This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research exploring staff attitudes towards computerized cognitive behavior therapy (cCBT). Chapter Two is an empirical study examining a range of potential predictor variables on well-being outcomes from cCBT. Chapter one is prepared for Behavioural and Cognitive Psychotherapy, whereas chapter two is prepared for submission to the journal, Behaviour Research and Therapy. Both chapters follow the relevant author guidelines. Background: Evidence suggests that computerised cognitive behavioural therapy (cCBT) is both effective and efficacious in treating depression and anxiety. Numerous barriers to its implementation and uptake have been identified, however, including attitudinal variables and high patient attrition rates. Research examining predictors of response from cCBT have tended to adopt the pathological model of distress, focussing on symptom reduction rather than the promotion of well-being. Furthermore, exploration of possible predictors has tended to focus on a narrow range of factors (e.g. age, gender), neglecting key psychosocial variables (e.g. social identification, baseline distress) that could be exerting an effect. Aims: A systematic review examined staff attitudes towards cCBT for depression, anxiety, and comorbid depression and anxiety, focussing on three attitudinal domains: Perceived acceptability of cCBT; staff's self-reported intention to use cCBT in the future, and perceived advantages and disadvantages of cCBT for depression and/or anxiety. An experimental study was subsequently conducted, examining a range of potential predictors on well-being outcomes from a cCBT intervention utilising Beating the Blues. Method: A systematic search across five databases was conducted, followed by manual searches. Strict search criteria were applied, resulting in the identification of 15 studies. These were subjected to quality assessment, data extraction and synthesis. For the empirical study, data from 1354 participants was collected, with subgroup-analyses conducted on those completing measures of life and mental health satisfaction, functioning and well-being. Key potential predictors of interest were level of group identification, baseline distress, and socioeconomic deprivation. Results: Findings from the systematic review indicated that staff held relatively positive attitudes towards cCBT, with some ambivalence emerging in relation to perceived advantages and disadvantages of the intervention. The empirical study obtained significant effects of group identification on life and mental health satisfaction. A mediating impact of group identity on baseline distress emerged, whereas a moderating effect of baseline distress on deprivation was obtained for the functioning model. Discussion: The current findings demonstrated both positive and negative aspects of staff attitudes towards cCBT for depression and/or anxiety, whereas the empirical project established a clear link between social identification, baseline distress, and well-being. Results from both studies are discussed in terms of clinical implications relating to the uptake of cCBT.

Orientador: Eliane Chaves Jorge / Resumo: Bissoli SFR. Mapeamento das evidências das revisões sistemáticas de oftalmologia da base de dados Cochrane. [dissertação]. Botucatu, SP: Faculdade de Medicina, Universidade Estadual Paulista; 2018. Justificativa e objetivos: A Colaboração Cochrane visa oferecer, por meio da publicação de revisões sistemáticas, informações atualizadas, objetivas e com evidências consistentes para a prática clínica e para o estabelecimento de políticas de saúde. Entretanto, verifica-se, frequentemente, uma inconsistência de evidências e incapacidade de gerar recomendações. O objetivo desse estudo foi analisar as revisões sistemáticas do Grupo Oftalmologia da Colaboração Cochrane e mapear sua utilidade para a prática clínica e para a pesquisa científica. Método: Realizou-se estudo transversal com análise de todas as revisões sistemáticas publicadas no Grupo Oftalmologia da Colaboração Cochrane até maio de 2018, verificando-se qual o tipo de recomendação para a prática clínica e para a pesquisa científica, por meio da análise das conclusões de seus autores. Além disso, computou-se o número de ensaios clínicos e meta-análises por revisão sistemática e por subespecialidade, por ano. Resultados: 202 revisões foram obtidas no período. Evidências que apoiam a intervenção, com recomendação para a realização de mais estudos ou sem recomendação para mais estudos: 36,3% [IC 95% 36,2-36,4] e 5,0% [IC 95% 4,8-5,1], respectivamente. Evidências contrárias à intervenção, com recomendação para realização de mai... