Research Articles (Centre for Evidence-Based Health Care)
Permanent URI for this collection
Browse
Recent Submissions
Now showing 1 - 5 of 137
- ItemReporting of methodological studies in health research : a protocol for the development of the Methodological Study reporting Checklist (MISTIC)(BMJ Publishing, 2020-12) Lawson, Daeria O.; Puljak, Livia; Pieper, Dawid; Schandelmaier, Stefan; Collins, Gary S.; Brignardello-Petersen, Romina; Moher, David; Tugwell, Peter; Welch, Vivian A.; Samaan, Zainab; Thombs, Brett D.; Nørskov, Anders K.; Jakobsen, Janus C.; Allison, David B.; Mayo-Wilson, Evan; Young, Taryn; Chan, An-Wen; Briel, Matthias; Guyatt, Gordon H.; Thabane, Lehana; Mbuagbaw, LawrenceIntroduction: Methodological studies (ie, studies that evaluate the design, conduct, analysis or reporting of other studies in health research) address various facets of health research including, for instance, data collection techniques, differences in approaches to analyses, reporting quality, adherence to guidelines or publication bias. As a result, methodological studies can help to identify knowledge gaps in the methodology of health research and strategies for improvement in research practices. Differences in methodological study names and a lack of reporting guidance contribute to lack of comparability across studies and difficulties in identifying relevant previous methodological studies. This paper outlines the methods we will use to develop an evidence-based tool—the Methodological Study reporting Checklist—to harmonise naming conventions and improve the reporting of methodological studies. Methods and analysis: We will search for methodological studies in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, MEDLINE, Web of Science, check reference lists and contact experts in the field. We will extract and summarise data on the study names, design and reporting features of the included methodological studies. Consensus on study terms and recommended reporting items will be achieved via video conference meetings with a panel of experts including researchers who have published methodological studies. Ethics and dissemination: The consensus study has been exempt from ethics review by the Hamilton Integrated Research Ethics Board. The results of the review and the reporting guideline will be disseminated in stakeholder meetings, conferences, peer-reviewed publications, in requests to journal editors (to endorse or make the guideline a requirement for authors), and on the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network and reporting guideline websites. Registration: We have registered the development of the reporting guideline with the EQUATOR Network and publicly posted this project on the Open Science.
- ItemXpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2019) Horne, David J.; Kohli, Mikashmi; Zifodya, Jerry S.; Schiller, Ian; Dendukuri, Nandini; Tollefson, Deanna; Schumache, Samuel G.; Ochodo, Eleanor A.; Pai, Madhukar; Steingart, Karen R.Background: Xpert MTB/RIF (Xpert MTB/RIF) and Xpert MTB/RIF Ultra (Xpert Ultra), the newest version, are the only World Health Organization (WHO)- recommended rapid tests that simultaneously detect tuberculosis and rifampicin resistance in persons with signs and symptoms of tuberculosis, at lower health system levels. A previous Cochrane Review found Xpert MTB/RIF sensitive and specific for tuberculosis (Steingart 2014). Since the previous review, new studies have been published. We performed a review update for an upcoming WHO policy review. Objectives: To determine diagnostic accuracy of Xpert MTB/RIF and Xpert Ultra for tuberculosis in adults with presumptive pulmonary tuberculosis (PTB) and for rifampicin resistance in adults with presumptive rifampicin-resistant tuberculosis. Search methods: We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, Web of Science, Latin American Caribbean Health Sciences Literature, Scopus, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, to 11 October 2018, without language restriction. Selection criteria: Randomized trials, cross-sectional, and cohort studies using respiratory specimens that evaluated Xpert MTB/RIF, Xpert Ultra, or both against the reference standard, culture for tuberculosis and culture-based drug susceptibility testing or MTBDRplus for rifampicin resistance. Data collection and analysis: Four review authors independently extracted data using a standardized form. When possible, we also extracted data by smear and HIV status. We assessed study quality using QUADAS-2 and performed meta-analyses to estimate pooled sensitivity and specificity separately for tuberculosis and rifampicin resistance. We investigated potential sources of heterogeneity. Most analyses used a bivariate randome Kects model. For tuberculosis detection, we first estimated accuracy using all included studies and then only the subset of studies where participants were unselected, i.e. not selected based on prior microscopy testing. Main results: We identified in total 95 studies (77 new studies since the previous review): 86 studies (42,091 participants) evaluated Xpert MTB/RIF for tuberculosis and 57 studies (8287 participants) for rifampicin resistance. One study compared Xpert MTB/RIF and Xpert Ultra on the same participant specimen.
