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PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 1: acupuncture.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with acupuncture. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of acupuncture; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: From a total of 48 potentially relevant reviews preselected in a screening process 39 met the inclusion criteria. 22 were on various pain syndromes or rheumatic diseases. Other topics addressed by more than one review were addiction, nausea, asthma and tinnitus. Almost unanimously the reviews state that acupuncture trials include too few patients. Often included trials are heterogeneous regarding patients, interventions and outcome measures, are considered to have insufficient quality and contradictory results. Convincing evidence is available only for postoperative nausea, for which acupuncture appears to be of benefit, and smoking cessation, where acupuncture is no more effective than sham acupuncture. CONCLUSIONS: A large number of systematic reviews on acupuncture exists. What is most obvious from these reviews is the need for (the funding of) well-designed, larger clinical trials.

Acupuncture↗
PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with homeopathy. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of homeopathy; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pretested form and summarized descriptively. RESULTS: Eighteen out of 22 potentially relevant reviews preselected in the screening process met the inclusion criteria. Six reviews addressed the question whether homeopathy is effective across conditions and interventions. The majority of available trials seem to report positive results but the evidence is not convincing. For isopathic nosodes for allergic conditions, oscillococcinum for influenza-like syndromes and galphimia for pollinosis the evidence is promising while in other areas reviewed the results are equivocal. INTERPRETATION: Reviews on homeopathy often address general questions. While the evidence is promising for some topics the findings of the available reviews are unlikely to end the controversy on this therapy.

Asthma↗
PubMed2001

Systematic reviews of complementary therapies - an annotated bibliography. Part 2: herbal medicine.

BACKGROUND: Complementary therapies are widespread but controversial. We aim to provide a comprehensive collection and a summary of systematic reviews of clinical trials in three major complementary therapies (acupuncture, herbal medicine, homeopathy). This article is dealing with herbal medicine. Potentially relevant reviews were searched through the register of the Cochrane Complementary Medicine Field, the Cochrane Library, Medline, and bibliographies of articles and books. To be included articles had to review prospective clinical trials of herbal medicines; had to describe review methods explicitly; had to be published; and had to focus on treatment effects. Information on conditions, interventions, methods, results and conclusions was extracted using a pre-tested form and summarized descriptively. RESULTS: From a total of 79 potentially relevant reviews pre-selected in the screening process 58 met the inclusion criteria. Thirty of the reports reviewed ginkgo (for dementia, intermittent claudication, tinnitus, and macular degeneration), hypericum (for depression) or garlic preparations (for cardiovascular risk factors and lower limb atherosclerosis). The quality of primary studies was criticized in the majority of the reviews. Most reviews judged the available evidence as promising but definitive conclusions were rarely possible. CONCLUSIONS: Systematic reviews are available on a broad range of herbal preparations prescribed for defined conditions. There is very little evidence on the effectiveness of herbalism as practised by specialist herbalists who combine herbs and use unconventional diagnosis.

Herbal Medicine↗
PubMed2004

An audit of the editorial process and peer review in the journal Clinical rehabilitation.

OBJECTIVE: To investigate the editorial process on papers submitted to a scientific journal. DESIGN: Descriptive and correlational analysis. SETTING: A single specialist rehabilitation journal from mid-1999 to mid-2003. SUBJECTS: The Editor, peer reviewers and authors. INTERVENTIONS: Submitted papers were initially screened, the majority were subject to review, and a decision was made on whether or not to publish. Reviewers scored papers on 11 items using a 0 (bad)-10 (good) scale. MEASURES: Time delays and rating of each paper on a pro-forma. RESULTS: The number of papers submitted each year increased from 136 to 209. Between 19% and 31% were rejected without review and 17-24% were rejected later. The proportion accepted dropped from 64% to 47%. The median delay between arrival and first author contact in papers subject to review was stable between 67 and 76 days. Agreement between reviewers was low with an intraclass correlation coefficient (ICC) varying between 0.12 and 0.27 and disagreement of 3 or more points in 32-51%. The main factor associated with eventual acceptance was the sum of the 'overall recommendation score' given by the two reviewers, but 20% of the variance in final decision was unexplained by the reviewers' scoring. The number of randomized trials published increased from 5 in 1996 to 21 in 2002. CONCLUSIONS: The influence of the Editor on final decisions remains significant, particularly for papers 'on the margin'; decisions on publication in this journal are guided by but not determined by reviewers.

