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Alberta Research Centre for Health Evidence (ARCHE)

The Alberta Research Centre for Health Evidence (ARCHE), located within the Department of Pediatrics at the University of Alberta, was established in 2000 to serve as a resource to individuals and groups interested in using evidence for decision making. The mandate of ARCHE is to support and foster the development of evidence-informed practice. To achieve this, ARCHE: - produces high quality evidence syntheses aimed at high priority issues in health; - advances the methods of conducting randomized controlled trials (RCTs) and evidence syntheses; - provides training and mentoring to health care professionals, trainees and students; - conducts knowledge translation activities to help inform clinical and policy decisions. ARCHE website: https://www.med.ualberta.ca/departments/pediatrics/pediatric-research/affiliated-research-units/alberta-research-centre-for-health-evidence-arche
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  1. Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews [Download]

    Title: Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews
    Creator: Featherstone, Robin
    Description: Background: Rapid review (RR) products are inherently appealing as they are intended to be less time-consuming and resource-intensive than traditional systematic reviews (SRs); however, there is concern about the rigor of methods and reliability of results. In 2013 to 2014, a workgroup comprising representatives from the Agency for Healthcare Research and Quality’s Evidence-based Practice Center Program conducted a formal evaluation of RRs. This paper summarizes results, conclusions, and recommendations from published review articles examining RRs. Methods: A systematic literature search was conducted and publications were screened independently by two reviewers. Twelve review articles about RRs were identified. One investigator extracted data about RR methods and how they compared with standard SRs. A narrative summary is presented. Results: A cross-comparison of review articles revealed the following: 1) ambiguous definitions of RRs, 2) varying time frames to complete RRs ranging from 1 to 12 months, 3) limited scope of RR questions, and 4) significant heterogeneity between RR methods. Conclusions: RR definitions, methods, and applications vary substantially. Published review articles suggest that RRs should not be viewed as a substitute for a standard SR, although they have unique value for decision-makers. Recommendations for RR producers include transparency of methods used and the development of reporting standards.
    Subjects: Rapid review, Review literature as topic, Health technology assessment, Systematic review, Knowledge synthesis, Evidence-based practice
    Date Created: 2016
  2. The contribution of databases to the results of systematic reviews: a cross-sectional study [Download]

    Title: The contribution of databases to the results of systematic reviews: a cross-sectional study
    Creator: Hartling, Lisa
    Description: Background: One of the best sources for high quality information about healthcare interventions is a systematic review. A well-conducted systematic review includes a comprehensive literature search. There is limited empiric evidence to guide the extent of searching, in particular the number of electronic databases that should be searched. We conducted a cross-sectional quantitative analysis to examine the potential impact of selective database searching on results of meta-analyses. Methods: Our sample included systematic reviews (SRs) with at least one meta-analysis from three Cochrane Review Groups: Acute Respiratory Infections (ARI), Infectious Diseases (ID), Developmental Psychosocial and Learning Problems (DPLP) (n = 129). Outcomes included: 1) proportion of relevant studies indexed in each of 10 databases; and 2) changes in results and statistical significance of primary meta-analysis for studies identified in Medline only and in Medline plus each of the other databases. Results: Due to variation across topics, we present results by group (ARI n = 57, ID n = 38, DPLP n = 34). For ARI, identification of relevant studies was highest for Medline (85 %) and Embase (80 %). Restricting meta-analyses to trials that appeared in Medline + Embase yielded fewest changes in statistical significance: 53/55 meta-analyses showed no change. Point estimates changed in 12 cases; in 7 the change was less than 20 %. For ID, yield was highest for Medline (92 %), Embase (81 %), and BIOSIS (67 %). Restricting meta-analyses to trials that appeared in Medline + BIOSIS yielded fewest changes with 1 meta-analysis changing in statistical significance. Point estimates changed in 8 of 31 meta-analyses; change less than 20 % in all cases. For DPLP, identification of relevant studies was highest for Medline (75 %) and Embase (62 %). Restricting meta-analyses to trials that appeared in Medline + PsycINFO resulted in only one change in significance. Point estimates changed for 13 of 33 meta-analyses; less than 20 % in 9 cases. Conclusions: Majority of relevant studies can be found within a limited number of databases. Results of meta-analyses based on the majority of studies did not differ in most cases. There were very few cases of changes in statistical significance. Effect estimates changed in a minority of meta-analyses but in most the change was small. Results did not change in a systematic manner (i.e., regularly over- or underestimating treatment effects), suggesting that selective searching may not introduce bias in terms of effect estimates.
    Subjects: Systematic Reviews, Literature Searching, Meta-analysis, Knowledge Synthesis, Bias
    Date Created: 2016
  3. Diagnosing Clinically Significant Dehydration in Children with Acute Gastroenteritis Using Noninvasive Methods: A Meta-Analysis [Download]

