This thesis consisted of three major components: 1. A sample of randomized controlled trials of herbal medicines was collected and assessed with a recently developed extension of the CONSORT statement for herbal medicine trials. 2. A methodological review of proposed methods of assessing clinical heterogeneity in meta-analyses of randomized controlled trials, 3. The application of permutation based resampling in meta-regression of multiple covariates. An analysis of 406 RCTs of herbal medicine interventions revealed that these trials are regularly under reporting important aspects of the intervention. Next, the second project showed that there are many resources providing suggestions for investigating clinical heterogeneity in systematic reviews of controlled clinical trials and though there is minimal consensus some recommendations are common across sources. Finally, the third project found that permutation tests result in more conservative, larger, p-values potentially reducing the rate of false positive findings when exploring multiple covariates.

This thesis consisted of three major components: 1. A sample of randomized controlled trials of herbal medicines was collected and assessed with a recently developed extension of the CONSORT statement for herbal medicine trials. 2. A methodological review of proposed methods of assessing clinical heterogeneity in meta-analyses of randomized controlled trials, 3. The application of permutation based resampling in meta-regression of multiple covariates. An analysis of 406 RCTs of herbal medicine interventions revealed that these trials are regularly under reporting important aspects of the intervention. Next, the second project showed that there are many resources providing suggestions for investigating clinical heterogeneity in systematic reviews of controlled clinical trials and though there is minimal consensus some recommendations are common across sources. Finally, the third project found that permutation tests result in more conservative, larger, p-values potentially reducing the rate of false positive findings when exploring multiple covariates.

Background : - The past two decades has seen an increasing emphasis placed on basing health care on the best available evidence. However, existing research has come under increasing scrutiny, which suggests its quality was often poor. This problem has been exacerbated by the ever increasing volume of health care literature. To address these difficulties systematic reviews have emerged as one of the most important ways by which research is summarised and communicated to its end-users. However, as these reviews have been primarily concerned with effectiveness, they have focused almost exclusively on randomised controlled trials. As a result, systematic reviews have excluded much of the research of nurses. Purpose : - The purpose of this study was to develop a process to systematically collect, appraise, summarise and synthesise the findings of a range of different types of research. Conceptual Framework : - To aid in the development of these expanded review methods, a conceptual framework was developed that addressed effectiveness, appropriateness and feasibility. Method : - A search of the literature was undertaken to identify published reviews of different types of research, and discussions in the health care literature related to the conduct of research reviews. These reviews and discussion papers served as the basis for developing the expanded review methods. Evaluation : - To evaluate the expanded review methods, two systematic reviews were conducted. The protocol and results of the first review on the use of music in hospitals are presented to demonstrate how the conceptual framework and expanded review methods enabled a broader evaluation of the topic. Selected results from the second review on the use of physical restraint are presented to demonstrate how the findings from a number of methodologically different types of research were incorporated into a systematic review. Conclusion : - The conduct of the two systematic reviews clearly demonstrated that the proposed expanded review process was able to rigorously collect and summarise a range of different types of research. Additionally, the conceptual framework underpinning these reviews enabled each of the studies to be located logically and coherently during the synthesis of data. / Thesis (Ph.D.)--Department of Clinical Nursing, 2001.

Thesis (M.S.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 68-76).

Osteoporosis is a growing cause of morbidity and mortality in aging populations worldwide, especially in postmenopausal women. Bisphosphonates are widely prescribed for fracture prevention in osteoporosis. Meta-analyses have been performed for alendronate, risedronate, and etidronate, examining their effectiveness versus placebo in fracture prevention. Total withdrawals and adverse event withdrawals were examined as safety outcomes. Systematic reviews were performed for two other bisphosphonates, ibandronate and zoledronic acid and the results combined with previously obtained data for the other bisphosphonates. Indirect treatment comparisons of the drugs against each other and versus placebo were performed using Bayesian and frequentist methods. Both types of analyses yielded almost identical results: zoledronic acid and alendronate were the most effective bisphosphonates for preventing vertebral fractures. No differences were found regarding withdrawals. Subgroup analyses found that fracture prevention was generally more effective with longer therapy (greater than or longer than 3 years).