Peer Review, Research↗
PubMed2006

An evaluation of search and selection methods used in dental systematic reviews published in English.

BACKGROUND: Increasing numbers of systematic reviews are published each year, though little has been done to evaluate their search and selection methodology. METHODS: The authors searched dental systematic reviews published between Jan. 1, 2000, and July 14, 2005, for descriptions of how researchers used multiple electronic databases and secondary searches. They evaluated search and selection methods of identified systematic reviews against the guidelines found in the 2005 Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The authors identified 220 unique dental systematic reviews. They found that all aspects of search and selection methodology had improved. In 2005, most systematic reviews documented database names and search dates (90 percent), electronic search terms (95 percent) and inclusion-exclusion criteria (95 percent), and most employed secondary searching (100 percent). Many still failed to search more than MEDLINE (20 percent), document the search strategy (20 percent), use multiple reviewers for selecting studies (25 percent) and include all languages (39 percent). CONCLUSIONS AND CLINICAL IMPLICATIONS: Systematic review methodology is improving, though key components frequently are absent. Reviews should be read critically and in consideration of the methodological flaws.

Databases, Bibliographic↗
PubMed1996

Group peer review in psychiatry: the relationship to quality improvement and quality care.

OBJECTIVE: This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care. METHOD: Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored. RESULTS: The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review. CONCLUSIONS: Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.

Attitude of Health Personnel↗
PubMed2001

A rapid and systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity.

BACKGROUND: The prevalence of obesity in developed societies is increasing. Obesity is associated with an increased risk of co-morbidity, including cardiovascular disease and diabetes. Following the withdrawal of fenfluramine and dexfenfluramine, interest has focused on a novel anti-obesity drug orlistat. OBJECTIVE: To systematically assess the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. METHODS - SEARCH STRATEGY: Nineteen electronic databases were searched from inception to June 2000. Additionally, Internet searches were carried out, bibliographies of retrieved articles were examined and submissions were received from the manufacturer of orlistat. METHODS - INCLUSION AND EXCLUSION CRITERIA: Randomised controlled trials (RCTs) evaluating the effectiveness of orlistat used for weight loss or maintenance of weight loss in overweight or obese patients were eligible for inclusion. Primary outcome measures were changes in body weight, fat content or fat distribution. Secondary outcomes were changes in obesity-related risk-factor profiles, such as lipid levels, indicators of glycaemic control and blood pressure. Studies recruiting people with eating disorders such as anorexia nervosa and bulimia nervosa were excluded. METHODS - PROCESS OF STUDY SELECTION: Assessment of titles and abstracts was performed independently by two reviewers. If either reviewer considered a reference to be relevant, the full paper was retrieved. Full papers were assessed against the review selection criteria by two independent reviewers, and disagreements were resolved through discussion. METHODS - DATA EXTRACTION: Data were extracted by one reviewer into structured summary tables and checked by a second reviewer. Any disagreements about data were resolved by discussion. METHODS - QUALITY ASSESSMENT: Each included trial was assessed against a comprehensive checklist for methodological quality. Quality assessment was performed independently by two reviewers with disagreements resolved by discussion. METHODS - METHODS OF ANALYSIS/SYNTHESIS: This report is a narrative summary, with results grouped according to study endpoint. Statistical pooling was undertaken in groups of trials that were considered to be sufficiently similar. METHODS - ESTIMATION OF QUALITY OF LIFE, COSTS AND COST-EFFECTIVENESS AND/OR COST PER QUALITY-ADJUSTED LIFE-YEAR: Relevant economic evaluations were identified from the search strategy described above. Assessment of methodological quality was undertaken using principles outlined in published guidelines. METHODS - COMPANY SUBMISSIONS: Data from company submissions were subject to the same selection and appraisal processes as other studies considered for inclusion in the review, except that only RCTs with a duration of at least 1 year were selected. RESULTS - RESULTS OF THE SEARCH STRATEGY: Fourteen RCTs (including three company submissions) and two economic evaluations (including one company submission) were included in the review. RESULTS - RESULTS OF THE QUALITY ASSESSMENT: Methodological quality of trials was moderate to good. The main problems were lack of detail on methods used to produce true randomisation, small sample sizes in some cases and failure to use intention-to-treat analysis. It is likely that maintenance of blinding was difficult due to adverse effects associated with the study medication. RESULTS - EVIDENCE OF CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS: Most of the trials showed greater weight loss and better weight maintenance with orlistat compared to placebo at all endpoints (statistically significant differences for both outcomes). Orlistat 120 mg three times daily was the optimum regimen in terms of weight loss. Most trials showed significant improvement in at least some lipid concentration parameters, and, in three RCTs, orlistat produced statistically significant reductions in blood pressure relative to placebo. In obese patients with type 2 diabetes, orlistat resulted in a significantly greater weight loss at 1 year compared with placebo, and some parameters of glycaemic control and lipid concentration also showed significantly greater improvements compared with placebo. The incidence of gastrointestinal adverse events was consistently higher in orlistat groups compared with placebo, and orlistat use was associated with lower serum levels of fat-soluble vitamins. The cost per quality-adjusted life-year for orlistat was 45,881 UK pounds. CONCLUSIONS - IMPLICATIONS FOR CLINICAL PRACTICE: Although many trials have demonstrated statistically significant differences between groups in terms of weight loss in favour of orlistat versus placebo, the differences may not always be of clinical significance. The clinical significance of between-group differences for secondary outcomes may also be debatable. Possible adverse effects should be taken into account when prescribing orlistat, particularly gastrointestinal effects. (ABSTRACT TRUNCATED)