    Title: Diagnosing Clinically Significant Dehydration in Children with Acute Gastroenteritis Using Noninvasive Methods: A Meta-Analysis
    Creator: Freedman, Stephen B.
    Description: OBJECTIVE: To determine the most accurate, noninvasive method of assessing dehydration. STUDY DESIGN: The following data sources were searched: electronic databases, gray literature, scientific meetings, reference lists, and authors of unpublished studies. Eligible studies were comparative outpatient evaluations that used an accepted reference standard and were conducted in developed countries in children aged <18 years with gastroenteritis. Data extraction was completed independently by multiple reviewers before a consensus was made. RESULTS: Nine studies that included 1039 participants were identified. The 4-item Clinical Dehydration Scale (CDS), the "Gorelick" score, and unstructured physician assessment were evaluated in 3, 2, and 5 studies, respectively. Bedside ultrasound, capillary digital videography, and urinary measurements were each evaluated in one study. The CDS had a positive likelihood ratio (LR) range of 1.87-11.79 and a negative LR range of 0.30-0.71 to predict 6% dehydration. When combined with the 4-item Gorelick Score, the positive LR was 1.93 (95% CI 1.07-3.49) and negative LR was of 0.40 (95% CI 0.24-0.68). Unstructured dehydration assessment had a pooled positive LR of 2.13 (95% CI 1.33-3.44) and negative LR of 0.48 (95% CI 0.28-0.82) to detect ≥ 5% dehydration. CONCLUSIONS: Overall, the clinical scales evaluated provide some improved diagnostic accuracy. However, test characteristics indicate that their ability to identify children both with and without dehydration is suboptimal. Current evidence does not support the routine use of ultrasound or urinalysis to determine dehydration severity.
    Subjects: pediatrics, emergency medicine, gastroenteritis, meta-analysis
    Date Created: 2015
  4. Children are not just small adults: the urgent need for high-quality trial evidence in children. [Download]

    Title: Children are not just small adults: the urgent need for high-quality trial evidence in children.
    Creator: Klassen, T. P.
    Description: Children are often touted as being very important members of society because they represent our future. Optimizing their health outcomes has the potential for a huge impact on public health because children are at an early stage in the life trajectory. But it is often unclear how society allocates its resources or creates policies to ensure that it invests in children's health. The under-investment in pediatric clinical trials is a good example of how our resource allocation may be insufficient. Over half of the pharmacological interventions we use for hospitalized children are off-label or unlicensed drugs [1,2]. The challenge for clinical care is that health care providers may fail to use medications that are indeed effective, or conversely, continue to use ineffective medications, or even those that bring unintended harm. Child health care providers must often rely on evidence that has been generated on adult populations [3]. However, both the safety and efficacy profiles of medications may be significantly different for children than adults due to differences in developmental physiology, disease pathophysiology, or developmental pharmacokinetics and pharmacodynamics
    Subjects: epilepsy, systematic reviews, drug therapy, child health
    Date Created: 2008
  5. Glucocorticoids for acute viral bronchiolitis in infants and young children [Download]

