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Report

Physical Activity and the Environment

YHEC authors: James Love-Koh, Matthew Taylor
Publication date: January 2018

Abstract

No abstract available.

Peer-reviewed publication

Information Retrieval for Systematic Reviews in Food and Feed Topics: A Narrative Review

YHEC authors: Hannah Wood, Annette O'Connor
Publication date: January 2018
Journal: Research Synthesis Methods

Abstract

INTRODUCTION: Systematic review methods are now being used for reviews of food production, food safety and security, plant health, and animal health and welfare. Information retrieval methods in this context have been informed by human health-care approaches and ideally should be based on relevant research and experience.

OBJECTIVE: This narrative review seeks to identify and summarize current research-based evidence and experience on information retrieval for systematic reviews in food and feed topics.

METHODS: MEDLINE (Ovid), Science Citation Index (Web of Science), and ScienceDirect (http://www.sciencedirect.com/) were searched in 2012 and 2016. We also contacted topic experts and undertook citation searches. We selected and summarized studies reporting research on information retrieval, as well as published guidance and experience.

RESULTS: There is little published evidence on the most efficient way to conduct searches for food and feed topics. There are few available study design search filters, and their use may be problematic given poor or inconsistent reporting of study methods. Food and feed research makes use of a wide range of study designs so it might be best to focus strategy development on capturing study populations, although this also has challenges. There is limited guidance on which resources should be searched and whether publication bias in disciplines relevant to food and feed necessitates extensive searching of the gray literature.

CONCLUSIONS: There is some limited evidence on information retrieval approaches, but more research is required to inform effective and efficient approaches to searching to populate food and feed reviews.

Peer-reviewed publication

Tool Features to Support Systematic Reviews in Software Engineering – A Cross Domain Study

YHEC authors: Chris Marshall
Publication date: January 2018
Journal: e-Informatica Software Engineering

Abstract

CONTEXT: Previously, the authors had developed and evaluated a framework to evaluate systematic review (SR) lifecycle tools.

GOAL: The goal of this study was to use the experiences of researchers in other domains to further evaluate and refine the evaluation framework.

METHOD: We investigate the opinions of researchers with experience of systematic reviews in the healthcare and social sciences domains. We used semi-structured interviews to elicit their experiences of systematic reviews and SR support tools.

RESULTS: Study participants found broadly the same problems as software engineering (SE) researchers with the SR process. They agreed with the tool features we had included in our evaluation framework. Furthermore although there were some differences the majority of the importance assessments were very close.

CONCLUSIONS: In the context of SRs, experiences of researchers in other domains can be useful to software engineering researchers. The evaluation framework for SR lifecycle tools appeared quite robust.

Peer-reviewed publication

Cost-Effectiveness Analysis of the Use of High-flow Oxygen through Nasal Cannula in Intensive Care Units in NHS England

YHEC authors: Emily Eaton Turner, Michelle Jenks
Publication date: December 2017
Journal: Expert Review of Pharmacoeconomics & Outcomes Research

Abstract

OBJECTIVE: To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective.

METHODS: Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted.

RESULTS: When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV.

For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses.

For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this.

CONCLUSIONS: For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.

Peer-reviewed publication

A Protocol for the Development and Piloting of Quality Measures to Support the Healthier You: The NHS Diabetes Prevention Programme

YHEC authors: Nick Hex
Publication date: November 2017
Journal: British Journal of General Practice

Abstract

BACKGROUND: The increasing prevalence of type 2 diabetes in the UK creates an additional, potentially preventable burden on health care and service providers. The Healthier You: NHS Diabetes Prevention Programme aims to reduce the incidence of type 2 diabetes through the identification of people at risk and the provision of intensive lifestyle change support. The provision of this care can be monitored through quality measurement at both the general practice and specialist service level.

AIM: To develop quality measures through piloting to assess the validity, credibility, acceptability, reliability, and feasibility of any proposed measures.

DESIGN AND SETTING: The non-experimental mixed design piloting study consists of consensus testing and exploratory research with GPs, commissioners, and patients from Herefordshire, England.

METHOD: A mixed-method approach will be used to develop and validate measures for diabetes prevention care and evaluate their performance over a 6-month pilot period consisting of consensus testing using a modified RAND approach with GPs and commissioners; four focus groups with 8-10 participants discussing experiences of non-diabetic hyperglycaemia (NDH), perceived ability to access care and prevent diabetes, and views on potential quality measures; and piloting final measures with at least five general practices for baseline and 6-month data.

RESULTS: The findings will inform the implementation of the diabetes prevention quality measures on a national scale while addressing any issue with validity, credibility, feasibility, and cost-effectiveness.

CONCLUSION: Healthcare professionals and patients have the opportunity to evaluate the reliability, acceptability, and validity of measures.

