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Feedback from community pharmacy users on the contribution of community pharmacy to improving the public's health: a systematic review of the peer reviewed and non-peer reviewed literature 1990-2002.

OBJECTIVE: To systematically review feedback from pharmacy users on their perceptions and experiences of health-related advice and services provided from community pharmacies. METHODS: The focus of the review was community pharmacy activities in relation to promoting health and well-being, preventing ill-health and maintaining health. Searches were conducted for peer-reviewed (international) and non-peer-reviewed (UK) research. Electronic databases searched included MEDLINE, EMBASE, Cochrane Library and International Pharmaceutical Abstracts; hand searches of key journals and conference abstracts, key informants. Key informants in the UK were contacted to identify unpublished studies. The inclusion period was 1990 onwards. Data extraction and synthesis Data were abstracted into a matrix by one author with a sample checked by a second. The Health Development Agency's Evidence Base 2000 standards and the evidence categories used by the Department of Health in the National Service Frameworks were applied to each item. MAIN RESULTS: Seven peer reviewed papers and 13 non-peer reviewed reports were identified for inclusion in the review. Consumer usage of pharmacies is almost universal with prescription supplies and purchase of over the counter medicines predominating. Evidence shows that not only is usage low for general health advice, but that pharmacists are perceived as 'drugs experts' rather than experts on health and illness. Emergency hormonal contraception and head lice management schemes have been well received. There is a need to consider privacy and confidentiality surrounding advice giving. CONCLUSIONS: Users of community pharmacy-based health development initiatives express a high level of satisfaction. If community pharmacies are to be used to their full extent, then actions to extending the public's awareness and acceptance of the pharmacist's role in giving advice will be crucial. Further research will be needed to measure any change in premises development on the public's perception of the level of privacy in pharmacies.

Confidentiality↗

The use of systematic reviews when designing studies.

BACKGROUND: The importance of systematic reviews in identifying gaps in the evidence base and providing a quantitative basis for informing new research initiatives is widely acknowledged, but little is known about what actually happens in practice. Our objective was to assess the use made of results of reviews in the designing of new studies. METHODS: Of all Cochrane reviews published in 1996, those updated in 2002 or 2003 were identified. Authors of trials added in the updates were contacted and asked if use had been made of the 1996 Cochrane or other reviews in designing their study. RESULTS: Of 32 authors of studies newly included in 33 Cochrane reviews which met our inclusion criteria, 24 (75%) responded. Eleven (46%) respondents were aware of the relevant Cochrane review at the time they designed their study. In eight (33%) cases the design of the new study had been influenced by a review; in two (8%) this was the relevant Cochrane review. CONCLUSIONS: Cautious interpretation of these results is necessary, but it is apparent that the proportion of study investigators using Cochrane or other systematic reviews in designing their new studies was very limited. Inclusion of encouragement in publication or application guidelines to consider and cite review results is desirable.

Clinical Trials as Topic↗

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

BACKGROUND: Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. METHODS: The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. RESULTS: Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. CONCLUSION: There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.

Clinical Protocols↗

Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties.

OBJECTIVE: To systematically review the measurement properties (i.e. internal consistency, reproducibility, validity, responsiveness and interpretability) of all performance-based methods which have been used to measure the physical function of patients with osteoarthritis of the hip or knee. METHODS: A systematic search was conducted in Medline, CINAHL, PsychINFO and Embase. Standardized criteria were applied to assess the quality of the clinimetric studies and the measurement properties. RESULTS: Twenty-six performance-based methods were included: 13 walking tests, two stair-climb tests, one chair test and ten multi-item tests. Three out of seven multi-activity tests were tested for internal consistency and two were rated positively. Fourteen tests were tested for reliability and five were rated positively. The absolute measurement error (agreement) was assessed for 10 tests. Only one test received a positive rating. Fourteen tests were tested for construct validity. Only two tests received positive ratings. Responsiveness was assessed for 12 tests, but none of them received a positive rating. A lot of indeterminate ratings were given, mostly for small studies or non-optimal analyses. CONCLUSION: Many more well-designed studies are needed to assess the measurement properties of performance-based methods. More importantly, however, before one can make a justified choice of a particular performance-based method, consensus is needed on what activities should be included in a performance-based test for patients with hip or knee osteoarthritis and which aspects of function should be measured.

Exercise Test↗

Epidemiological status of bovine viral diarrhea virus in water buffalo (Bubalus bubalis): A global systematic review and meta-analysis.

