Systematic reviews and meta-analyses (SRs/MAs) are designed to be rigorous research methodologies that synthesize information and inform practice. An increase in their publication runs parallel to ...quality concerns and a movement toward standards to improve reporting and methodology. With the goal of informing the guidance librarians provide to SR/MA teams, this study assesses online journal author guidelines from an institutional sample to determine whether these author guidelines address SR/MA methodological quality.
A Web of Science Core Collection (Clarivate) search identified SRs/MAs published in 2014-2019 by authors affiliated with a single institution. The AMSTAR 2 checklist was used to develop an assessment tool of closed questions specific to measures for SR/MA methodological quality in author guidelines, with questions added about author guidelines in general. Multiple reviewers completed the assessment.
The author guidelines of 141 journals were evaluated. Less than 20% addressed at least one of the assessed measures specific to SR/MA methodological quality. There was wide variation in author guidelines between journals from the same publisher apart from the American Medical Association, which consistently offered in-depth author guidelines. Normalized Eigenfactor and Article Influence Scores did not indicate author guideline breadth.
Most author guidelines in the institutional sample did not address SR/MA methodological quality. When consulting with teams embarking on SRs/MAs, librarians should not expect author guidelines to provide details about the requirements of the target journals. Librarians should advise teams to follow established SR/MA standards, contact journal staff, and review SRs/MAs previously published in the journal.
Clinical trials have described variation in radiation therapy plan quality, of which contour delineation is a key component, and linked this to inferior patient outcomes. In response, consensus ...guidelines have been developed to standardize contour delineation. This investigation assesses trends in contouring guidelines and examines the methodologies used to generate and deliver recommendations.
We conducted a literature search for contouring guidelines published after 1995. Of 11,124 citations, 332 were identified for full-text review to determine inclusion. We abstracted articles for the intent of the consensus process, key elements of the methodology, and mode of information delivery. A Fisher exact test was used to identify elements that differed among the guidelines generated for clinical trials and routine care.
Overall, 142 guidelines were included, of which 16 (11%) were developed for a clinical trial. There was an increase in guideline publication over time (0 from 1995-1999 vs 65 from 2015- 2019; P = .03), particularly among recommendations for stereotactic radiation and brachytherapy. The most common disease sites were head and neck (24%), gastrointestinal (12%), and gynecologic (12%). Methods used to develop recommendations included literature review (50%) and image-based methods (45%). Panels included a median of 10 physicians (interquartile range, 7-16); 70% of panels represented multidisciplinary expertise. Guidelines developed for a clinical trial were more likely to include an image-based approach, with quantitative analysis of contours submitted by the panel members and to publish a full set of image-based recommendations (P < .005).
This review highlights an increase in consensus contouring recommendations over time. Guidelines focus on disease sites, such as head and neck, with evidence supporting a correlation between treatment planning and patient outcomes, although variation exists in the approach to the consensus process. Elements that may improve guideline acceptance (ie, image-based consensus contour analysis) and usability (ie, inclusion of a full image set) are more common in guidelines developed for clinical trials.
There is lack of uniformity in the reflectance confocal microscopy (RCM) terminology for melanocytic lesions.
To review published RCM terms for melanocytic lesions and identify redundant, synonymous ...terms.
A systematic review of original research articles adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was conducted until August 15, 2018. Two investigators gathered all published RCM terms used to describe melanoma and melanocytic nevi. Synonymous terms were grouped based on similarity in definition and in histopathologic correlation.
Out of 156 full-text screened articles, 59 studies met the inclusion criteria. We identified 209 terms; 191 (91.4%) corresponding to high-magnification/cellular-level terms and 18 (8.6%) corresponding to low-magnification/architectural patterns terms. The overall average use frequency of RCM terms was 3.1 times (range, 1-31). By grouping of individual RCM terms based on likely synonymous definitions and by eliminating terms lacking clear definition, the total number of RCM terms could be potentially reduced from 209 to 40 terms (80.8% reduction).
Non-English and non–peer-reviewed articles were excluded.
This systematic review of published RCM terms identified significant terminology redundancy. It provides the basis for subsequent terminology consensus on melanocytic neoplasms.
Conduct a systematic review of available evidence on food and beverage intake during cancer treatment.
Determine what food or beverages consumed during cancer treatment might prevent recurrence, ...subsequent malignancies, treatment-related toxicity, or death.
Food and beverage intake, as well as weight status, can integrate with cancer treatment to mitigate treatment-related toxicities, support treatment success, and prevent recurrence. Yet, evidence-based recommendations are lacking.
We searched PubMed, Embase, and Cochran for research studies conducted within the last 10 years on food and beverage consumption during cancer treatment, with no restrictions on age or cancer type. Two reviewers independently extracted information on intervention type, diet, and outcomes; these data were confirmed by a third reviewer.