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Bissoli SFR. Mapping of the evidences of systematic reviews of Ophthalmology Cochrane database. [dissertation]. Botucatu, SP: Botucatu Medical School, State University of São Paulo 2018. Rationale and objectives: The Cochrane Collaboration aims to provide, through the publication of systematic reviews, up-to-date, objective information and with consistent evidence for clinical practice and for the establishment of health policies. However, there is often an inconsistency of evidence and inability to generate recommendations. The objective of this study was to analyze the systematic reviews of the Cochrane Collaboration Ophthalmology Group and to map its usefulness to clinical practice and to scientific research. Methods: A cross-sectional study was carried out with an analysis of all the systematic reviews published in the Ophthalmology Group of the Cochrane Collaboration until May 2018, confirming the type of recommendation for clinical practice and for scientific research, through analysis of the conclusions of its authors. In addition, we counted the number of clinical trials and meta-analyzes by systematic review and by subspecialty, per year. Results: 202 revisions were obtained in the period. Evidence that supports the intervention, with recommendation for further studies: 36.3% [CI 95% 36.2-36.4] or no recommendation for further studies: 5.0% [CI 95% 4.8-5.1]. Evidence contrary to intervention, with recommendation for further studies 3.0% [CI 95% 2.8-3.1] or no recomme... (Complete abstract click electronic access below) / Mestre

O objetivo dessa revisão sistemática foi avaliar a prevalência de traumatismo em dentes decíduos, analisando fatores associados e possíveis tendências em relação à ocorrência desse agravo. Assim, busca com termos relacionados ao trauma dental e à dentição decídua foi realizada. Após critérios de inclusão e exclusão, os artigos selecionados foram analisados. Meta-análises com os dados de prevalência de traumatismo em dentes decíduos no mundo, e em subgrupos (classificações, dentes e idades avaliadas), assim como no Brasil e em suas regiões foram realizadas, complementadas pela análise da tendência do agravo nessas populações. Além disso, meta-análise com os valores de Odds Ratio (OR) e Intervalo de Confiança (IC) das variáveis sexo, idade, maloclusões, renda e escolaridade materna foram realizadas. A busca foi realizada para artigos que relatavam trauma dental em dentes decíduos indexados no PubMed até o dia 18 de abril de 2012 e listou 953 artigos. Após critérios de inclusão e exclusão, 34 (3,6%) estavam relacionados ao escopo dessa revisão sistemática. A prevalência agregada de traumatismo em dentes decíduos no mundo é de 23% e apresenta tendência discreta de aumento. No grupo de estudos que utilizaram classificações que avaliam trauma periodontal, a prevalência agregada é de 26% com tendência de aumento, enquanto que no grupo de estudos que utilizam classificações que não contemplam esse tipo de trauma, a prevalência agregada diminui para 20%, assim como a tendência passa a ser de diminuição da prevalência. O grupo de estudos que analisou todos os dentes anteriores apresenta prevalência agregada de 25%, enquanto que os que avaliaram apenas dentes anteriores superiores e apenas incisivos apresentam 17% e 23%, respectivamente. A meta-análise do grupo de estudos que avaliou faixas etárias maiores que um ano apresentou prevalência agregada de 23%. São fatores positivamente associados a prevalência de traumatismo em dentes decíduos: ser do sexo masculino (OR=1,20;IC:1,09;1,33), ter quatro anos (OR=2,18;IC:1,66;2,86), apresentar mordida aberta anterior (OR=2,26;IC:1,38;3,70), sobressaliência acentuada (OR=2,51;IC:1,66;3,79), incompetência labial (OR=1,66;IC:1,26;2,20), a família ter renda superior a oito salários mínimos (OR=0,79;IC:0,69;0,92) e a mãe ter mais de oito anos de estudo (OR=1,30;IC:1,01;1,66). A prevalência agregada