Peer-reviewed publication

Assessing the Performance of Methodological Search Filters to Improve the Efficiency of Evidence Information Retrieval: Five Literature Reviews and a Qualitative Study

YHEC authors: Carol Lefebvre, Julie Glanville, Sophie Beale, Rachael McCool
Publication date: November 2017
Journal: Health Technology Assessment

Abstract

BACKGROUND: Effective study identification is essential for conducting health research, developing clinical guidance and health policy and supporting health-care decision-making. Methodological search filters (combinations of search terms to capture a specific study design) can assist in searching to achieve this.

OBJECTIVES: This project investigated the methods used to assess the performance of methodological search filters, the information that searchers require when choosing search filters and how that information could be better provided.

METHODS: Five literature reviews were undertaken in 2010/11: search filter development and testing; comparison of search filters; decision-making in choosing search filters; diagnostic test accuracy (DTA) study methods; and decision-making in choosing diagnostic tests. We conducted interviews and a questionnaire with experienced searchers to learn what information assists in the choice of search filters and how filters are used. These investigations informed the development of various approaches to gathering and reporting search filter performance data. We acknowledge that there has been a regrettable delay between carrying out the project, including the searches, and the publication of this report, because of serious illness of the principal investigator.

RESULTS: The development of filters most frequently involved using a reference standard derived from hand-searching journals. Most filters were validated internally only. Reporting of methods was generally poor. Sensitivity, precision and specificity were the most commonly reported performance measures and were presented in tables. Aspects of DTA study methods are applicable to search filters, particularly in the development of the reference standard. There is limited evidence on how clinicians choose between diagnostic tests. No published literature was found on how searchers select filters. Interviewing and questioning searchers via a questionnaire found that filters were not appropriate for all tasks but were predominantly used to reduce large numbers of retrieved records and to introduce focus. The Inter Technology Appraisal Support Collaboration (InterTASC) Information Specialists' Sub-Group (ISSG) Search Filters Resource was most frequently mentioned by both groups as the resource consulted to select a filter. Randomised controlled trial (RCT) and systematic review filters, in particular the Cochrane RCT and the McMaster Hedges filters, were most frequently mentioned. The majority indicated that they used different filters depending on the requirement for sensitivity or precision. Over half of the respondents used the filters available in databases. Interviewees used various approaches when using and adapting search filters. Respondents suggested that the main factors that would make choosing a filter easier were the availability of critical appraisals and more detailed performance information. Provenance and having the filter available in a central storage location were also important.

LIMITATIONS: The questionnaire could have been shorter and could have included more multiple choice questions, and the reviews of filter performance focused on only four study designs.

CONCLUSIONS: Search filter studies should use a representative reference standard and explicitly report methods and results. Performance measures should be presented systematically and clearly. Searchers find filters useful in certain circumstances but expressed a need for more user-friendly performance information to aid filter choice. We suggest approaches to use, adapt and report search filter performance. Future work could include research around search filters and performance measures for study designs not addressed here, exploration of alternative methods of displaying performance results and numerical synthesis of performance comparison results.

Peer-reviewed publication

Comparative Assessment of the Efficacy OfonabotulinumtoxinA and Oral Therapies (Anticholinergics and Mirabegron) for Overactive Bladder: A Systematic Review and Network Meta-Analysis

YHEC authors: Rachael McCool, Julie Glanville
Publication date: November 2017
Journal: BJU Int

Abstract

OBJECTIVES: To compare the efficacy of onabotulinumtoxinA, mirabegron, and anticholinergics in adults with idiopathic overactive bladder (OAB) using network meta-analysis (NMA).

PATIENTS AND METHODS: Information sources were searched for blinded randomised controlled trials (RCTs), of =2 weeks duration, comparing any dose of onabotulinumtoxinA, eligible oral/transdermal anticholinergics, or mirabegron, with each other or placebo, in adults with OAB. Bayesian random-effects models were used to synthesise the results at week 12: NMA for responder analyses and network meta-regression (NMR) for change from baseline analyses. The NMR was used to adjust for differences in baseline severity between studies. Sensitivity analysis, excluding studies considered to be at a high risk of methodological bias, was conducted.

RESULTS: In all, 56 RCTs were included in the networks. For each outcome, results are reported for all licensed treatment doses. For each NMR, results are based on patients with an average number of episodes of the outcome at baseline. After 12 weeks, all treatments were more efficacious than placebo. Patients who received onabotulinumtoxinA (100 U) had, on average, the greatest reductions in urinary incontinence episodes (UIE), urgency episodes, and micturition frequency, and the highest odds of achieving decreases of 100% and =50% from baseline in UIE/day. When comparing onabotulinumtoxinA with other pharmacotherapies, mean differences favoured onabotulinumtoxinA 100 U over all comparators for UIE and urgency episodes (credible intervals excluded zero) and all but two of the comparators for micturition frequency. OnabotulinumtoxinA 100 U was also associated with higher odds of achieving a 100% and =50% decrease in UIE/day than most other licensed treatments in the network. The exclusion of studies with a high risk of bias had little impact on the conclusions.

CONCLUSION: The results indicate that, after 12 weeks, onabotulinumtoxinA 100 U provides greater relief of OAB symptoms compared with most other licensed doses of other pharmacotherapies in the network.

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