- ItemUniversity curricula in evidence-informed decision making and knowledge translation : integrating best practice, innovation, and experience for effective teaching and learning(Frontiers Media, 2019) Jessani, Nasreen; Hendricks, Lynne; Nicol, Liesl; Young, TarynAs attention to Evidence Informed Decision Making (EIDM) and Knowledge Translation (KT) in research, policy and practice grows, so does a need for capacity enhancement in amongst evidence producers and evidence users. Recognizing that most researchers enter the professional sphere with little or no appreciation of the importance and power of EIDM, the Centre for Evidence-based Health Care at Stellenbosch University, South Africa, spearheaded the development and accreditation of a foundational course titled Evidence-Informed Decision making: The Art, Science and Complexity of knowledge translation. The curriculum draws on the principles of adult learning and effective teaching that includes integrating seven key aspects: (1) extraction of intuitive and tacit knowledge (2) autonomous knowledge generation (3) diverse perspectives (4) learning by doing (5) peer-support and critique (6) facilitator coaching and (7) constant reflection. In this paper, we reflect on these techniques in enhancing understanding and utilization of KT in advancing EIDM. The in-person short course has been offered 5 times since its launch in September 2017 with attendance by ~85 senior researchers and government officials—each of whom left the workshop with three completed outputs: a stakeholder matrix, an engagement strategy for their chosen stakeholder and a plan for evaluating the impact of their KT strategy. Interest in the course has grown considerably: (a) Requests from local institutes of research for dedicated training to their staff; (b) Incorporation into international program partner capacity enhancing strategies; (c) Publication of a book chapter designed using course content; (d) Adaptation and utilization of the templates and tools as teaching resources (e) Informing organizational stakeholder engagement strategies (f) Adaptation of the modules for conference capacity building workshops. In summary, designing courses that take into consideration adult principles of learning is not a new concept. However, effective delivery of such courses is still nascent. We found that integrating the seven aspects mentioned above, including researchers together with decision-makers in the workshops, and having an experienced facilitator is critical for effective learning. Enhancing knowledge and skills “just in time” rather than “just in case” has demonstrated increased potential for immediate relevance, uptake and sustainability.
- ItemBurden of non-communicable diseases in sub-Saharan Africa, 1990–2017 : results from the Global Burden of Disease Study 2017(Elsevier, 2019-10) Gouda, Hebe N.; Charlson, Fiona; Sorsdahl, Katherine; Ahmadzada, Sanam; Ferrari, Alize J.; Erskine, Holly; Leung, Janni; Santamauro, Damian; Lund, Crick; Aminde, Leopold Ndemnge; Mayosi, Bongani M.; Kengne, Andre Pascal; Harris, Meredith; Achoki, Tom; Wiysonge, Charles S.; Stein, Dan J.; Whiteford, HarveyBackground: Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of noncommunicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017. Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)—with crude counts as well as all-age and age-standardised rates per 100000 population—with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country’s Socio-demographic Index. Findings: All-age total DALYs due to NCDs increased by 67·0% between 1990 (90·6 million [95% UI 81·0–101·9]) and 2017 (151·3 million [133·4–171·8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18·6% [95% UI 17·1–20·4] to 29·8% [27·6–32·0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100000 population) due to NCDs in 2017 (21757·7 DALYs [95% UI 19 377·1–24380·7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26491·6 DALYs [25165·2–28129·8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22·9 million (21·5–24·3) DALYs (15·1% of the total NCD burden), after the group of disorders categorised as other NCDs (28·8 million [25·1–33·0] DALYs, 19·1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer). Interpretation: NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs.
- ItemMaternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study(Elsevier, 2019-04) Bishop, David; Dyer, Robert A.; Maswime, Salome; Rodseth, Reitze N.; Van Dyk, Dominique; Kluyts, Hyla-Louise; Tumukunde, Janat T.; Madzimbamuto, Farai D.; Elkhogia, Abdulaziz M.; Ndonga, Andrew K. N.; Ngumi, Zipporah W. W.; Omigbodun, Akinyinka O.; Amanor-Boadu, Simbo D.; Zoumenou, Eugene; Basenero, Apollo; Munlemvo, Dolly M.; Youssouf, Coulibaly; Ndayisaba, Gabriel; Antwi-Kusi, Akwasi; Gobin, Veekash; Forget, Patrice; Mbwele, Bernard; Ndasi, Henry; Rakotoarison, Sylvia R.; Samateh, Ahmadou L.; Mehyaoui, Ryad; Patel-Mujajat, Ushmaben; Sani, Chaibou M.; Esterhuizen, Tonya M.; Madiba, Thandinkosi E.; Pearse, Rupert M.; Biccard, Bruce M.Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.