de traumatismo em dentes decíduos no Brasil é de 26% e apresenta tendência de aumento com os anos. A região sudeste e sul apresentam prevalência agregada em torno de 29% e 31%, respectivamente, com tendência de aumento, enquanto a região nordeste apresenta 19% com tendência de diminuir a prevalência com o passar dos anos. Podemos concluir que por volta de 23% dos pré-escolares apresentam traumatismo em dentes decíduos sendo que ser do sexo masculino, ter mais idade, apresentar mordida aberta anterior, sobressaliência acentuada, incompetência labial, a família ter renda superior a oito salários mínimos e a mãe ter mais de oito anos de estudo são fatores que aumentam a chance do agravo estar presente. Além disso, a utilização de classificações que contemplam todos os tipos de trauma dental, avaliar dentes anteriores superiores e inferiores em faixas etárias amplas parece contribuir para resultados mais realistas quando o objetivo é estudar o comportamento do traumatismo em dentes decíduos. / The aim of this systematic review was to evaluate the prevalence of dental trauma in deciduous teeth, assessing associated factors and possible trends concerned to the occurrence of this disorder. For this purpose, search for terms related to dental trauma and deciduous dentition was performed. Upon considering inclusion and exclusion criteria, the selected material was analyzed. Afterwards, meta-analysis was performed based on the data recorded on the prevalence of dental trauma in deciduous teeth worldwide and in subgroups (classifications, teeth and ages assessed) as well as in Brazil and its regions, complemented by the trend analysis of this injury. Meta-analysis with Odds Ratio (OR) and Confidence Interval (CI) values of variables as sex, age, malocclusions, income and maternal level of education was performed. Literature search was carried out for articles reporting on dental trauma prevalence in deciduous teeth indexed in PubMed up to April 18, 2012, and listed 953 articles. Upon analyzing the studies for inclusion and exclusion purposes, 34 (3,6%) essays were related to the scope of this systematic review. The pooled prevalence of trauma in deciduous teeth worldwide is 23% showing a slight tendency to increase over the years. The study group that used classifications which evaluate traumas in the supportive tissue showed a pooled prevalence of 26% with a trend to increase, while in the study group which adopt classifications that do not contemplate this type of trauma, the pooled prevalence decreases to 20%, with a trend to decrease over the years. The study group which analyzed all anterior teeth demonstrated a pooled prevalence of 25%, while the study group which evaluated only anterior upper teeth and only incisors evidenced 17% and 23%, respectively. The meta-analysis of the study group that evaluates age range greater than 1 year showed pooled prevalence of 23%. The following factors are positively associated to the prevalence of traumatism in deciduous teeth: male individuals (OR=1.20;CI:1.09;1.33), older individuals (OR=2.18;CI:1.66;2.86), patients presenting anterior open-bite (OR=2.26;CI:1.38;3.70), increased overjet (OR=2.51;CI:1.66;3.79), lip incompetence (OR=1.66;CI:1.26;2.20), family with income higher than eight minimum wages (OR=0.79;CI:0.69;0.92), mother\'s education level having more than eight years at school (OR=1.30;CI:1.01;1.66). The pooled prevalence of trauma in deciduous teeth in Brazil is 26% and presents tendency to increase. The Southeast and South regions of Brazil present pooled prevalence of 29% and 31% respectively, showing a trend to increase, while the Northeast region shows 19% with a trend to decrease over the years. In conclusion, around 23% of the preschoolers present trauma in deciduous teeth, and that being male, older, with anterior open bite, increased overjet, lip incompetence, family with income higher than eight minimum wages and mother\'s education level having more than eight years at school are factors which may increase the chance this injury be present. Moreover, the use of classifications that contemplate all types of dental trauma, to evaluate upper and lower anterior teeth within large age range seems to contribute to more realistic results when the objective is to study the behavior of dental trauma in deciduous teeth.

