Re-examining the evidence in radiation dermatitis management literature : an overview and a critical appraisal of systematic reviews

Purpose: To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. Methods and Materials: We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for “assessment of multiple systematic reviews”). Results: Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. Conclusions: An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.

Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews

Background Physical rehabilitation interventions aim to ameliorate the effects of critical illness-associated muscle dysfunction in survivors. We conducted an overview of systematic reviews (SR) evaluating the effect of these interventions across the continuum of recovery.

Methods Six electronic databases (Cochrane Library, CENTRAL, DARE, Medline, Embase, and Cinahl) were searched. Two review authors independently screened articles for eligibility and conducted data extraction and quality appraisal. Reporting quality was assessed and the Grading of Recommendations Assessment, Development and Evaluation approach applied to summarise overall quality of evidence.

Results Five eligible SR were included in this overview, of which three included meta-analyses. Reporting quality of the reviews was judged as medium to high. Two reviews reported moderate-to-high quality evidence of the beneficial effects of physical therapy commencing during intensive care unit (ICU) admission in improving critical illness polyneuropathy/myopathy, quality of life, mortality and healthcare utilisation. These interventions included early mobilisation, cycle ergometry and electrical muscle stimulation. Two reviews reported very low to low quality evidence of the beneficial effects of electrical muscle stimulation delivered in the ICU for improving muscle strength, muscle structure and critical illness polyneuropathy/myopathy. One review reported that due to a lack of good quality randomised controlled trials and inconsistency in measuring outcomes, there was insufficient evidence to support beneficial effects from physical rehabilitation delivered post-ICU discharge.

Conclusions Patients derive short-term benefits from physical rehabilitation delivered during ICU admission. Further robust trials of electrical muscle stimulation in the ICU and rehabilitation delivered following ICU discharge are needed to determine the long-term impact on patient care. This overview provides recommendations for design of future interventional trials and SR.

Reviews and critical essays ...

Mode of access: Internet.

Biographical and critical essays. Reprinted from reviews, with additions and corrections,

Mode of access: Internet.

How can systematic reviews incorporate qualitative research? A critical perspective

Systematic review has developed as a specific methodology for searching for, appraising and synthesizing findings of primary studies, and has rapidly become a cornerstone of the evidence-based practice and policy movement. Qualitative research has traditionally been excluded from systematic reviews, and much effort is now being invested in resolving the daunting methodological and epistemological challenges associated with trying to move towards more inclusive forms of review. We describe our experiences, as a very diverse multidisciplinary group, in attempting to incorporate qualitative research in a systematic review of support for breastfeeding. We show how every stage of the review process, from asking the review question through to searching for and sampling the evidence, appraising the evidence and producing a synthesis, provoked profound questions about whether a review that includes qualitative research can remain consistent with the frame offered by current systematic review methodology. We conclude that more debate and dialogue between the different communities that wish to develop review methodology is needed, and that attempts to impose dominant views about the appropriate means of conducting reviews of qualitative research should be resisted so that innovation can be fostered. Copyright © 2006 SAGE Publications.

Teaching To Trouble: Critical Book Reviews as Pedagogy to Interrogate Education Praxis

How might education professors disrupt traditional curriculum and teaching practices that teach future teachers to label, segregate, and marginalize students with disabilities? The Disability Studies in Education (DSE) approach grounds practice on the perspectives of people with disabilities and challenges practices that isolate and de-humanize individuals. The pedagogy for eliciting critical book reviews using a DSE perspective is described.

A Delphi study on the critical sustainability criteria and indicators for Australian road infrastructure projects

With increasing media exposure and evidence of environmental impacts, it is increasingly recognized that incorporating sustainability principles in construction works is both crucial and beneficial. However a recent survey reveals that among stakeholders of infrastructure projects such as roads, there is no common understanding on what constitutes sustainability in real-life projects. Sustainability has been interpreted widely and differently and as a result, sustainability outcomes are not tangible at the project level or often neglected. Under such conditions, policies and strategies on sustainability remain largely ideological and cannot be sufficiently reflected in the actual project delivery. The major difficulty of this sustainability pursuit lies in the lack of consensus among the experts on sustainability criteria and indicators. To move ahead, these criteria and indicators are to be agreed upon. This paper reviews the sustainable infrastructure development, its criteria and indicators, focusing on road infrastructure context. It goes on to introduce a Delphi study, an integral part of a QUT research, aimed at identifying critical sustainability criteria and indicators for Australian road infrastructure projects. It paves the way for further identification of solutions for each critical indicator at a subsequent stage. The criteria, indicators and solutions will be encapsulated into a decision making framework for the enhancement of sustainability deliverables. By doing so, the research will promote more integrated thinking of and consistent approaches to the sustainability agenda in road and highway infrastructure projects in Australia.

Critical attributes of public-private partnerships : a case study in vocational education

The term ‘partnership’ is increasingly used by governments, industry, community organisations and schools in supporting their daily businesses. Similar to the terms ‘ICT’ and ‘learning’, ‘partnerships’ are now ubiquitous in policy discourse. Yet, the term remains ill-defined and ambiguous. This study reviews and reflects on a government led industry-school partnership initiative in the state of Queensland, Australia, to understand how the term is used in this initiative. Given the frequent use of Public Private Partnership (PPP) language, PPP was used as a framework to review this initiative. The methodology of this qualitative case study involved consultations with stakeholders and an analysis of Gateway schools documents, policy documents, and literature. The review suggests that despite the use of terminology akin to PPP projects in Gateway school and policy documents, the implicit suggestion that this initiative is a public-private partnership is untenable. The majority of principles shaping a PPP have not been considered to a significant extent in the Gateway project. Although the review recognises the legitimate and sincere purpose of the Gateway schools initiative, the adoption of a PPP framework during the design, monitoring, or evaluation stages could have strengthened the initiative in terms of outcomes, benefits, and sustainability.