Nineteen studies were selected from 1551 potential studies. Nine were randomized controlled trials, analyzing high protein diets, short-term fasting, low-fat diets, FODMAP diet, or comparing consumption of 1 specific food or nutrient, including Concord grape juice, onions, and fiber. The remaining 10 studies were observational or retrospective and tracked treatment symptoms, general dietary intake, or weight status as well as consumption of specific foods including nuts, coffee, sugar-sweetened beverages.
Available evidence suggests food can be effective at ameliorating cancer treatment-related toxicities and improving prognosis, but more research is needed.
Abstract
Introduction
Adoption of rigorous standards for reporting treatment fidelity is essential for advancing discovery, validation, and implementation of behavioral treatments. Whereas the NIH ...Behavior Change Consortium (BCC) developed an assessment tool to assess the quality of reporting and monitoring of treatment fidelity across health behavior change interventions, it has not yet been applied specifically to treatment fidelity in behavioral tobacco treatment trials.
Aims and Methods
We conducted a scoping review of peer-reviewed, clinical trials of behavioral adult tobacco treatment interventions published in English between 2006 and 2018. Using the BCC treatment fidelity checklist, articles were coded for the presence or absence of various treatment fidelity strategies within each of 5 domains: Design, Training, Delivery, Receipt, and Enactment. Eligible articles (N = 755) were coded by two independent coders.
Results
The proportion of reporting strategies varied within the fidelity domains, ranging from 5.2% to 96.3% in Design, 1.9% to 24.9% in Training, 2.6% to 32.3% in Delivery, 5.2% to 44.3% in Receipt, and 6.7% to 43.2% in Enactment. The mean proportion of adherence to treatment fidelity strategies within each domain was: Design (68%), Training (14%), Delivery (15%), Receipt (16%), and Enactment (25%). Only 11 studies achieved ≥80% reporting across >1 fidelity domain. There was no evidence for improvement in fidelity reporting across the 13-year time frame from the initial BCC publication to the present.
Conclusions
These findings illustrate the lack of consistency in fidelity reporting in tobacco treatment trials and underscore the challenges faced in evaluating rigor and reproducibility, as well as interpretation and dissemination of findings. Recommendations are made for improving fidelity reporting in tobacco treatment trials.
Implications
The SRNT Treatment Research Network sponsored a scoping review to summarize the current state of reporting treatment fidelity and make recommendations for best practices in reporting fidelity in tobacco treatment trials. The review identified a lack of consistency in fidelity reporting, illustrating the challenges faced in evaluating rigor, and reproducibility, as well as interpretation and dissemination of findings.
Library orientation at an academic health sciences library consisted of a five-minute overview within new student orientation. Past experience indicated this brief presentation was insufficient for ...students to learn about library resources. In 2014, an effort was made to supplement orientation by developing an online game aimed at enabling students to become self-sufficient through hands-on learning. A gaming model was chosen with expectations that competition and rewards would motivate students. Although the pilots suffered from low participation rates, the experience merits further research into the potential of a broader model of online library instruction in the health sciences environment.
Arc magmas are commonly assumed to form by melting of sub-arc mantle that has been variably enriched by a component from the subducted slab. Although most magmas that reach the surface are not ...primitive, the impact of assimilation of the arc crust is often ignored with the consequence that trace element and isotopic compositions are commonly attributed only to varying contributions from different components present in the mantle. This jeopardises the integrity of mass balance recycling calculations. Here we use Sr and O isotope data in minerals from a suite of volcanic rocks from St Lucia, Lesser Antilles arc, to show that assimilation of oceanic arc basement can be significant. Analysis of 87Sr/86Sr in single plagioclase phenocrysts from four Soufrière Volcanic Complex (SVC; St Lucia) hand samples with similar composition (87Sr/86Sr=0.7089–0.7091) reveals crystal isotopic heterogeneity among hand samples ranging from 0.7083 to 0.7094 with up to 0.0008 difference within a single hand sample. δO18 measurements in the SVC crystals show extreme variation beyond the mantle range with +7.5 to +11.1‰ for plagioclase (n=19), +10.6 to +11.8‰ for quartz (n=10), +9.4 to +9.8‰ for amphibole (n=2) and +9 to +9.5‰ for pyroxene (n=3) while older lavas (Pre-Soufriere Volcanic Complex), with less radiogenic whole rock Sr composition (87Sr/86Sr=0.7041–0.7062) display values closer to mantle range: +6.4 to +7.9‰ for plagioclase (n=4) and +6 to +6.8‰ for pyroxene (n=5). We argue that the 87Sr/86Sr isotope disequilibrium and extreme δO18 values provide compelling evidence for assimilation of material located within the arc crust. Positive correlations between mineral δO18 and whole rock 87Sr/86Sr, 143Nd/144Nd and 206,207,208Pb/204Pb shows that assimilation seems to be responsible not only for the isotopic heterogeneity observed in St Lucia but also in the whole Lesser Antilles since St Lucia encompasses almost the whole-arc range of isotopic compositions. This highlights the need for detailed mineral-scale investigation of oceanic arc suites to quantify assimilation that could otherwise lead to misinterpretation of source composition and subduction processes.
