediatric laboratory results.• Adult RIs are often more easily established and validated.What is New:• Adult RIs can be applied to children as young as 2 years for some analytes. Conversely, for some analytes, adult RIs cannot be applied in children aged 1-17 years.• Laboratory data can be applied in evaluating the need for partitioning in reference intervals.

The safety and applicability of synthetic pyrethroid insecticides for aircraft disinsection: A systematic review

BACKGROUND

Air travel contributes to the global spread of vectors and vector-borne infections. Although WHO provides guidance on methods for disinsection of aircraft, there is currently no harmonized or standardized decision-making process to decide when disinsection of an aircraft should be conducted. It is however compulsory for flights arriving in certain countries. Concerns have been expressed about the usefulness of disinsection for preventing the international spread of vectors and vector-borne diseases via air travel and possible toxicity for passengers and flight crew.

METHODS

We performed a systematic literature review using the databases PubMed, Embase, Medline, Scopus and CINAHL to evaluate all research findings about the applicability and safety of chemical-based, aircraft disinsection. Official reports from the WHO were also screened. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and meta-analysis (PRISMA) statement. The literature search strategy included "disinsection, airplane/plane/aviation/aircraft" and several other search items including d-phenothrin, permethrin, insecticide. Papers in English, French and German were reviewed. Reports of adverse events attributed to the disinsection of aircraft were also searched. AMP and PS screened all papers of relevance and agreed on a final selection.

RESULTS

Our search resulted in 440 papers of possible relevance. After screening, we included a total of 25 papers in this systematic review. Ten papers reported possible human toxicity and 17 papers addressed the applicability of disinsection and 2 papers addressed both topics. Chemical disinsection at recommended insecticide concentrations was found to be highly effective against a broad range of arthropods. Three papers reported passenger or crew illness possibly associated with insecticide spraying in passenger cabins - one describing a single passenger, the other two papers describing occupational illness of 12 and 33 aircrew members respectively, possibly due to aircraft disinsection. Another paper evaluating exposure of flight attendants to permethrin found higher levels of urinary metabolites in those working in planes that had recently been sprayed but this could not be linked to adverse health outcomes.

CONCLUSION

Our analysis confirmed that disease vectors are carried on international flights and can pose a threat particularly to island populations and certain airport hub areas. Disinsection with permethrin or d-phenothrin was shown to be highly effective against vectors. Despite several hundred million passenger and crew exposures to chemical disinsection, very few proven cases of toxicity have been reported. There is limited evidence linking exposure to insecticide spraying with negative health impact.

The TRANSFER Approach for assessing the transferability of systematic review findings

BACKGROUND

Systematic reviews are a key input to health and social welfare decisions. Studies included in systematic reviews often vary with respect to contextual factors that may impact on how transferable review findings are to the review context. However, many review authors do not consider the transferability of review findings until the end of the review process, for example when assessing confidence in the evidence using GRADE or GRADE-CERQual. This paper describes the TRANSFER Approach, a novel approach for supporting collaboration between review authors and stakeholders from the beginning of the review process to systematically and transparently consider factors that may influence the transferability of systematic review findings.

METHODS

We developed the TRANSFER Approach in three stages: (1) discussions with stakeholders to identify current practices and needs regarding the use of methods to consider transferability, (2) systematic search for and mapping of 25 existing checklists related to transferability, and (3) using the results of stage two to develop a structured conversation format which was applied in three systematic review processes.

RESULTS

None of the identified existing checklists related to transferability provided detailed guidance for review authors on how to assess transferability in systematic reviews, in collaboration with decision makers. The content analysis uncovered seven categories of factors to consider when discussing transferability. We used these to develop a structured conversation guide for discussing potential transferability factors with stakeholders at the beginning of the review process. In response to feedback and trial and error, the TRANSFER Approach has developed, expanding beyond the initial conversation guide, and is now made up of seven stages which are described in this article.

CONCLUSIONS

The TRANSFER Approach supports review authors in collaborating with decision makers to ensure an informed consideration, from the beginning of the review process, of the transferability of the review findings to the review context. Further testing of TRANSFER is needed.

Comparison of the General Threshold Model of Survival and Dose-Response Models in Simulating the Acute Toxicity of Metals to Danio rerio

We exposed zebrafish (Danio rerio) to different concentrations of lead and cadmium, and monitored them for survival at 24, 48, 72, and 96 h. Metal toxicity was predicted and compared using the dose-response and general threshold survival models in terms of required data sets, fit performance, and applicability. Environ Toxicol Chem 2019;38:2169-2177. © 2019 SETAC.

Development of microbial community-based index of biotic integrity to evaluate the wetland ecosystem health in Suzhou, China

The development of microbial community-based biological indicators for assessing aquatic ecological status is urgently needed in heavily impaired regions, due to the local extinction of traditional indicator macro-organisms. The aim of this study was to develop and validate a microbial community-based index of biotic integrity (MC-IBI) to assess the health of wetlands in Suzhou, China. High-throughput sequencing was used to obtain information about microbial communities in wetlands and to investigate the health of the wetlands. When constructing the index, we selected what we considered were the most important environmental factors and biological parameters, and identified sensitive and tolerant species. We then used the index to evaluate the health of the inflows and outflows of 15 wetlands in Suzhou. The results showed that, of the 30 samples collected at the 10 impacted inflow sites, 2 were classified as "poor," 5 were "commonly," 18 were sub-healthy, and 5 were healthy; at the restored outflow sites, 24 were "healthy" and 6 were "sub-healthy." The health was worst at the inflows of wetlands that received agricultural effluent, followed by those that received industrial effluent, and was best at those that received urban effluent. The results from our study show that this newly developed MC-IBI gave reasonable evaluations of the health of wetland ecosystems. This application demonstrates that the evaluation system was feasible and we suggest that evaluations that further MC-IBI evaluation approaches should be developed further in the future.

Towards greater understanding of implementation during systematic reviews of complex healthcare interventions: the framework for implementation transferability applicability reporting (FITAR)

Background

There have been calls for greater consideration of applicability and transferability in systematic reviews, to improve their usefulness in informing policy and practice. Understanding how evidence is, or is not applicable and transferable to varying local situations and contexts, is a key challenge for systematic review synthesis in healthcare. Assessing applicability and transferability in systematic reviews is reported to be difficult, particularly in reviews of complex interventions. There is a need for exploration of factors perceived to be important by policy-makers, and for further guidance on which items should be reported. In this paper we focus on the process of development of a framework that can be used by systematic reviewers to identify and report data across studies relating to applicability and transferability.

Methods

The framework was developed by scrutinising existing literature on applicability and transferability, examining data during a systematic review of highly complex changes to health service delivery, and was informed by stakeholder engagement. The items of the framework were thus grounded in both data identified during a real review, and stakeholder input. The paper describes examples of data identified using the framework during a review of integrated care interventions, and outlines how it informed analysis and reporting of the review findings.

Results

The Framework for Implementation Transferability Applicability Reporting (FITAR) comprises 44 items which can be used to structure analysis and reporting across studies during systematic reviews of complex interventions. The framework prompts detailed consideration of contextual data during extraction and reporting, within areas of: patient type and populations; type of organisations and systems; financial and commissioning processes; systems leadership elements; features of services; features of the workforce; and finally elements of the interventions/initiatives.

Conclusions

Use of the framework during our review of complex healthcare interventions helped the review team to surface contextual data, which may not be commonly extracted, analysed and reported. Further exploration and evaluation of systems for identifying and reporting these factors during reviews is required.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0723-y) contains supplementary material, which is available to authorized users.