Anti-Obesity Agents↗
PubMedDate not supplied

A comprehensive review of the effects of worksite health promotion on health-related outcomes.

PURPOSE: This article provides the foundation for a series of literature reviews that critically examine the effectiveness of worksite health promotion programs. This issue reviews the exercise, health risk appraisal, nutrition and cholesterol, and weight control literatures; a future issue will review the alcohol, HIV/AIDS, multicomponent program, seat belt, smoking, and stress management literatures. METHODS: The literature search used a four-step process that included a computerized database search, a reference search, a manual search of relevant health promotion journals, and the writing of the review by a recognized expert in the area being searched. The databases were searched from 1968 through 1994 and included Medline, Aidsline, Psychological Abstracts, Combined Health Information Database, Employee Benefits Infosource, National Prevention Evaluation Research Collection, National Resource Center on Worksite Health Promotion, National Technical Information Service, and the Substance Abuse Information database. A total of 288 articles were identified by the search, not including the 37 articles in the hypertension literature. Authors of each review were requested to incorporate additional studies not identified by the search, provide a research rating for each individual article, and a rating for the overall literature for their respective area. The authors reviewed 316 studies. FINDINGS: The overall ratings for the reviews reported in this issue were suggestive for exercise, weak for health risk appraisals, suggestive/indicative for both nutrition and cholesterol, and indicative for weight control. The ratings for the other reviews will be reported in the subsequent issue. CONCLUSIONS: Research reported in these reviews suggests the effectiveness of worksite health promotion programs, however, additional research is required to provide conclusive evidence of their impact.

Health Knowledge, Attitudes, Practice↗
PubMed1997

Selecting and appraising studies for a systematic review.

After thoroughly searching the potentially relevant literature for a systematic review, reviewers face the sequential tasks of selecting studies for inclusion and appraising these studies. Methodical, impartial, and reliable strategies are necessary for these two tasks because systematic reviews are retrospective exercises and are therefore prone to both bias and random error. To plan for study selection, reviewers begin with a focused clinical question and choose selection criteria that reflect this question. A detailed selection protocol that specifies the study designs and publication status of articles to be included is often helpful. Selection criteria are itemized on customized forms and are used to examine each potentially relevant primary study, usually by two different reviewers. In planning the critical appraisal of included studies, reviewers decide which clinical and methodologic study features require documentation. After choosing methods for evaluating study quality, reviewers construct customized appraisal forms and an explicit protocol for the actual evaluation. Some of the techniques commonly used to minimize the potential for error in study appraisal include duplicate, independent examination; blinding to study results and other identifying features of each article; and correspondence with study authors to clarify issues. Ultimately, primary studies should be selected, appraised, and reported in sufficient detail to allow readers to judge the applicability of the review to clinical practice and to clarify the strength of the inferences that can be drawn from the review.