Researching 'what works' in early intervention and prevention of homelessness : From systematic reviews to collaborative inquiry

Mechanisms of intervention and the contexts they are used in interact in complex ways. This helps explain why we can’t overgeneralize about what works in respect of models of service designed to prevent or respond to homelessness. This said there are some key messages from the totality of evidence that has been accumulated to date. First homelessness would be a lot easier to prevent for first or subsequent episodes if adequate and appropriate (developmentally/ culturally) housing was available. Second (and often dependent on the first) timely support of a particular character ‘works’ both in a preventive sense and in periods when people experience ongoing challenges which may render them vulnerable to further homelessness. This paper reflects on some of the critical features of how we can generate and use evidence, and how these complement each other in important ways.

Product feature taxonomy learning based on user reviews

In recent years, the Web 2.0 has provided considerable facilities for people to create, share and exchange information and ideas. Upon this, the user generated content, such as reviews, has exploded. Such data provide a rich source to exploit in order to identify the information associated with specific reviewed items. Opinion mining has been widely used to identify the significant features of items (e.g., cameras) based upon user reviews. Feature extraction is the most critical step to identify useful information from texts. Most existing approaches only find individual features about a product without revealing the structural relationships between the features which usually exist. In this paper, we propose an approach to extract features and feature relationships, represented as a tree structure called feature taxonomy, based on frequent patterns and associations between patterns derived from user reviews. The generated feature taxonomy profiles the product at multiple levels and provides more detailed information about the product. Our experiment results based on some popularly used review datasets show that our proposed approach is able to capture the product features and relations effectively.

Critical review of time-dependent shortest path algorithms: A multimodal trip planner perspective

A multimodal trip planner that produces optimal journeys involving both public transport and private vehicle legs has to solve a number of shortest path problems, both on the road network and the public transport network. The algorithms that are used to solve these shortest path problems have been researched since the late 1950s. However, in order to provide accurate journey plans that can be trusted by the user, the variability of travel times caused by traffic congestion must be taken into consideration. This requires the use of more sophisticated time-dependent shortest path algorithms, which have only been researched in depth over the last two decades, from the mid-1990s. This paper will review and compare nine algorithms that have been proposed in the literature, discussing the advantages and disadvantages of each algorithm on the basis of five important criteria that must be considered when choosing one or more of them to implement in a multimodal trip planner.

Estimating the mean critical gap

The estimation of the critical gap has been an issue since the 1970s, when gap acceptance was introduced to evaluate the capacity of unsignalized intersections. The critical gap is the shortest gap that a driver is assumed to accept. A driver’s critical gap cannot be measured directly and a number of techniques have been developed to estimate the mean critical gaps of a sample of drivers. This paper reviews the ability of the Maximum Likelihood technique and the Probability Equilibrium Method to predict the mean and standard deviation of the critical gap with a simulation of 100 drivers, repeated 100 times for each flow condition. The Maximum Likelihood method gave consistent and unbiased estimates of the mean critical gap. Whereas the probability equilibrium method had a significant bias that was dependent on the flow in the priority stream. Both methods were reasonably consistent, although the Maximum Likelihood Method was slightly better. If drivers are inconsistent, then again the Maximum Likelihood method is superior. A criticism levelled at the Maximum Likelihood method is that a distribution of the critical gap has to be assumed. It was shown that this does not significantly affect its ability to predict the mean and standard deviation of the critical gaps. Finally, the Maximum Likelihood method can predict reasonable estimates with observations for 25 to 30 drivers. A spreadsheet procedure for using the Maximum Likelihood method is provided in this paper. The PEM can be improved if the maximum rejected gap is used.

Educational interventions for preventing vascular catheter bloodstream infections in critical care: Evidence map, systematic review and economic evaluation

Background Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1–36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. Objective To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Data sources Sixteen electronic bibliographic databases – including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases – were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. Review methods References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Results Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Limitations Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Conclusions Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Potential uses of Bayesian networks as tools for synthesis of systematic reviews of complex interventions

Bayesian networks (BNs) are tools for representing expert knowledge or evidence. They are especially useful for synthesising evidence or belief concerning a complex intervention, assessing the sensitivity of outcomes to different situations or contextual frameworks and framing decision problems that involve alternative types of intervention. Bayesian networks are useful extensions to logic maps when initiating a review or to facilitate synthesis and bridge the gap between evidence acquisition and decision-making. Formal elicitation techniques allow development of BNs on the basis of expert opinion. Such applications are useful alternatives to ‘empty’ reviews, which identify knowledge gaps but fail to support decision-making. Where review evidence exists, it can inform the development of a BN. We illustrate the construction of a BN using a motivating example that demonstrates how BNs can ensure coherence, transparently structure the problem addressed by a complex intervention and assess sensitivity to context, all of which are critical components of robust reviews of complex interventions. We suggest that BNs should be utilised to routinely synthesise reviews of complex interventions or empty reviews where decisions must be made despite poor evidence.