Impact of medication reconciliation on health outcomes: An overview of systematic reviews
Ana Belén Guisado-GilMarta Mejías-TruebaEva Rocío Alfaro‐LaraMarina Sánchéz‐HidalgoNieves Ramírez‐DuqueMaría Dolores Santos-Rubio
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The objectives of this study were to determine nurses' use of electronic databases to inform practice. A questionnaire survey of 114 nurses working on five acute wards in a large inner city teaching hospital investigated their general use of computers and the three databases, CINAHL, MEDLINE and the Cochrane Library. Eighty-two qualified nurses responded (response rate 72%). The results show limited confidence and low frequency in using the databases. Thirty-four per cent expressed low confidence using CINAHL. Twenty-seven per cent used CINAHL on a regular basis. Twenty-two per cent never used it. Eighteen per cent were unaware that it was available locally. Knowledge and use of MEDLINE was even lower with only 18% using it regularly. Knowledge of the Cochrane Library was extremely limited, with 75% unaware of its existence. Use of a home computer and higher education were associated with higher frequency of use of CINAHL and MEDLINE. If nurses are to make use of electronic resources to contribute to evidence-based practice, effort needs to be put into ensuring that already qualified nurses have basic computer skills and specific knowledge of available resources. More emphasis should be placed on 'evidence-based' resources, such as the Cochrane library, as sources of information for practice.
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Cross-sectional study
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Purpose The purpose of this study is twofold. First, the study shall evaluate the extent of usage of grey literature and its different types of addiction research. The second purpose of the research is to analyze the extent of usage of reports such as research reports, survey reports, data reports, etc. As the reports are produced in general by various organizations and can be accessed by not only academicians but also the general public, they play an important role in the dissemination of research to the people. Therefore, the study endeavored to identify the major organizations that are involved in the publishing of research reports in the field of addiction. Design/methodology/approach Scopus database was used for the purpose of collecting the data. References in the reference lists of the articles published in 2018 in the journal Psychology of Addictive Behaviors of the American Psychological Association were collected. Scopus indexes the references of the papers in two different categories, namely, indexed in scopus/scopus references and reference lists. They were then categorized as grey literature and non-grey literature. Further, reports were searched manually so that their producers/authors can be found and categorized according to the organizations. Findings The study found that grey literature comprises a very small proportion of citations in addiction research (just approximately 5 per cent). This suggests that the improper indexing and bibliographic control of grey literature may be one of the reasons behind the low numbers. Reports comprised the largest proportion of the grey literature cited in addiction research, followed by software documentation, unpublished manuscripts, guidebooks, handbooks, manuals, websites, government publications, etc. The reports of the US Department of Health and Human Services comprised the maximum citations in the reports category because of the reports produced by organizations like Substance Abuse and Mental Health Services Administration (SAMHSA) which comprised 17.59 per cent of the total reports. National Institute of Health (USA) and Centers for Disease Control and Prevention and others. Other than the reports of the organizations of the USA, the reports published by the organizations of Canada, Australia, UK, New Zealand and one European Body were also cited by the articles of the journal. Practical implications The research focuses on the use of grey literature in addiction research. The findings of the study indicate very low citations to grey literature in addiction research. This reinforces the need for a separate worldwide information retrieval system for grey literature for researchers to conduct systematic reviews. Originality/value Very few studies have been conducted on the use of grey literature and hardly any research focuses on the use of grey literature in addiction research. The study goes one step further and identifies major organizations that are involved in the production of research reports in the field so that their reports can be properly indexed.