Research Design↗
PubMed1999

[A reproducibility and validity study of a systematic review on ischemic cardiopathy. The Study Group of the Quality of Care (GRECA)].

BACKGROUND: The systematic literature reviews have been proposed as a method of scientific evidence identification since they protect the final product from the subjectivity of each primary source reviewer. However, it is not known whether the different ways of evidence synthesis accomplish suitable criteria of objectivity, reliability and biases protection so as to be considered scientifically valid. An experiment of reliability and validity of a systematic literature review about coronary heart disease was carried out. MATERIAL AND METHODS: Study of blind concordance between two independent reviewers for the identification, selection, retrieval and quality evaluation of the articles by using the same protocol. The concordance was analysed by the kappa index for two observers in different categories. The validity was evaluated throughout the acceptability of the review users. RESULTS: The concordance for their identification capacity was poor although they used the same key words (869 versus 476). But the concordance improved when considering selection (26.6% versus 29.2%), retrieval (agreement = 76%) classification by kind of article (kappa = 0.60) and scoring by strength of the evidence (kappa = 0.87). The acceptability was high among review users. CONCLUSIONS: It would be assumed that, even under tight rules of performance, the systematic literature reviews are not completely protected against some biases which could damage their validity in a non easily controllable form. The implication of reviewers, experts in documentation and users of the literature, together with pilot studies performed previous to the review, seems to be the best way to yield better results.

Humans↗
PubMed2003

An exploratory cost analysis of performing hospital-based concurrent utilization review.

OBJECTIVE: To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry. STUDY DESIGN: A production process model focusing on resource utilization. SUBJECTS: The 29 clinical services of a 500-bed academic health center were aggregated into 9 clinical groups. A random sample of at least 15 reviews per group was studied. METHODS: Time sampling and cost analysis methods were used to determine the cost to the hospital of conducting utilization review. Component activities of the process were identified and analyzed to determine differences among clinical services and among the component tasks of the utilization review process. RESULTS: In 12 months, 13 126 reviews were completed in an average of 15 minutes 41 seconds. Across clinical groups, the average total time of each review ranged from 11 minutes 18 seconds (medical group) to 19 minutes 4 seconds (pediatrics group). Significant differences existed among clinical service groups for the activity of preparing for conducting the review, with the pediatrics group spending more time than the cardiology and oncology groups. The total cost of the process was nearly dollar 166 000 annually. The average cost per review was dollar 11, the average cost per patient-day denied was dollar 478, and the average cost per patient denial was dollar 1592. CONCLUSIONS: These figures are conservative in that they do not include the payer component of the costs, which could be as high as the hospital provider cost. Given a denial rate of < 2% and the high cost of the process, it may be beneficial to investigate alternative processes for conducting utilization review.

Academic Medical Centers↗
PubMed2003

[Time for professionalising the system of medical ethics review in the Netherlands].

In two recent papers, a radical change of the review system for medical ethics review committees was proposed. The current systems in Great Britain and Australia were described and it was suggested that the extended roles and responsibilities of the medical ethics review committees could not be fulfilled by the present committees. It was proposed that professional medical ethics committees be established with full time members who would receive an appropriate honorarium. The Netherlands has a decentralised system of medical ethics review, which is based on peer review. A radical change of the current system of medical ethics review is not warranted. There is however a need for further improvements to the current peer-review system. An important aspect of this improvement is an honorarium for the members as well as a budget for training and for the adequate scientific and administrative support of the committee by a secretariat. The fees levied for reviewing each protocol could in part finance the committee and its secretariat. However, these fees will probably not meet all of the costs. Therefore the centres involved in medical research should consider supporting their committees. It is in their interest to demonstrate their wish to protect those persons who consent to participate as research subjects. This will maintain the confidence of both the public and future participants in clinical trials. Furthermore, an efficient and adequate system of ethical review will support a balanced view towards medical research with human subjects and will also contribute to a positive image of the centre also as an attractive environment for medical professionals.

Ethics Committees↗
PubMed2006

What is submitted and what gets accepted in Indian Pediatrics: analysis of submissions, review process, decision making, and criteria for rejection.