    Title: Glucocorticoids for acute viral bronchiolitis in infants and young children
    Creator: Fernandes, Ricardo M.
    Description: BACKGROUND: Previous systematic reviews have not shown clear benefit of glucocorticoids for acute viral bronchiolitis, but their use remains considerable. Recent large trials add substantially to current evidence and suggest novel glucocorticoid-including treatment approaches. OBJECTIVES: To review the efficacy and safety of systemic and inhaled glucocorticoids in children with acute viral bronchiolitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, issue 4); MEDLINE (1950 to November 2009); EMBASE (1980 to Week 47 2009); LILACS (1982 to November 2009); Scopus® (1823 to November 2009); and IRAN MedEx (1998 to November 2009). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing short-term systemic or inhaled glucocorticoids versus placebo or another intervention in children < 24 months with acute bronchiolitis (first episode with wheezing). Our primary outcomes were: admissions by days 1 and 7 for outpatient studies; and length of stay (LOS) for inpatient studies. Secondary outcomes included clinical severity parameters, healthcare use, pulmonary function, symptoms, quality of life and harms. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data on study and participant characteristics, interventions and outcomes. We assessed risk of bias and graded strength of evidence. Inpatient and outpatient results were meta-analysed separately using random-effects models. We pre-specified subgroup analyses, including the combined use of protocolised bronchodilators. MAIN RESULTS: We included 17 trials (2596 participants); only two had low overall risk of bias. Baseline severity, glucocorticoid schemes, comparators and outcomes were heterogeneous. Glucocorticoids did not significantly reduce outpatient admissions by days 1 and 7 when compared to placebo (pooled risk ratios (RRs) 0.92; 95% CI 0.78 to 1.08; and 0.86; 95% CI 0.7 to 1.06, respectively). There was no benefit in LOS for inpatients (mean difference -0.18 days; 95% CI -0.39 to 0.04). Unadjusted results from a large factorial low risk of bias RCT found combined high-dose systemic dexamethasone and inhaled epinephrine reduced admissions by day 7 (baseline risk of admission 26%; RR 0.65, 95% CI 0.44 to 0.95; number needed to treat 11, 95% CI 7 to 76), with no differences in short-term adverse effects. No other comparisons showed relevant differences in primary outcomes. AUTHORS' CONCLUSIONS: Current evidence does not support a clinically relevant effect of systemic or inhaled glucocorticoids on admissions or length of hospitalization. Combined dexamethasone and epinephrine may reduce outpatient admissions, but results are exploratory and safety data limited. Future research should further assess the efficacy, harms and applicability of combined therapy.
    Subjects: Glucocorticoids, Ambulatory Care, Bronchiolitis, Cochrane Acute Respiratory Infections Group, Infants
    Date Created: 2013/02/15
  6. Controlled trials in children: quantity, methodological quality and descriptive characteristics of pediatric controlled trials published 1948-2006. [Download]

    Title: Controlled trials in children: quantity, methodological quality and descriptive characteristics of pediatric controlled trials published 1948-2006.
    Creator: Thomson, D.
    Description: Background The objective of this study was to describe randomized controlled trials (RCTs) and controlled clinical trials (CCTs) in child health published between 1948 and 2006, in terms of quantity, methodological quality, and publication and trial characteristics. We used the Trials Register of the Cochrane Child Health Field for overall trends and a sample from this to explore trial characteristics in more detail. Methodology/Principal Findings We extracted descriptive data on a random sample of 578 trials. Ninety-six percent of the trials were published in English; the percentage of child-only trials was 90.5%. The most frequent diagnostic categories were infectious diseases (13.2%), behavioural and psychiatric disorders (11.6%), neonatal critical care (11.4%), respiratory disorders (8.9%), non-critical neonatology (7.9%), and anaesthesia (6.5%). There were significantly fewer child-only studies (i.e., more mixed child and adult studies) over time (P = 0.0460). The proportion of RCTs to CCTs increased significantly over time (P<0.0001), as did the proportion of multicentre trials (P = 0.002). Significant increases over time were found in methodological quality (Jadad score) (P<0.0001), the proportion of double-blind studies (P<0.0001), and studies with adequate allocation concealment (P<0.0001). Additionally, we found an improvement in reporting over time: adequate description of withdrawals and losses to follow-up (P<0.0001), sample size calculations (P<0.0001), and intention-to-treat analysis (P<0.0001). However, many trials still do not describe their level of blinding, and allocation concealment was inadequately reported in the majority of studies across the entire time period. The proportion of studies with industry funding decreased slightly over time (P = 0.003), and these studies were more likely to report positive conclusions (P = 0.028). Conclusions/Significance The quantity and quality of pediatric controlled trials has increased over time; however, much work remains to be done, particularly in improving methodological issues around conduct and reporting of trials.
    Subjects: systematic review, randomized-control trials, clinical trials, drug research, child health
    Date Created: 2010
  7. Intravenous immunoglobulin for presumed viral myocarditis in children and adults [Download]

    Title: Intravenous immunoglobulin for presumed viral myocarditis in children and adults
    Creator: Robinson J
    Subjects: Randomized Controlled Trials as Topic, Immunoglobulins, Intravenous, Myocarditis, Virus Diseases, Acute Disease
    Date Created: 2005
  8. Long-term non-invasive ventilation therapies in children: a scoping review protocol [Download]