Bovine viral diarrhea virus (BVDV) remains a neglected viral disease in water buffalo despite its significant economic impact in production systems. Although limited epidemiological studies have been reported worldwide, the serostatus and active infection in buffalo have not been systematically reviewed. A systematic review and meta-analysis were conducted to estimate BVDV prevalence in water buffalo and identify associated epidemiological factors. Relevant studies published up to January 31, 2026, were retrieved from five electronic databases. A total of 49 studies were identified from 15 different countries were found for inclusion. A random-effects model was used to estimate pooled-prevalence and assess heterogeneity among studies. A meta-analysis of 37 studies (9270 buffalo) estimated a pooled BVDV seroprevalence of 30.5%, while analysis of 16 studies (7189 animals) indicated an antigen prevalence of 16.5%. Continent-wise analysis revealed the highest BVDV seroprevalence in South-America (44.0%), while antigen prevalence was highest in Africa (21.2%) followed by Asia at 12.2%, and no BVDV data reported from North-America. Among the different countries, the highest BVDV seroprevalence was detected in Turkey (61.6%) and Argentina (59.0%), while antigen prevalence was highest in Egypt (21.2%), with lower estimates in Brazil (11.8%) and Iraq (11.3%). Notably, high heterogeneity (I2 > 90%) was observed in the all-pooled estimates, indicating variations in sampling period, age, sex, sample source and types, diagnostic methods, production-system, and study quality. These findings demonstrate the widespread presence of BVDV in water buffalo populations and indicate the need for targeted control strategies to mitigate its impact on health and productivity.

Animals↗

Systematic review as an evidence-based tool for the operating room.

THIS ARTICLE DETAILS advantages of using systematic reviews (ie, meta-analyses) to determine evidence-based best practices. A NUMBER OF SYSTEMATIC REVIEWS relevant to the OR and produced under the auspices of the Cochrane Collaboration are explored with the aim of encouraging perioperative nurses to become familiar with, if not part of, the process of systematic review development.

Evidence-Based Medicine↗

The effect of income inequality and macro-level social policy on infant mortality and low birthweight in developed countries--a preliminary systematic review.

OBJECTIVE: To carry out a preliminary systematic review of literature to address the question - among rich nations (or states within nations) what is the evidence that income inequality and differences in macro-level social policy affect rates of infant mortality and low birthweight (LBW)? STUDY DESIGN: A systematic literature review. SEARCH STRATEGY: Medline database (1968-August 2003) was searched for empirical studies of the relationship between macro-level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross-national comparison of infant mortality and LBW that did not compare the effects of macro-level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro-level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated. RESULTS: Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re-distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult. CONCLUSIONS: The results of this review represent a preliminary attempt to summarize the literature linking macro-level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re-distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.

Developed Countries↗

Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVE: To systematically review studies of male circumcision and the risk of HIV-1 infection in men in sub-Saharan Africa, and to summarize the findings in a meta-analysis. DESIGN: A meta-analysis of observational studies. METHODS: A systematic literature review was carried out of studies published up to April 1999 that included circumcision as a risk factor for HIV-1 infection among men in sub-Saharan Africa. A random effects meta-analysis was used to calculate a pooled relative risk (RR) and 95% confidence interval (CI) for all studies combined, and stratified by type of study population. Further analyses were conducted among those studies that adjusted for potential confounding factors. RESULTS: Twenty-seven studies were included. Of these, 21 showed a reduced risk of HIV among circumcised men, being approximately half that in uncircumcised men (crude RR = 0.52, CI 0.40-0.68). In 15 studies that adjusted for potential confounding factors, the association was even stronger (adjusted RR = 0.42, CI 0.34-0.54). The association was stronger among men at high risk of HIV (crude RR = 0.27; adjusted RR = 0.29, CI 0.20-0.41) than among men in general populations (crude RR = 0.93; adjusted RR = 0.56, CI 0.44-0.70). CONCLUSION: Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.

Africa South of the Sahara↗

Glass-ionomer restoratives: a systematic review of a secondary caries treatment effect.

