Resource use during systematic review production varies widely: a scoping review.

OBJECTIVE: We aimed to map the resource use during systematic review (SR) production and reasons why steps of the SR production are resource intensive to discover where the largest gain in improving efficiency might be possible. STUDY DESIGN AND SETTING: We conducted a scoping review. An information specialist searched multiple databases (e.g., Ovid MEDLINE, Scopus) and implemented citation-based and grey literature searching. We employed dual and independent screenings of records at the title/abstract and full-text levels and data extraction. RESULTS: We included 34 studies. Thirty-two reported on the resource use-mostly time; four described reasons why steps of the review process are resource intensive. Study selection, data extraction, and critical appraisal seem to be very resource intensive, while protocol development, literature search, or study retrieval take less time. Project management and administration required a large proportion of SR production time. Lack of experience, domain knowledge, use of collaborative and SR-tailored software, and good communication and management can be reasons why SR steps are resource intensive. CONCLUSION: Resource use during SR production varies widely. Areas with the largest resource use are administration and project management, study selection, data extraction, and critical appraisal of studies.

Communication of children's weight status: what is effective and what are the children's and parents' experiences and preferences? A mixed methods systematic review.

BACKGROUND: Early intervention and conversation about a child's weight may offer an important chance of success in reducing weight and implementing a healthier lifestyle. This review explores the most effective ways to notify parents and children about the child's weight as well as their preferences and experiences around weight notification. METHODS: We systematically searched nine databases for relevant primary research. Records were independently screened by two authors. We extracted data into a form designed for this review. Effect data was analysed using narrative synthesis and qualitative data using a best-fit framework synthesis. We assessed our confidence in the evidence using GRADE and GRADE-CERQual. RESULTS: Studies of effect found that the format of feedback made little or no difference in parents attending further treatment, recognising their child as overweight or obese, reactions to the way the weight notification is given, motivation for lifestyle change, understanding how to reduce the risk of overweight, or taking any action. However, parents receiving feedback with motivational interviewing have somewhat greater satisfaction with the way the healthcare provider supports them. Qualitative studies found that parents had clear preferences for the format, timing, content and amount of information they wanted to receive in relation to both the weighing process and weight notification. They also had clear preferences for how they wanted health care providers to interact and communicate with them and their children. Both parents and children often felt that they were not receiving enough information and worried about how their results would be kept private. Many parents experienced an emotional response when told about their child's weight ranging from positive, disbelief and negative feelings. Those who reacted with disbelief or negatively were less likely to accept their child's weight status and/or act upon the notification letter. No studies reported results for children who were underweight. CONCLUSIONS: Based on these qualitative results people working with weight assessment and notification programs should consider parents' preferences when developing feedback formats, considering the mode of feedback they are going to use and provide parents and children with tailored feedback and personalized follow up once a child is identified as overweight or obese.

Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: a systematic review and meta-analysis.

BACKGROUND: For many women, the need for multiple clinical visits is a barrier to medical abortion. OBJECTIVES: We assessed the effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home versus routine clinic follow up after medical abortion. SEARCH STRATEGY: We searched databases such as MEDLINE, Embase, and CENTRAL to find studies published in 1991-2018. SELECTION CRITERIA: Eligible studies included women of reproductive age who had undergone a medical abortion that was completed at home. The intervention and self-assessment of the outcome of medical abortion done by urine pregnancy tests kits by women at home was compared with routine medical follow up at a clinic. DATA COLLECTION AND ANALYSIS: Two researchers completed the study selection, data extraction, critical appraisal, and assessment of the evidence. The outcomes were successful complete abortions, side effects and complications, and acceptability. We performed meta-analyses when possible and GRADE to ascertain the certainty of the evidence. The protocol was registered in PROSPERO (CRD42017055316). MAIN RESULTS: Four randomised controlled trials (RCTs; n = 5493) met our inclusion criteria. The pooled analysis from all studies showed no significant difference in complete abortion rates between self-assessment and routine clinic follow up: RR = 1.00, 95% CI 0.99-1.01. The ongoing pregnancy rates were similar and the pooled results for the safety outcomes showed no significant differences between the groups. There was a significantly greater preference for self-assessment as the follow-up method. CONCLUSIONS: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion completed at home are not inferior to routine clinic follow up. TWEETABLE ABSTRACT: The effectiveness, safety, and acceptability of self-assessment of the outcome of medical abortion are not inferior to routine clinic follow up.

The effectiveness of surgical interventions for women with FGM/C: a systematic review.