Alzheimer\'s disease (AD) is one of the main causes of dependency and disability in the elderly population. A number of investigations have been seeking its prevention and/or management. In this context, it is important to highlight the role of modifiable risk factors, such as nutrition. This study aims to conduct a systematic review and subsequent meta-analysis, to assess the effect of food and/or nutrients for the management of AD at different stages. This work was steered based on the Cochrane Handbook for systematic reviews of interventions and the PRISMA Statement. Electronic databases were searched up to 2014, in Portuguese, English or Spanish. Relevant publications were identified by title and abstract using key search terms referring to Alzheimer\'s disease, nutrition interventions and type of study. Trials\' risk of bias was appraised by applying the Cochrane\'s tool for assessing risk of bias. The main outcome measures comprise neuropsychological tests such as MMSE, ADCS-ADL, NPI and CDR-sob, biomarkers and brain imaging. Pairwise meta-analyses were performed in a random-effect model by estimating the weighted mean differences between treatment and placebo groups, with 95% confidence intervals for outcome measures by treatment. Network meta-analysis and the ranking probability of treatment for each nutrition intervention were undertaken on cognitive outcome. The strength and quality of evidence were rated according to the GRADE approach. From the whole research, 182 studies met the systematic review\'s purpose. Thirty-five clinical trials complied with eligibility criteria and risk of bias assessment. Included studies utilized: antioxidants, B-vitamin complex, carbohydrates, lipids, omega-3 fatty acids, polymeric formulas, polypeptide and vitamin D. Estimates treatment effects from pairwise meta-analyses show a significant positive effect from the supplementation with proline-rich polypeptide (WMD 12.00 [95% CI 10.20, 13.80] P < 0.00001) and B-vitamin complex (WMD 0.44 [95% CI 0.09, 0.79] P = 0.01) on cognitive function measured by the MMSE. Remaining nutrients supplementation did not show any significant effect on functional, behavioral, global performance, biomarkers or brain imaging outcomes. Isolated nutrient supplementations show no convincing evidence of providing a significant benefit on clinical manifestations or neuropathology of AD. As a treatment strategy, nutrients did not show any effect when delivered individually, probably due to their synergistic work on brain function at different domains. Nevertheless, nutrients represent a potential preventive approach and an adjuvant treatment for patients with AD at earlier stages. / A doença de Alzheimer (DA) é uma das maiores causas de dependência e incapacidade na população idosa, o que tem levado a inúmeras investigações sobre sua prevenção e ou manejo. Neste contexto, é importante destacar o papel desempenhado pelos fatores de risco modificáveis, como a nutrição. Este estudo trata de uma revisão sistemática e meta-análise, para avaliar o efeito das intervenções nutricionais no manejo da DA, em seus diferentes estágios. Este trabalho segue as propostas da Colaboração Cochrane e a declaração PRISMA. Bases de dados eletrônicas foram pesquisadas a partir do seu início até o 2014, em Português, Inglês ou Espanhol. Estudos relevantes foram identificados por título e resumo usando as palavras-chave referente à doença de Alzheimer, intervenções nutricionais e tipo de estudo. A qualidade dos estudos foi avaliada mediante a ferramenta da Cochrane para avaliação do risco de viés. As principais medidas de desfechos compreenderam os testes neuropsicológicos MEEM, AVD, NPI e CDR-sob, biomarcadores e neuroimagem. As meta-análises em pares foram realizadas em modelo de efeito aleatório pela estimativa de diferença de médias ponderadas entre os grupos de tratamento e placebo, com 95% de intervalo de confiança para as medidas de desfecho segundo a intervenção. A meta-análise em rede e a probabilidade da posição do tratamento para cada intervenção nutricional foi realizada para o desfecho cognitivo. A força e a qualidade da evidência foram avaliadas de acordo com o método GRADE. Da busca total inicial, 182 estudos cumpriam com o propósito desta revisão sistemática. Ainda, 35 ensaios clínicos preencheram os critérios de elegibilidade e avaliação de risco de viés. Os estudos incluídos usaram: antioxidantes, vitaminas do complexo B, carboidratos, lipídeos, ácidos graxos ômega-3, formula poliméricas, polipeptídios e vitamina D. As estimativas de efeito do tratamento das meta-análises em pares mostraram um efeito positivo significativo a partir da suplementação com um polipeptídio rico em prolina (MD 12.00 [95% IC 10.20, 13.80] P < 0.00001) e com as vitaminas do complexo B (MD 0.44 [95% IC 0.09, 0.79] P = 0.01) na função cognitiva avaliada pelo MEEM. A suplementação com os demais nutrientes não mostrou um efeito significativo na funcionalidade, comportamento, desempenho global, biomarcadores da DA, nem desfechos de imagem. A suplementação com nutrientes isolados não mostrou um efeito significativo nas manifestações clínicas ou neuropatologicas da DA. Como estratégia de tratamento, os nutrientes não demonstraram um efeito separadamente, provavelmente devido a seu trabalho sinérgico nos diferentes domínios da função cerebral. Ainda assim, os nutrientes representam uma abordagem preventiva potencial e um tratamento adjuvante nas pessoas com DA nos estágios iniciais.