It is generally accepted that glass ionomers inhibit secondary caries in vivo, and data from in vitro studies support this effect. The aim of this review was a systematic assessment, from the literature, of clinical evidence for the ability of glass-ionomer restoratives to inhibit secondary caries at the restoration margin. Inclusion and exclusion criteria for selection of the review papers were established prior to commencement of the literature search. Papers which conformed to these criteria, and reported on secondary caries as an outcome, were selected (N = 52). Primary and secondary lists of systematic criteria for use in the assessment of the papers were drawn up. The primary list of 14 criteria was applied to each paper. No paper fulfilled all these criteria, necessitating the use of the secondary measures: (i) a prospective study and (ii) use of an appropriate control. This yielded 28 papers. Tabulation of these papers by occurrence of secondary caries in the glass-ionomer or control groups demonstrated an even distribution between positive and negative outcomes. Valid evidence is considered to be best obtained from randomized, controlled studies of sufficient sample size. No conclusive evidence for or against a treatment effect of inhibition of secondary caries by the glass-ionomer restoratives was obtained from the systematic review. There is a need for appraisal of the methods currently adopted for the clinical evaluation of glass-ionomer restorative materials, and for further development of the methodology to support future systematic reviews.

Dental Caries↗

Treatment of severe malaria with artemisinin derivatives. A systematic review of randomised controlled trials.

This systematic review of randomised or pseudorandomised trials aimed at summarising the effectiveness and safety of artemisinin drugs for treating severe falciparum malaria in adults and children. Survival was better with artemisinin drugs in 1.265 patients compared with 1.183 treated with quinine (OR: 0.68; 95% CI: 0.55-0.84). However, the difference is barely significant when only studies with adequate concealment of allocation at enrolment are included in the analysis (OR: 0.77; 95% CI: 0.61-0.98). In 1784 patients with cerebral malaria, mortality was also lower with artemisinin drugs overall (OR: 0.70; 95% CI: 0.55-0.90), but not significantly better than quinine in studies reporting adequate concealment of allocation. No difference in neurological sequelae has been demonstrated. Artemisinin drugs clear parasites from the blood faster than quinine. Adverse effects are similarly common with artemisinin drugs and quinine, although reporting varies between trials. There is no evidence from this review that any one artemisinin derivative is better than the others, but comparative studies are few, small and heterogeneous.

Adult↗

Twelve tips for undertaking a systematic review.

The need to underpin health and education with a firm evidence base is of increasing significance. Systematic review offers an effective approach to critically assessing research in order to understand its overall impact on practice. Based on 5 years' experience undertaking systematic reviews of interprofessional education, this paper offers guidance for researchers and practitioners about to embark upon systematic review work.

England↗

Treatment of uncomplicated malaria with artemisinin derivatives. A systematic review of randomised controlled trials.

This systematic review of randomised or pseudorandomised trials was aimed at summarising the effectiveness and safety of artemisinin drugs for treating uncomplicated falciparum malaria. Ninety-three potentially eligible studies were identified and 38 met the inclusion criteria. Most data are from Southeast Asian areas of mefloquine-resistant falciparum malaria, Thailand in particular. Artemisinin drugs achieve high cure rates at follow-up in all endemic areas represented by the studies included provided that the duration of treatment is adequate. Combination with mefloquine improves sustained parasite clearance and is effective in multidrug resistant areas. Provided the dose of both drugs is adequate, the combination can shorten the duration of treatment. There is no evidence from randomised trials that any artemisinin derivative is better than the others. Data from just over 4,300 patients are included for analysis in this review. Despite the large amount of clinical research that has been done, variation in study design, quality and comparisons make synthesis of the data problematic. It is extremely difficult to draw clear conclusions from the existing database.

Adult↗

The safety and efficacy of laparoscopic live donor nephrectomy: a systematic review.

BACKGROUND: The aim of this systematic review was to compare the safety and efficacy of laparoscopic live donor nephrectomy with the "gold" standard of open live donor nephrectomy. METHODS SEARCH STRATEGY: Three search strategies were devised to enable literature retrieval from the Medline, Current Contents, Embase, and Cochrane Library databases up until, and including, February 2000. STUDY SELECTION: Inclusion of a report was determined on the basis of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. English language reports were selected and acceptable study designs included randomized-controlled trials, controlled clinical trials, case series, or case reports. Each report was required to provide information on at least one of several safety and efficacy outcomes as detailed in the protocol. DATA COLLECTION AND ANALYSIS: Twenty-five reports met the inclusion criteria. They were tabulated and critically appraised in terms of the methodology and design, sample size, outcomes, and the possible influence of bias, confounding, and chance. RESULTS: High level evidence comparing the safety and efficacy of laparoscopic live donor nephrectomy with open donor nephrectomy was not available at the time of this review. Limited low level evidence suggested that the laparoscopic approach might be advantageous regarding the donor's hospital stay, convalescence, pain, and resumption of employment. CONCLUSIONS: The ASERNIP-S Review Group concluded that the evidence-base for laparoscopic live donor nephrectomy was inadequate to make a safety and efficacy recommendation. Clinical and research recommendations were developed regarding the introduction and current practice of this procedure in Australia.