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Review question/objective Public health interventions are often implemented directly by government and so have an observational, rather than experimental, evidence base that may not be captured in traditional academic published sources. There is, therefore, a need to determine whether this grey literature is being actively sought when evaluating the effectiveness of public health interventions through systematic literature review; and also whether the inclusion of this grey literature has an impact on the conclusions of systematic literature reviews (SRs) evaluating public health interventions. This is particularly important as the findings of systematic literature reviews are increasingly used to inform public health policy decisions. Where possible, the sources used to obtain the grey literature in the included SRs will be categorised. As the prevention of childhood obesity is a major emerging public health issue in developed countries, this has been chosen as the topic for this methodological systematic review. The review question is: What is the impact of findings from grey literature on the outcomes of systematic reviews on interventions to prevent obesity among children? Primary Review Objective is to evaluate the impact of findings from grey literature on the results of systematic reviews on prevention of childhood obesity. Secondary Review Objective is to determine the ratio of black to grey literature (definitions are provided in Background) included in the eligible systematic reviews; to determine the study design of the grey literature included in SRs. Background By 2025 obesity rates are predicted to rise in Australia by 65% despite the myriad substantial efforts of a multiplicity of interventions and strategies from the public health sector, particularly those at the community or small unit level.1 Childhood obesity often persists into adulthood, and these strongly established links to adult obesity along with all the attendant risks and consequences make childhood a natural starting point for a closer examination of prevention literature.2,5-6 It also provides a logical focus for early intervention and therefore an abundance of literature exists in the field. Recent literature increasingly supports the argument that high level policy, regulation and legislation is required to prevent childhood obesity, and that whole-of-population, whole-of -environment approaches need to be developed and implemented.7-8 However while policy: “a set of plans to establish and achieve the desired performance goals of a group or organisation”9 abounds, and often confounds10 successes remain generally elusive. To be genuinely evidence-informed, policy needs to access systematic reviews which provide summary conclusions derived from their critical assessments and syntheses of the relevant evidence base. To be comprehensive and representative this base should include, or at least consider, “grey literature and unpublished studies”.11There are two types of literature which could be included in systematic reviews and are known colloquially as black and grey. Black literature is that which is published in academic, scholarly journals. Grey literature, which is usually defined as “Information produced on all levels of government, academia, business and industry in electronic and print formats not controlled by commercial publishing i.e. where publishing is not the primary activity of the producing body”12, takes many different forms13 but is essentially documents that have not been formally published, and have commonly not been peer-reviewed.14 Research institutes for example, produce working papers, technical and consensus reports, issues papers and policy briefs which have valuable content to impart and constitute grey literature. In addition the Joanna Briggs Institute, the Cochrane Collaboration and the Campbell Collaboration stipulate that, in addition to black literature, searches for grey and unpublished literature must be conducted by their systematic reviewers in order to avoid publication bias.15 While systematic reviews sum up the best available research on a specific question by “synthesizing the results of several studies”16 decision makers are now often faced with numerous systematic reviews on the same health issue. The next logical and appropriate step is an overview of systematic reviews, to synthesise and summarise the findings17 and if the overview is itself a systematic review, then the end result should provide stronger and even more comprehensive evidence. A recent dialogue of Australian public health professionals and dietitians emphasised the advocacy approach to obesity prevention, settling on the tripartite strategy of “political commitment, multi-sectoral support and community engagement.”18 It is this complexity of approach that may benefit from an examination of the grey literature (GL) supporting these policies. Simkhada's view19 that GL is needed to fill the information gap as “an essential part of the evidence base for practice in complex interventions, which may have multi-stakeholders, have multi-variables, have a lack of predictability and robust data and require a broad literature approach”, is held by many others20-23. Currently the Australian government is investing in research into the access and preservation of GL in light of its relevance to the development of health policy24. Similarly in 2006 the U.S. National Library of Medicine, aware that policymakers, more than any other research group, found GL especially relevant for context, and for its ability to reflect and map “how debate changes over time on a particular topic”25 commissioned AcademyHealth26 to conduct a research project into the scope and status of this literature. Often the strength of GL lies in the way it can reflect the lay voice, the voice from the field, public opinion: what people think. How can policy succeed when individuals' beliefs and behaviours are at odds with the underlying principles and truths of achieving healthy weight?27-28 Baum and others suggest that we need to look below the surface, focusing on the underlying social determinants of heath rather than “immediate and visible causes” and that the role of public policy should be to shape the social environment so that it is more conducive to good health.29-30 As Australian obesity prevalence continues to rise (in fact no country has managed to reverse obesity trends)31-32, it is reasonable to suggest that policy associated with obesity prevention is at best flawed or