Systematic reviews of diagnostic test accuracy (DTA) studies are fundamental to the decision-making process in evidence-based medicine. Although such studies are regarded as high-level evidence, these reviews are not always reported completely and transparently. Sub-optimal reporting of DTA systematic reviews compromises their validity, generalizability, and value to key stakeholders. This thesis evaluates the completeness of reporting of published DTA systematic reviews based on the PRISMA-DTA checklist and provides an explanation for the new and modified items (relative to PRISMA), along with their meaning and rationale. Our results demonstrate that recently published reports of DTA systematic reviews are not fully informative, when evaluated against the PRISMA-DTA guidelines: mean reported items=18.6/26(71%, SD=1.9) for PRISMA-DTA; 5.5/11(50%, SD=1.2) for PRISMA-DTA for abstracts. The PRISMA-DTA statement, this document, and the associated website (http://www. prisma-statement.org/Extensions/DTA) are meant to be helpful resources to support the transparent reporting of DTA systematic reviews and guide knowledge translation strategies.

"May 2004" / Bibliography: leaves 172-184. / xvi, 186 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (D.Nurs.)--University of Adelaide, Dept. of Clinical Nursing, 2004

<b>Background:</b> The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach offers a transparent framework for rating the certainty of evidence in systematic reviews. Concerns, however, have been raised that use of GRADE beyond biomedical interventions frequently downgrades the 'best evidence possible' for many complex interventions. This DPhil thesis aims to (1) further investigate the challenges of using GRADE in systematic reviews of complex interventions, (2) explore how the GRADE approach can be advanced to address these challenges, and (3) inform the write-up and dissemination of a new GRADE guidance for complex interventions. <b>Methods:</b> To address the broad aims of this thesis a range of methodological approaches were employed, primarily drawing on the best-practice techniques for developing research reporting guidelines (see Chapter 2). First, a systematic literature review method was used to establish whether an adequate system already exists for rating the certainty of evidence for complex interventions and informing the need for a new guidance (Chapter 3). Further consultation with experts, including semi-structured interviews with review authors and GRADE methodologists, provided a nuanced understanding of the challenges of applying GRADE in reviews of complex interventions and suggestions for advancing the guidance on GRADE (Chapter 4). Agreement around these suggestions was explored in a Delphi-based online expert panel (Chapter 5), and the content of the new GRADE guidance for complex interventions was discussed indepth in a three-day expert meeting held in Oxford in May 2017 (Chapter 6). <b>Results:</b> The systematic literature review identified a few systems attempting to modify GRADE for public health interventions; however, there was little reporting of rigorous procedures in the development and dissemination of these systems. Qualitative interviews captured differences in views on GRADE use between review authors and GRADE methodologists. Specifically, GRADE methodologists found it critical to consider GRADE from the beginning of the review process and exercise judgment in GRADE ratings. Review authors, on the other hand, often thought of GRADE as an 'annoying add-on' at the end of the review process and felt challenged by the need to be more interpretative with evidence and sift through many publications on GRADE. Suggestions were made to enhance the GRADE guidance. No significant disagreement was found in the online expert panel on any domain of evidence, and the expert meeting provided further insights into the content of the new GRADE guidance for complex interventions. Participants agreed that the new guidance should specify the meaning of the construct of 'certainty of evidence' for complex interventions, consider revisions of the initial categorisation of evidence based on study design, and better assess the coherence of the causal pathway of complex interventions. <b>Conclusion:</b> This thesis work consolidates up-to-date methodological knowledge on reviewing complex interventions by providing critical examination of the existing approaches and new insights. In transparent reporting of the research phases, it informs development of a new GRADE guidance on rating the certainty of evidence in systematic reviews of complex interventions.