Australia↗

Can electronic search engines optimize screening of search results in systematic reviews: an empirical study.

BACKGROUND: Most electronic search efforts directed at identifying primary studies for inclusion in systematic reviews rely on the optimal Boolean search features of search interfaces such as DIALOG and Ovid. Our objective is to test the ability of an Ultraseek search engine to rank MEDLINE records of the included studies of Cochrane reviews within the top half of all the records retrieved by the Boolean MEDLINE search used by the reviewers. METHODS: Collections were created using the MEDLINE bibliographic records of included and excluded studies listed in the review and all records retrieved by the MEDLINE search. Records were converted to individual HTML files. Collections of records were indexed and searched through a statistical search engine, Ultraseek, using review-specific search terms. Our data sources, systematic reviews published in the Cochrane library, were included if they reported using at least one phase of the Cochrane Highly Sensitive Search Strategy (HSSS), provided citations for both included and excluded studies and conducted a meta-analysis using a binary outcome measure. Reviews were selected if they yielded between 1000-6000 records when the MEDLINE search strategy was replicated. RESULTS: Nine Cochrane reviews were included. Included studies within the Cochrane reviews were found within the first 500 retrieved studies more often than would be expected by chance. Across all reviews, recall of included studies into the top 500 was 0.70. There was no statistically significant difference in ranking when comparing included studies with just the subset of excluded studies listed as excluded in the published review. CONCLUSION: The relevance ranking provided by the search engine was better than expected by chance and shows promise for the preliminary evaluation of large results from Boolean searches. A statistical search engine does not appear to be able to make fine discriminations concerning the relevance of bibliographic records that have been pre-screened by systematic reviewers.

Abstracting and Indexing↗

Pregnancy-associated death: a qualitative systematic review of homicide and suicide.

A systematic review of the literature on maternal homicide and suicide was performed to understand the causes of pregnancy-associated death. Forty-four studies examined homicide and/or suicide and pregnancy-associated death (defined as the death of a woman, from any cause, while she is pregnant or within 1 year of termination of pregnancy) (1). Of these studies, 747 homicides and 349 suicides were identified. All studies were included except duplicate datasets, case reports of less than 3 events, suicide attempts, unpublished manuscripts, review articles, or non-English studies. Homicide is a leading cause of pregnancy-associated death and suicide is also an important cause of death among pregnant and recently pregnant women. Healthcare providers should understand that homicide is a leading cause of pregnancy-associated death, most commonly as a result of partner violence. Therefore, screening for both partner violence and suicidal ideation are essential components of comprehensive medical care for women during and after pregnancy.

Adult↗

Relationship between self-report and performance measures of function: a systematic review.

UNLABELLED: The authors conducted a systematic review of studies examining correlations between assessments of function obtained using self-report and those obtained using performance-based measures for community-dwelling older adults. METHODS: Articles for this review were identified using electronic searching in MEDLINE, CINHAL, and AGELINE and hand-searching techniques. Two reviewers selected the studies that met the inclusion criteria, extracted the data, and assessed the methodological quality of the data. RESULTS: Seventeen studies met the inclusion criteria for review. Correlations between self-report and performance ranged from -0.72 to 0.60. Sixty per cent of the studies compared self-report instruments measuring disability with performance measures addressing functional limitations. In studies that assessed the same functional tasks and functional limitations using the two methods, the correlation varied between 0.60 and 0.86. CONCLUSION: When the construct measured by the two methods was the same, the correlations were moderate to large and, therefore, measurement of functional limitations by self-report or performance probably reflected a similar assessment of function.

Adult↗

Can exercise improve self esteem in children and young people? A systematic review of randomised controlled trials.

A systematic review to determine if exercise alone or as part of a comprehensive intervention can improve self esteem in children and young people is described. Twenty three randomised controlled trials were analysed. A synthesis of several small, low quality trials indicates that exercise may have short term beneficial effects on self esteem in children and adolescents. However, high quality research on defined populations with adequate follow up is needed.

Adolescent↗