OBJECTIVES: To identify the characteristics of the manuscripts submitted to the Indian Pediatrics; attributes of the peer-review process and decision-making; and factors associated with their acceptance or rejection. METHODS: All submissions to Indian Pediatrics during 2002 were analyzed by a retrospective review of records. Manuscripts were categorized by their place of origin (Indian vs. foreign), geographic region of India (north, south, east, west, central), submitting institution (teaching vs. non-teaching), subject (general pediatrics, systemic pediatrics, neonatology, genetic syndrome, allied sub-specialities, etc.), and type of article (research paper, case report, images, letter to editor, review, etc.). Manuscript details were recorded in a database that also included information on peer reviewer assignment, editorial and reviewer comments, and final disposition of the manuscript. Characteristics of accepted and rejected manuscripts were compared. RESULTS: Indian Pediatrics received 687 manuscripts for consideration in the year 2002; mostly from Indian authors (89%). Maximum contributions were received from North India (236, 39%) followed by 165 (27%) from South, 95 (16%) from West, 90 (15%) from Central and 26 (4%) from Eastern part of India. Of 687 papers, 457 (66%) articles qualified for peer review. Agreement between the reviewers was not significantly greater than that expected by chance; kappa for inter-rater agreement was 0.35, 0.17 and 0.21 between any two sets of reviewers for 431, 228 and 203 articles, respectively (P < 0.005). Of 687 submitted manuscripts, 294(43%) were accepted, 347(50%) were rejected and no decision was possible on 46(7%) manuscripts. The top reasons for rejection were 'absence of a message', 'lack of originality', 'inadequate methods', 'not relevant to journal', 'over-interpretation of results', 'unsatisfactory writing style', 'inaccurate/inconsistent/insufficient data', and 'inappropriate statistical analysis', in that order. Median number of days (IQR) needed to reach the final decision was 81 (25-210) d; ranging from 8 (3-29.5) d for Images to 180 (90-341) d for Research papers. No preference for acceptance was noted for foreign articles, geographic region of India, type of institution, or a particular topic, on both univariate and multivariate analysis. CONCLUSION: Indian Pediatrics is receiving contributions from all over India. Majority of the manuscripts are peer-reviewed. Of every 10 articles submitted, almost 4 are accepted. Median time interval from submission to final decision is less than 3 months. The decision-making is not influenced by the place of origin of manuscript.

Bibliometrics↗
PubMed1993

Full-spine radiography: a review.

OBJECTIVE: The literature pertaining to full-spine radiography was reviewed to clarify its current role in clinical practice, to identify appropriate parameters for patient selection criteria, to evaluate the validity of spinographic analysis procedures, and to review the latest technological advancements in radiation protection and radiographic technology. DATA SOURCES: The English language literature search included chiropractic textbooks, technique manuals and position papers as well as references from MEDLINE, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (CHIROLARS). References from non-indexed sources were reviewed from sources obtained in the indexed literature. Current texts on radiographic technology, radiation biology and radiation physics also were reviewed. STUDY SELECTION: The literature was reviewed by a single reviewer. All chiropractic references obtained were referenced. Nonchiropractic references that addressed relevant related topics were also included. DATA EXTRACTION: This study was primarily a qualitative review of the literature. A single observer extracted quantitative data only from controlled studies that examined validity, inter- and intraobserver reliability, and clinical relevance. DATA SYNTHESIS: The conclusions and recommendations in this review are based primarily on the work of experts in the field and well-established principles of radiation biology, radiation protection and radiation physics. CONCLUSIONS: Full-spine radiography and spinographic analysis are controversial procedures in chiropractic. An extensive review of the literature reveals that the role of full-spine radiography is well established. With proper patient selection, careful attention to technical detail and utilization of several technological advancements, full-spine radiography is an effective diagnostic and analytic procedure with an acceptable risk/benefit ratio. Although the reliability of certain spinographic parameters has been established, many questions remain regarding the validity and clinical relevance of those parameters.

Biomechanical Phenomena↗
PubMed1997

National tuberculosis programme review: experience over the period 1990-95.

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies.

Cost-Benefit Analysis↗
PubMed2026

Preregistration nursing student attrition and strategies to improve student retention in university; an umbrella review.