BACKGROUND: Female genital mutilation/cutting (FGM/C) changes normal genital functionality and can cause complications. There is an increasing demand for treatment of FGM/C-related complications. OBJECTIVES: We conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications. SEARCH STRATEGY: A search specialist searched 16 electronic databases. SELECTION CRITERIA: Selection was performed independently by two researchers. We accepted quantitative studies that examined the outcome of an intervention for an FGM/C-related concern. DATA COLLECTION AND ANALYSIS: We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses. MAIN RESULTS: We included 62 studies (5829 women), which investigated the effect of defibulation, excision of cysts, and clitoral reconstruction. Meta-analyses of defibulation versus no defibulation showed a significantly lower risk of caesarean section (relative risk, RR: 0.33; 95% confidence interval, 95% CI: 0.25-0.45) and perineal tears with defibulation: second-degree tear (RR: 0.44, 95% CI: 0.24-0.79), third-degree tear (RR: 0.21, 95% CI: 0.05-0.94), fourth-degree tear (RR: 0.06, 95% CI: 0.01-0.41). The meta-analyses detected no significant differences in obstetric outcomes of antenatal versus intrapartum defibulation. Except for one study, none of the studies on the excision of cysts indicated any complications, and the results were deemed favourable. Reconstructive surgery resulted in a visible clitoris in about 77% of women. Most women self-reported improvements in their sexual life, but up to 22% experienced a worsening in sexuality-related outcomes after reconstruction. CONCLUSIONS: Women with FGM/C who seek therapeutic surgery should be informed about the scarcity of evidence for benefits and the potential harms of the available procedures. TWEETABLE ABSTRACT: Systematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain.

An updated systematic review and meta-analysis of the obstetric consequences of female genital mutilation/cutting.

In our recent systematic review in Obstetrics and Gynecology International of the association between FGM/C and obstetric harm we concluded that FGM/C significantly increases the risk of delivery complications. The findings were based on unadjusted effect estimates from both prospective and retrospective studies. To accommodate requests by critics, we aimed to validate these results through additional analyses based on adjusted estimates from prospective studies. We judged that 7 of the 28 studies included in our original systematic review were prospective. Statistical adjustments for measured confounding factors were made in eight studies, including three prospective studies. The adjusted confounders differed across studies in number and type. Results from meta-analyses based on adjusted estimates, with or without data from retrospective studies, consistently pointed in the same direction as our earlier findings. There were only small differences in the sizes or the level of statistical significance. Using GRADE, we assessed that our confidence in the effect estimates was very low or low for all outcomes. The adjusted estimates generally show similar obstetric harms from FGM/C as unadjusted estimates do. Thus, the current analyses confirm the findings from our previous systematic review. There are sufficient grounds to conclude that FGM/C, with respect to obstetric circumstances, involves harm.

Barebacking among men who have sex with men recruited through a Swedish website: associations with sexual activities at last sexual encounter.

The research topic of barebacking emerged in the mid-1990s. Since then, a multitude of studies, largely from the United States, have produced invaluable knowledge of factors that help explain the behaviour among men who have sex with men (MSM), and that may contribute to HIV risk reduction programming and advice to counsellors working with barebackers. Given the scant empirical research about barebacking among European MSM, we conducted a survey among 3,634 MSM recruited through a web community in Nordic countries. The objectives of the study were twofold: to describe the sexual activities associated with barebacking behaviour at last sexual encounter, and to evaluate the relationship of barebacking with relevant variables. Men who reported barebacking (n=356) and men who did not (n=3,278) were compared. On the basis of the results of the analyses, the socio-sexual profile of barebackers drawn was one that is at increased risk of acquiring human immunodeficiency virus (HIV) and other sexually transmitted infections due to their sexual practices, particularly unprotected anal intercourse, but also group sex and rimming. In a multivariate logistic regression analysis, the likelihood of engaging in barebacking was higher for MSM who reported more frequent HIV testing (odds ratio (OR)=5.16), a higher number of female sex partners (OR=16.80), using gay cruising places (OR=1.51) and gay chat rooms (OR=2.11).

The receiving simplification partnership: a win-win approach to better service and higher profitability.

To achieve competitive advantage, customers and suppliers are increasingly forming logistics partnerships to improve supply chain performance and reduce costs. The partnerships are typically motivated by the need to solve a particular problem, but with attention and open communication, new program ideas can develop, sometimes even breakthrough concepts. During the course of their partnership, Avery Dennison and United Stationers created a program that dramatically simplifies and speeds receiving and put-away of shipments with the aim of reducing workloads, improving service, and increasing profitability. The program involves optimizing order quantity increments to full-pallet, layer, and case volumes based on demand and warehouse configurations. Within six weeks, the results included a 50 percent reduction in shipment line items and 92 percent fewer put-away pieces, despite unchanged inventory levels.