As mudanças que as inovações tecnológicas têm promovido em nossas vidas tem se tornado cada vez mais profundas e rápidas. O convívio social, os ambientes de trabalho, as opções de entretenimento transformam-se continuamente. As crianças de hoje são nativos digitais, convivendo com videogames, smartphones e computadores algumas vezes até antes de sua alfabetização. A educação, que é uma das bases que propiciou esta revolução, e, de uma forma mais especifica o ensino de matemática, essencial no campo de ciências e engenharia, tem a necessidade de acompanhar estas mudanças, através da adoção de novas tecnologias e métodos em sala de aula. Este trabalho tem por objetivo buscar uma resposta para uma das questões levantadas por este cenário: qual a real efetividade do uso de jogos sérios eletrônicos como auxiliares no processo de ensino-aprendizagem de matemática na educação básica? Através de uma revisão sistemática apresentamos um panorama do estudo acadêmico sobre o tema nos últimos cinco anos, concluindo que realmente os jogos sérios eletrônicos são ferramentas de alavancagem no processo de ensino-aprendizagem de matemática, apontando caminhos futuros a serem explorados dentro da realidade brasileira. / Technological innovations have promoted changes our lives, in a way ever deeper and faster. Social networking, work environments, entertainment options are continually changing. Todays kids are digital natives, playing video games, using smartphones, and computers sometimes even before their literacy. Education, which is one of the foundations for this revolution, and, more specifically, the teaching of mathematics, which is essential in the field of science and engineering, has the need to follow these changes through the adoption of new technologies and methods in classroom. This paper aims to find an answer to one of the questions raised by this scenario: what is the real effectiveness of the use of serious electronic games as aids in the teaching-learning process of mathematics in basic education? Through a systematic review we present a panorama of the academic study on the subject in the last five years, concluding that serious electronic games are actually powerful tools in the teaching-learning process of mathematics, pointing out new paths to be explored within the Brazilian reality.

Although research confirms the effectiveness of training to improve law enforcement officers’ awareness and knowledge of people with intellectual disability, learning disabilities, and mental health disorders (Bailey, Barr, & Bunting, 2001; McAllister, Bailey, & Barr, 2002; Scantlebury et al., 2017; Wood & Watson, 2017), research related to the efficacy of autism-specific law enforcement training is limited. In order to provide up-to-date information regarding training for LEOs related to autism spectrum disorder (ASD), a systematic review of the literature was conducted for the first study. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 (PRISMA), a search of 13 professional databases and 28 journals was conducted using search terms related to both ASD and law enforcement training. Two research team members compared decisions for study inclusion at two points, including upon initial screening and final inclusion. From 724 articles identified during the initial search, only two articles met inclusion criteria, which suggests that limited research exists that explores ASD and law enforcement training. Included studies were summarized in terms of participants as well as training format, content, and outcomes. Limitations of the current literature, directions for future research and current implications for practice are discussed. When developing trainings, it is important to consider the input of multiple stakeholders. Thus, in the second paper, qualitative data was collected through semi-structured interviews with LEOs, adults with ASD, and caregivers. Given the importance of including the ASD community in research (Pellicano, Dinsmore, & Charman, 2014), input from individuals with ASD and caregivers was obtained to complement information solely from LEOs. The goals for study two centered around (a) characterizing LEOs’ knowledge of ASD, (b) understanding LEOs’ previous interactions with individuals with ASD, and (c) identifying training needs to best prepare LEOs for interactions with individuals with ASD. In addition, members of the ASD community, including adults with ASD and caregivers, shared perspectives regarding real and hypothetical interactions with LEOs as well as suggestions regarding LEOs’ ASD-specific training needs. Researchers utilized a grounded theory approach to analyze data from 17 participants, including six LEOs, six adults with ASD, and five caregivers. All semi-structured interviews were audio recorded, transcribed, thematically coded, and summarized by researchers according to grounded theory. Common themes among participants included the (a) potential for misinterpretations of behavior of individuals with ASD, (b) helpfulness of a universal identification system/symbol for ASD, (c) need for interactive, mandatory training unique to LEOs’ needs and roles, and (d) importance of building community connections between LEOs and individuals with ASD. Together, these two studies add significant information to the current understanding of interactions between LEOs and the ASD community as well as autism-specific training for LEOs. Study one provides up-to-date information regarding evidence-based interventions for LEOs related specifically to ASD. Further, the second study provides an in-depth understanding of the interactions between LEOs and the ASD community as reported by multiple stakeholders. Across both studies, information regarding ASD-specific training, including LEOs’ prior experiences and participants’ training recommendations, can be utilized to inform the development and implementation of ASD-specific training currently being created and utilized in communities nationwide.