Implementation strategies for the use of clinical practice guidelines are an integral component in bridging the gap between the best research evidence and clinical practice. However, despite some remarkable investments in health research regarding clinical practice guidelines implementation strategies, it is not yet known which of these are the most effective for intensive care units. The purpose of this research study was to systematically identify and /or search, appraise, extract and synthesize the best available evidence for clinical practice guidelines implementation strategies in intensive care units, in order to develop a draft guideline for clinical practice guidelines implementation strategies in the intensive care units. A systematic review design was used to systematically identify and /or search, appraise, extract and synthesize the best available evidence from the eligible included Level 2 studies (randomized controlled trials and quasi-experimental studies). Level 2 studies were applicable because they present robust evidence in the research results regarding effectiveness of clinical practice guideline implementation strategies. Furthermore, although other systematic reviews conducted in this area before, they included studies of In addition, no systematic review was identified that reviewed Level 2 studies and developed a guideline for clinical practice guideline implementation strategies in the intensive care units. Hence, including only Level 2 studies was distinctive to this research study. Databases searched included: CINAHL with full text, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials Issue 8 of 12, August 2013, and MEDLINE via PUBMED. Hand search in bound journals was also done. The search strategy identified 315 potentially relevant studies. After the process of critical appraisal, thirteen Level 2 studies were identified as relevant for the review. Of the 13 relevant studies, 10 were randomized controlled trials and three were quasi experimental studies. After the critical appraisal ten RCTs were included in the systematic review. Three studies (quasi-experimental) were excluded on the basis of methodological quality after the critical appraisal and agreement by the two independent reviewers. The Joanna Briggs Institute Critical Appraisal MASTARI Instrument for Randomized Controlled trials/ Experimental studies, and The Joanna Briggs Institute data extraction tools were used to critically appraise, and extract data from the ten included randomized controlled trials. The two reviewers who performed the critical appraisal were qualified critical care professional nurses and experts in research methodology. These reviewers conducted the critical appraisal independently to ensure the objectivity of the process. Appropriate ethical considerations were maintained throughout the process of the research study. The results indicated that 80 percent of the included studies were conducted in adult intensive care units while 20 percent were conducted in the neonatal intensive care units. Furthermore, 60 percent of the studies were conducted in the United States of America, 10 percent in France, a further 10 percent in Taiwan, another 10 percent in England and yet another 10 percfent was conducted in Australia and Newzealand. The included studies utilized more than one (multifaceted) implementation strategies to implement clinical practice guidelines in the intensive care units. The first most utilized were: printed educational materials; Information/ educational sessions/meetings; audit and feedback and champion/local opinion leaders; seconded by educational outreach visits; and computer or internet usage. Third most used were active/passive reminders; systems support; academic detailing/ one-on-one sessions teleconferences/videoconferences and workshops/in services. Fourth most used were ollaboration/interdisciplinary teams; slide shows, teleconferences/videoconferences and discussions. Fifth most used were practical training; monitoring visits and grand rounds. However all the strategies were of equal importance. Conclusively, the included studies utilized multifaceted implementation strategies. However, no study indicated the use of a guideline for the implementation strategies in the process of clinical practice guidelines implementation. The systematic review developed a draft guideline for clinical practice guideline implementation strategies in the intensive care units. The guideline will enhance effective implementation of clinical practice guidelines in such a complex environment.

Background: Persistent anemia has been described in kidney transplant (KTx) recipients with parvovirus B19 virus infection. However, the epidemiology of parvovirus B19 and parvovirus B19-related anemia after KTx remains unclear. We conducted this systematic review (1) to investigate the incidence of parvovirus B19 infection after KTx and (2) to assess the incidence of parvovirus B19 among KTx patients with anemia. Materials and Methods: A systematic review was conducted in EMBASE, MEDLINE, and Cochrane databases from inception to March 2019 to identify studies that reported the incidence rate of parvovirus B19 infection and/or seroprevalence of parvovirus B19 in KTx recipients. Effect estimates from the individual studies were extracted and combined using random-effects, generic inverse variance method of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42019125716). Results: Nineteen observational studies with a total of 2108 KTx patients were enrolled. Overall, the pooled estimated seroprevalence of parvovirus B19 immunoglobulin G was 62.2% (95% confidence interval [CI]: 45.8%-76.1%). The pooled estimated incidence rate of positive parvovirus B19 DNA in the 1st year after KTx was 10.3% (95% CI: 5.5%-18.4%). After sensitivity analysis excluded a study that solely included KTx patients with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA after KTx was 7.6% (95% CI: 3.7%-15.0%). Among KTx with anemia, the pooled estimated incidence rate of positive parvovirus B19 DNA was 27.4% (95% CI: 16.6%-41.7%). Meta-regression analysis demonstrated no significant correlations between the year of study and the incidence rate of positive parvovirus B19 DNA (P = 0.33). Egger's regression asymmetry test was performed and demonstrated no publication bias in all analyses. Conclusion: The overall estimated incidence of positive parvovirus B19 DNA after KTX is 10.3%. Among KTx with anemia, the incidence rate of positive parvovirus B19 DNA is 27.4%. The incidence of positive parvovirus B19 DNA does not seem to decrease overtime.