    Title: Long-term non-invasive ventilation therapies in children: a scoping review protocol
    Creator: Castro Codesal, Maria L.
    Description: Introduction: Non-invasive ventilation (NIV) in children has become an increasingly common modality of breathing support where pressure support is delivered through a mask interface or less commonly through other non-invasive interfaces. At this time, NIV is considered a first-line option for ventilatory support of chronic respiratory insufficiency associated with a range of respiratory and sleep disorders. Previous reviews on the effectiveness, complications and adherence to NIV treatment have lacked systematic methods. The purpose of this scoping review is to provide an overview of the evidence for the use of long-term NIV in children. Methods and analysis: We will use previously established scoping methodology. Ten electronic databases will be searched to identify studies in children using NIV for longer than 3 months outside an intensive care setting. Grey literature search will include conference proceedings, thesis and dissertations, unpublished trials, reports from regulatory agencies and manufacturers. Two reviewers will independently screen titles and abstracts for inclusion, followed by full-text screening of potentially relevant articles to determine final inclusion. Data synthesis will be performed at three levels: (1) an analysis of the number, publication type, publication year, and country of publication of the studies; (2) a summary of the study designs, outcomes measures used; (3) a thematic analysis of included studies by subgroups. Ethics and dissemination: This study will provide a wide and rigorous overview of the evidence on the use of long-term NIV in children and provide critical information for healthcare professionals and policymakers to better care for this group of children. We will disseminate our findings through conference proceedings and publications, and evaluate the results for further systematic reviews and meta-analyses.
    Subjects: pediatrics, systematic review, non-invasive ventilation
    Date Created: 2015/18/12
  9. A descriptive analysis of overviews of reviews published between 2000 and 2011. [Download]

    Title: A descriptive analysis of overviews of reviews published between 2000 and 2011.
    Creator: Hartling, L.
    Description: Background: Overviews of systematic reviews compile data from multiple systematic reviews (SRs) and are a new method of evidence synthesis. Objectives: To describe the methodological approaches in overviews of interventions. Design: Descriptive study. Methods: We searched 4 databases from 2000 to July 2011; we handsearched Evidence-based Child Health: A Cochrane Review Journal. We defined an overview as a study that: stated a clear objective; examined an intervention; used explicit methods to identify SRs; collected and synthesized outcome data from the SRs; and intended to include only SRs. We did not restrict inclusion by population characteristics (e.g., adult or children only). Two researchers independently screened studies and applied eligibility criteria. One researcher extracted data with verification by a second. We conducted a descriptive analysis. Results: From 2,245 citations, 75 overviews were included. The number of overviews increased from 1 in 2000 to 14 in 2010. The interventions were pharmacological (n = 20, 26.7%), non-pharmacological (n = 26, 34.7%), or both (n = 29, 38.7%). Inclusion criteria were clearly stated in 65 overviews. Thirty-three (44%) overviews searched at least 2 databases. The majority reported the years and databases searched (n = 46, 61%), and provided key words (n = 58, 77%). Thirty-nine (52%) overviews included Cochrane SRs only. Two reviewers independently screened and completed full text review in 29 overviews (39%). Methods of data extraction were reported in 45 (60%). Information on quality of individual studies was extracted from the original SRs in 27 (36%) overviews. Quality assessment of the SRs was performed in 28 (37%) overviews; at least 9 different tools were used. Quality of the body of evidence was assessed in 13 (17%) overviews. Most overviews provided a narrative or descriptive analysis of the included SRs. One overview conducted indirect analyses and the other conducted mixed treatment comparisons. Publication bias was discussed in 18 (24%) overviews. Conclusions: This study shows considerable variation in the methods used for overviews. There is a need for methodological rigor and consistency in overviews, as well as empirical evidence to support the methods employed.
    Subjects: systematic reviews, child health, decision making
    Date Created: 2012
  10. Visual Research Data: an Infographics Primer [Download]

    Title: Visual Research Data: an Infographics Primer
    Creator: Featherstone, Robin
    Description: They may be a hot topic in health research and libraries, but infographics are not new. Information visualizations have a long history of use in medicine, particularly epidemiology. Now ubiquitous in modern urban landscapes, infographics are rebranded knowledge assemblages for an information age. Amateur designers use web-based tools to create ephemeral infographics that are rapidly disseminated via social media networks. The best examples of graphic data displays utilize established design principles to increase the impact of scholarly research. Inexpensive or free web tools can provide graphic elements and design templates, but effective information visualizations still require compelling data and logical narratives. Infographics communicate research findings, but the immense scale of production makes classification, description, access, and preservation challenging.
    Subjects: Infographics, Information science, Knowledge translation, Information visualizations
    Date Created: 2014/12/01