In recent years much effort has been dedicated to the purpose of combating commercial sexual exploitation yet there is a lack of concise and comprehensive information on the effectiveness of strategies and interventions to help this population. Research in this field has helped define and illuminate consequences of this lifestyle. The existing literature points to the complexity of the population's needs and the challenges faced when trying to leave 'the life' however there is a dearth of information on what works. The purpose of this project is to identify and summarize the findings of any empirical studies which evaluate interventions that target a successful exit for a life of sexual exploitation. Through a systematic review of results from search term combinations in two academic databases, peer-reviewed journal articles meeting selection criteria were analyzed and themes are presented. Results from the systematic review revealed only a small number of articles for inclusion and they are described in detail in this study. Recommendations for further research and review are also discussed.

Introduction: Diabetes is a global and rapidly increasing disease that in 2014 affected morethan 422 million people, and takes 1,2 million lives per year. The importance of identifyingnew ways to manage and prevent the disease has led science to a new area – modulation ofthe gut microbiota. It is well known that the composition of gut microbiota differs betweennon-diabetic and diabetic adults, and that nutrition is the main way to modulate gutmicrobiota composition. Food and lifestyle are of great importance for the development andtreatment of type 2 diabetes and pre-diabetes, but less is known about whether gut microbiotamodulation is mediating that link. Aim: The aim is to examine whether there is a scientifically well-supported link between diet,gut microbiota and the development or treatment of type 2 diabetes or pre-diabetes in humans. Methods: Systematic review with literature search via PubMed and Cochrane, following themanual from the Swedish Agency for Health Technology Assessment and Assessment ofSocial Services (SBU). Results: Of 12 articles finally included, two studies found a strong impact of diet on diabetesrelatedvariables via modulation of gut microbiota. Another four studies did not find anassociation, and six studies lacked sufficient data to be able to draw a conclusion. Dietinterventions and study design differed between studies, which led to heterogeneous results. Conclusions: This review demonstrates a large knowledge gap in how dietary modificationscan prevent or treat type 2 diabetes or pre-diabetes via changes in gut microbiota.

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

Objective to systematically review randomized trials that compared methotrexate (MTX) monotherapy to MTX in combination with other non-biologic disease-modifying anti-rheumatic Drugs (DMARD) and to compare the performances of PubMed versus MEDLINE (Ovid®) and EMBASE. Methods We performed a systematic review of randomized trials comparing MTX alone and MTX in combination with other non-biologic DMARDs. Heterogeneity was investigated and explored. The performances of Pubmed and MEDLINE were evaluated. The EMBASE unique trials were identified and investigated. Results A total of 19 trials were included and grouped by the type of patients randomized. Trials in DMARD naive patients showed no significant advantage of the MTX combination versus monotherapy. The recall was 85% vs. 90% for Ovid and PubMed, respectively, while the precision and number-needed-to read of Ovid and Pubmed were comparable. Only 23% of trials were EMBASE unique trials Conclusions In DMARD naive patients, the balance of efficacy/toxicity favours MTX monotherapy.