BACKGROUND: Attrition among preregistration nursing students remains a persistent international challenge, contributing to nursing workforce shortages. Although extensive research has examined factors influencing student attrition and retention, the evidence is fragmented across review-level literature, limiting clarity regarding priority and evidence-informed retention strategies. AIM: To synthesize review-level evidence on factors associated with preregistration nursing student attrition and to identify strategies that support student retention in university-based nursing programs. METHODS: An umbrella review was conducted in accordance with the Joanna Briggs Institute methodology. Six electronic databases were systematically searched for peer-reviewed literature reviews published in English between January 2016 and October 2025. Eligible reviews focused on undergraduate preregistration nursing students in face-to-face university programs. Methodological quality was appraised using the JBI critical appraisal checklist. Findings were synthesised using narrative and thematic approaches. RESULTS: Seventeen literature reviews were included. Attrition was consistently described as multifactorial, influenced by academic preparedness, psychosocial wellbeing, socio-demographic factors, and institutional support. Retention strategies reported across reviews were predominantly relational, developmental, and sustained over time, including mentoring, tutoring, academic skills development, psychosocial support, and interventions that foster belonging. Faculty engagement and holistic approaches were repeatedly associated with improved student persistence. However, the evidence base was largely descriptive, with limited experimental evaluation of intervention effectiveness. CONCLUSION: Preregistration nursing student retention is best supported through multifaceted, sustained strategies that begin at admission and extend throughout the curriculum. While current evidence highlights consistent patterns of effective support, further rigorous research is required to evaluate retention interventions and extend evidence to flexible nursing education pathways.

Humans↗
PubMed2026

Association of media use with sleep of children and adolescents: an umbrella review.

Adequate sleep is essential for child and adolescent development, driving extensive research across scientific disciplines. This umbrella review provides a comprehensive overview of existing evidence on media consumption and sleep and thereby lays the foundation for identifying key concepts and gaps. An inclusive systematic search for reviews reporting literature searches was conducted in 02/2021 and updated last in 09/2024. Methodological quality of the included reviews was assessed using AMSTAR-2. We included 84 reviews reporting on the association between media use and sleep in individuals aged 0-18 years. The field is dominated by reviews of low methodological quality, mainly including original cross-sectional studies with subjective measures in older children and adolescents. A total of 475 original articles were covered by the reviews; only 10 of them appeared in at least seven and at most nine reviews. Screen time generally had a negative impact on sleep, though evidence varied from very low to strong. Evidence for effects of conventional books on sleep remains inconclusive. High quality systematic reviews are needed to evaluate robust studies using objective measures of sleep and contemporary media use across all age groups up to adolescence and to explore the impact of non-digital media use on sleep, considering age and gender differences.

Humans↗
PubMed2001

Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer.

CONTEXT: Studies using physician implicit review have suggested that the number of deaths due to medical errors in US hospitals is extremely high. However, some have questioned the validity of these estimates. OBJECTIVE: To examine the reliability of reviewer ratings of medical error and the implications of a death described as "preventable by better care" in terms of the probability of immediate and short-term survival if care had been optimal. DESIGN: Retrospective implicit review of medical records from 1995-1996. SETTING AND PARTICIPANTS: Fourteen board-certified, trained internists used a previously tested structured implicit review instrument to conduct 383 reviews of 111 hospital deaths at 7 Department of Veterans Affairs medical centers, oversampling for markers previously found to be associated with high rates of preventable deaths. Patients considered terminally ill who received comfort care only were excluded. MAIN OUTCOME MEASURES: Reviewer estimates of whether deaths could have been prevented by optimal care (rated on a 5-point scale) and of the probability that patients would have lived to discharge or for 3 months or more if care had been optimal (rated from 0%-100%). RESULTS: Similar to previous studies, almost a quarter (22.7%) of active-care patient deaths were rated as at least possibly preventable by optimal care, with 6.0% rated as probably or definitely preventable. Interrater reliability for these ratings was also similar to previous studies (0.34 for 2 reviewers). The reviewers' estimates of the percentage of patients who would have left the hospital alive had optimal care been provided was 6.0% (95% confidence interval [CI], 3.4%-8.6%). However, after considering 3-month prognosis and adjusting for the variability and skewness of reviewers' ratings, clinicians estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would have lived 3 months or more in good cognitive health if care had been optimal, representing roughly 1 patient per 10 000 admissions to the study hospitals. CONCLUSIONS: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes.

Bias↗