•We performed single mineral δO18 and 87Sr/86Sr analyses in lavas from St Lucia.•Mineral 87Sr/86Sr variations argue for assimilation of sediment in the arc crust.•“Out of mantle range” mineral δO18 also argue for crustal assimilation.•Mineral δO18 correlate with whole rock 87Sr/86Sr.•Arc crust assimilation controls St Lucia whole rock isotopic compositions.
Abstract
Background
Mortality associated with Staphylococcus aureus bacteremia (SAB) has prompted the development of “bundle”-based approaches to improve outcomes. Components of bundled strategies ...include appropriate antibiotic selection, early source control, documenting negative cultures, echocardiogram, and adequate treatment duration. In 7/2016, the UNC Antimicrobial Stewardship Program (ASP) began prospective monitoring of SAB patients. Here we describe the impact of these ASP efforts.
Methods
Quasi-experimental study of patients ≥16 years with SAB 9/2015-3/2016 (pre-intervention) and 9/201/2017 (post-intervention). Patients were excluded if the bloodstream infection was polymicrobial, therapy began at an outside hospital, or the patient was discharged or died within 72 hours of positive blood culture. Minimum adequate treatment duration was defined as 14 days for uncomplicated SAB; 28 days for complicated SAB; 42 days if endovascular disease or osteomyelitis present. Categorical variables were compared using the chi-squared test, significance level of P < 0.05. The study was approved by the UNC IRB.
Results
217 treatment courses were included; 114 pre- and 103 post-intervention. Rates of adequate empirical antibiotics were consistently high throughout the study (Table 1). Pre-intervention, individual bundle components occurred frequently: negative culture documented (95%), echocardiogram (80%), and adequate duration of an appropriate antibiotic (71%; Table 2). After ASP intervention, echocardiography and adequate treatment duration rates increased to 92% (P < 0.05, both outcomes), as did ID consultation rates (59% to 67%; P = 0.04). Overall bundle achievement increased from 54% to 82%. ASP interventions were documented for 11 (10%) and 32 (31%) of patients during the periods. Mortality and readmission within 6 months of discharge were unchanged (12% and 11%; 41% and 42%, respectively).
Conclusion
ASP intervention was associated with increased rates of bundle achievement but did not impact mortality or 6-month readmission. Despite adequate empiric therapy and relatively high rates of adherence to best-evidenced practices, SAB continues to be associated with significant mortality and high rates of 6-month readmission.
Disclosures
All authors: No reported disclosures.
Postoperative atrial fibrillation (AF) frequently complicates coronary artery bypass grafting (CABG) operations. As the frequency of obesity has increased in the United States, the number of obese ...patients undergoing CABG has kept pace. This study sought to define the association between body mass index (BMI) and postoperative AF.
We studied 12,367 consecutive patients with no history of AF who underwent isolated CABG operations. BMI was stratified according to Centers for Disease Control and Prevention criteria, and differences in baseline clinical and operative characteristics were adjusted through multivariate logistic regression models.
The unadjusted incidence of new-onset postoperative AF demonstrated a U-shape with regard to BMI. The highest incidence (34%) was found in the "lean" stratum (BMI<18.5 kg/m2), followed by 32% in the "severely obese" (BMI≥40 kg/m2) stratum. Lower incidences were found in the "normal" stratum (30%), in the "obese" stratum (28%), and the lowest incidence (26%) was in the overweight stratum. Observed incidence was 50% greater than the expected incidence in the "severely obese" stratum (32% vs 21%). In multivariate regression analysis adjusted for age and other covariates, BMI remains a strong risk factor for new-onset postoperative AF. Compared with normal BMI, obesity (odds ratio, 1.24; 95% confidence interval, 1.08 to 1.42) and severe obesity (odds ratio, 2.00; 95% confidence interval, 1.54 to 2.57) both emerged as strong risk factors for postoperative AF. No association was found between a lean BMI and postoperative AF (odds ratio, 1.14; 95% confidence interval, 0.66 to 1.98).
After adjusting for potential confounders, obesity, as reflected by the body mass index, remains an independent predictor of postoperative AF.
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