limited and possibly under- or ill-informed. As Badger et al argue “it is irresponsible to interfere in the lives of other people on the basis of theories unsupported by reliable empirical evidence”11. Community engagement is a challenging but well-supported aspect of behavioural change in public health. Community receptiveness needs to be gauged and substantiated in creative ways so that it can feed into the information that underpins our policies and supports implementations.33-34. To achieve a greater degree of success in regard to childhood obesity prevention, there is a need to tap into evidence from the widest variety of sources, so as to reflect the complexities of the issue and perceptions of end-users.35 Grey literature is where community attitudes, beliefs, values and opinions might be reasonably expected to be found, and also where pilot programs and case studies assessing the feasibility of public health interventions will have been reported. The degree to which this literature has been accessed and incorporated into the evidence that informs policy may have an impact on the ultimate success or sustained “take-up” of an intervention. To determine the extent to which systematic reviews in the field of child obesity prevention identify and include grey literature in their collated evidence-bases, a comprehensive search of the literature will be undertaken. The resultant systematic reviews will be retrieved and examined for inclusion. Those that do not match the selection criteria will be excluded. The ratio of black to grey literature in the included systematic reviews will be calculated and the proportion of systematic reviews that are grey will be briefly discussed. A comparison of results from grey versus black systematic reviews, and of those systematic reviews with high versus low ratios of included grey literature, will be undertaken to determine whether grey literature changes the findings or interpretation of the outcomes that are assessed. Inclusion criteria Types of studies Systematic reviews of interventions to prevent obesity among children, where there is either meta-analysis or narrative summary or tabular presentation of results. Types of reviews will include those where the primary literature consists of experimental or observational literature. Traditional literature reviews, or narrative reviews not based upon an a-priori protocol and rigorous methodology will be excluded. Qualitative synthesis or mixed methods reviews will also be included. Types of participants The reviews of interest will only include studies on children aged two to 18 years without (at baseline) a diagnosis of obesity, or eating disorders, or co-morbid conditions that pre-dispose to obesity. Types of intervention(s) Public health interventions aimed at obesity prevention that may be applied at the population, community (including schools) or primary care level. Types of outcomes Primary - Obesity prevention will be measured according to body mass index (weight/height2) as calculated against a suitable growth reference e.g. relevant age and .sex growth classification standards, with classification into underweight, healthy weight, overweight, and obese categories.36-37 Outcomes will be grouped according to the type of prevention program implemented. Secondary - Ratio of black to grey eligible systematic reviews; ratio of black to grey studies included in eligible systematic reviews; study designs of grey literature included in eligible systematic reviews; sources used in eligible systematic reviews to obtain grey literature Search strategy The search strategy aims to find both published and unpublished systematic reviews. A three-step search strategy will be utilised in this review. An initial limited search of MEDLINE, EMBASE, CINAHL and the Cochrane Library will be undertaken to “scope” the literature followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reviews, reports and articles will be searched for additional systematic reviews. Systematic reviews published in English will be considered for inclusion in this review, with no date limitation. The databases to be searched include: ARIF (Aggressive Research Intelligence Facility): Reviews database & Methodology database; Biological Abstracts; Campbell Library; CINAHL; Cochrane Library; EMBASE; ERIC; Google Scholar; INFORMIT: Education, Health and Social Science databases; Medline/PubMed; PAIS; Proquest; PsycInfo; Scopus; Sociological Abstracts; TRIP (Turning Research into Practice) database. The search for unpublished systematic reviews will include: DIPEx - Database of Individual Patient Experiences; EPPI Centre (particularly Obesity and Sedentary Behaviour Database); Google Advanced Search; Google Books; GreyNet; Mednar; Scirus; Social Care Online (SCIE); TROVE (for theses, books); WHOLIS. Major international institutional repositories will also be searched. Journals which will be hand searched include Childhood Obesity, International Journal of Pediatric Obesity, Obesity and Obesity Reviews. Initial search keywords to be used will be: (Obesity OR obese) AND (Child or paediatric or pediatric or adolescent or youth or infant) AND (prevent* or intervent*) AND (systematic review or meta-analys* or meta analys*). Where a thesaurus of descriptors or index terms exists, or the ability to “explode” headings, or limit to years of publication and/or document type, full advantage will be taken of these database-specific features. Searches will comprise of a combination of keywords and other available options designed to maximize the chances of retrieval of eligible studies. An example of a completed reproducible search strategy will be appended to the systematic review report. (Appendix I) All study titles and abstracts will be imported into reference management software, duplicates removed, and each title/abstract reviewed according to the inclusion criteria. The full text paper of each potentially relevant study will then be retrieved and again reviewed for eligibility according to the inclusion criteria. Reasons for exclusion will be documented. In cases where study eligibility is uncertain, a consensus decision will be reached by the co-authors. A final database of included systematic reviews will be produced. A PRISMA flowchart38 will be constructed so that the article selection process is transparent and can be replicated. Assessment of methodological quality Systematic reviews selected for retrieval will be assessed by two independent reviewers for methodological validity using the Joanna Briggs Institute (JBI) critical appraisal checklist for systematic reviews prior to inclusion in the review (Appendix II). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Data collection Data will be extracted using the JBI standardised extraction tool for systematic reviews (Appendix III). The data extracted will include specific details about the phenomenon of interest, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis The unit of interest is the pooled body mass index results from the eligible systematic reviews (whether presented as a mean difference in BMI or difference in proportions of underweight, healthy, overweight or obese), grouped according to type of obesity prevention program. As the eligible systematic reviews are likely to include studies presented in other eligible systematic reviews in the evidence base (ie duplicated data), it would not be appropriate to meta-analyse the pooled body mass index results for the same interventions reported in these systematic reviews as it would result in double-counting. As the objective of this systematic review is to determine the impact of grey literature on review results, for each type of childhood obesity prevention program an assessment of the concordance of pooled results between grey and black systematic reviews will be undertaken. ie overlapping confidence intervals of the pooled results, and evaluating the agreement of findings/discrepancy in findings. It will also be determined whether there are patterns or trends in pooled results according to the increasing levels/ratios of grey literature in the included systematic reviews. Potentially, sensitivity analysis will be undertaken and publication bias39 will be examined, both as tests of the impact of Grey Literature if there are a sufficient number of studies A narrative meta-synthesis (i.e. meta-synthesis and narrative summary) of the results for each pre-specified outcome will be presented within subheadings appropriate to each type of obesity prevention program identified and assessed in the included systematic reviews. In the event that any systematic reviews compare results from grey and black literature, these will be presented narratively and potentially meta-analysed if the data are homogenous and not duplicated between systematic reviews. Conflicts of interest No conflicts of interest Acknowledgements This review will form part of a submission for the Masters of Clinical Science and therefore a secondary reviewer Lisa Heuch (LH) will only be used for critical appraisal. LH is a Masters of Clinical Science Candidate, The Joanna Briggs Institute, The University of Adelaide.
Grey Literature
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This review aims to identify support delivered to informal carers of older people making the transition into residential aged care, and to examine which specific outcome measures were used in the evaluation of the support provided.Little support is provided to informal carers of newly admitted aged care residents, both during the admission process and in the subsequent months. Mapping of the support delivered to informal carers of those admitted to a residential aged care facility is needed.We will include any form of support (eg, financial, psychological, social) provided to informal carers of people making the transition to residential aged care, from the time a decision is made to proceed with admission, up to 12 months post-admission.We will search peer-reviewed literature in English from 2000 to the present from key databases (ie, MEDLINE, CINAHL, Cochrane Library, JBI Evidence Synthesis, PsycINFO, Embase, and Scopus). Additionally, gray literature will be searched through databases (eg, Google, Google Scholar, BASE, OpenGrey, Grey Literature Report, Informit, MedlinePlus, MedNar, Medscape), government websites, and websites of national organizations that provide support for the care of older people. We will use the JBI approach for search strategy, study selection, and data extraction, and will descriptively map the results using a textual narrative synthesis approach.
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PsycINFO
Data extraction
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There is ongoing interest in including grey literature in systematic reviews. Including grey literature can broaden the scope to more relevant studies, thereby providing a more complete view of available evidence. Searching for grey literature can be challenging despite greater access through the Internet, search engines and online bibliographic databases. There are a number of publications that list sources for finding grey literature in systematic reviews. However, there is scant information about how searches for grey literature are executed and how it is included in the review process. This level of detail is important to ensure that reviews follow explicit methodology to be systematic, transparent and reproducible. The purpose of this paper is to provide a detailed account of one systematic review team's experience in searching for grey literature and including it throughout the review. We provide a brief overview of grey literature before describing our search and review approach. We also discuss the benefits and challenges of including grey literature in our systematic review, as well as the strengths and limitations to our approach. Detailed information about incorporating grey literature in reviews is important in advancing methodology as review teams adapt and build upon the approaches described.
Grey Literature
Scope (computer science)
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Abstract This paper suggests how the ‘grey literature’, the diverse and heterogeneous body of material that is made public outside, and not subject to, traditional academic peer‐review processes, can be used to increase the relevance and impact of management and organization studies (MOS). The authors clarify the possibilities by reviewing 140 systematic reviews published in academic and practitioner outlets to answer the following three questions: (i) Why is grey literature excluded from/included in systematic reviews in MOS? (ii) What types of grey material have been included in systematic reviews since guidelines for practice were first established in this discipline? (iii) How is the grey literature treated currently to advance management and organization scholarship and knowledge? This investigation updates previous guidelines for more inclusive systematic reviews that respond to criticisms of current review practices and the needs of evidence‐based management.
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Relevance
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In this article, we describe the strengths and weaknesses of several methods of locating systematic reviews, including electronic databases such as MEDLINE, Best Evidence (the electronic version of ACP Journal Club and Evidence-Based Medicine), and the Cochrane Library (a regularly updated source of reviews and controlled trials produced by the Cochrane Collaboration). We also present steps that can be used to critically appraise review articles; as an example, we use a systematic review that evaluates the gastrointestinal toxicity of various nonsteroidal anti-inflammatory drugs in the context of a clinical scenario.
Critical appraisal
Evidence-Based Medicine
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Summary Background The Cochrane collaboration aims to produce high‐quality systematic reviews. It is not known whether the methods used in producing Cochrane Skin Group (CSG) reviews result in higher quality reviews than other systematic reviews in dermatology. Objectives To determine how the methodological quality of dermatological CSG reviews published in The Cochrane Library and in peer‐reviewed journals compare with non‐Cochrane systematic reviews. Methods Two blinded investigators independently assessed review quality using the 10‐item Oxman and Guyatt scale. Results Thirty‐eight systematic reviews (17 Cochrane reviews published in The Cochrane Library, 11 Cochrane reviews published in peer‐reviewed journals and 10 non‐Cochrane reviews published in peer‐reviewed journals) were examined. The Cochrane Library reviews included quality of life (11/17 vs. 1/10, P = 0·014) and adverse outcomes (14/17 vs. 2/10, P = 0·003) more often than non‐Cochrane reviews published in peer‐reviewed journals. Cochrane reviews published in both peer‐reviewed journals and The Cochrane Library were more likely to include comprehensive search strategies (11/11 and 17/17 vs. 6/10, P‐values = 0·04 and 0·01), take steps to minimize selection bias (11/11 and 16/17 vs. 3/10, P‐values = 0·003 and 0·001) and appropriately assess the validity of all included trials (10/11 and 16/17 vs. 4/10, P‐values = 0·04 and 0·007) than non‐Cochrane reviews. Overall, Cochrane reviews published both in peer‐reviewed journals and in The Cochrane Library were assigned higher quality scores by reviewers than non‐Cochrane reviews (median = 6·0 and 6·5 vs. 4·5, P‐values = 0·01 and 0·002). Conclusions The Cochrane Library systematic review methodology leads to higher quality reviews on dermatological topics.
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Purpose: The purpose of this study was to review the effect of foot care education in type 2 diabetes mellitus patients. Methods: A systematic literature search was conducted using Ovid-Medline, EMBASE, Cochrane library, CINAHL, PsycINFO, RISS, NDSL, and KISS to identify studies reported in English or Korean from 2000 to 2022. Results: From the 3,070 studies extracted, 13 were selected for review. The studies were classified as information study, design study, subject study, intervention analysis, and effect analysis. Conclusion: The results of this study could be useful key principles in developing and applying foot care education programs for type 2 diabetes mellitus patients. Further research should be conducted to develop foot care education programs suitable for each patient group and to measure its effectiveness.
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Foot care
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Abstract Background Harmful alcohol use is a leading risk to the health of populations worldwide. Within Africa, where most consumers are adolescents, alcohol use represents a key public health challenge. Interventions to prevent or substantially delay alcohol uptake and decrease alcohol consumption in adolescence could significantly decrease morbidity and mortality, through both immediate effects and future improved adult outcomes. In Africa, these interventions are urgently needed; however, key data necessary to develop them are lacking as most evidence to date relates to high-income countries. The purpose of this review is to examine and map the range of interventions in use and create an evidence base for future research in this area. Methods In the first instance, we will conduct a review of systematic reviews relevant to global adolescent alcohol interventions. We will search the Cochrane Database of Systematic Reviews, MEDLINE (Ovid), CINAHL, Web of Science, Global Health and PubMed using a broad search. In the second instance we will conduct a scoping review by drawing on the methodological framework proposed by Arksey and O’Malley. We will search for all study designs and grey literature using the Cochrane Database of Systematic Reviews, MEDLINE (Ovid), CINAHL, Web of Science and Global Health, Google searches and searches in websites of relevant professional bodies and charities. An iterative approach to charting, collating, summarising and reporting the data will be taken, with the development of charting forms and the final presentation of results led by the extracted data. In both instances, the inclusion and exclusion criteria have been pre-defined, and two reviewers will independently screen abstracts and full text to determine eligibility of articles. Discussion It is anticipated that our findings will map intervention strategies aiming to reduce adolescent alcohol consumption in Africa. These findings are likely to be useful in informing future research, policy and public health strategies. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia. Protocol Registration This protocol was submitted to the Open Science Framework on May 03, 2021. www.osf.io/qnvba
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