Delphi survey on the most promising areas and methods to improve systematic reviews' production and updating.

BACKGROUND: Systematic reviews (SRs) are invaluable evidence syntheses, widely used in biomedicine and other scientific areas. Tremendous resources are being spent on the production and updating of SRs. There is a continuous need to automatize the process and use the workforce and resources to make it faster and more efficient. METHODS: Information gathered by previous EVBRES research was used to construct a questionnaire for round 1 which was partly quantitative, partly qualitative. Fifty five experienced SR authors were invited to participate in a Delphi study (DS) designed to identify the most promising areas and methods to improve the efficient production and updating of SRs. Topic questions focused on which areas of SRs are most time/effort/resource intensive and should be prioritized in further research. Data were analysed using NVivo 12 plus, Microsoft Excel 2013 and SPSS. Thematic analysis findings were used on the topics on which agreement was not reached in round 1 in order to prepare the questionnaire for round 2. RESULTS: Sixty percent (33/55) of the invited participants completed round 1; 44% (24/55) completed round 2. Participants reported average of 13.3 years of experience in conducting SRs (SD 6.8). More than two thirds of the respondents agreed/strongly agreed the following topics should be prioritized: extracting data, literature searching, screening abstracts, obtaining and screening full texts, updating SRs, finding previous SRs, translating non-English studies, synthesizing data, project management, writing the protocol, constructing the search strategy and critically appraising. Participants have not considered following areas as priority: snowballing, GRADE-ing, writing SR, deduplication, formulating SR question, performing meta-analysis. CONCLUSIONS: Data extraction was prioritized by the majority of participants as an area that needs more research/methods development. Quality of available language translating tools has dramatically increased over the years (Google translate, DeepL). The promising new tool for snowballing emerged (Citation Chaser). Automation cannot substitute human judgement where complex decisions are needed (GRADE-ing). TRIAL REGISTRATION: Study protocol was registered at https://osf.io/bp2hu/ .

Motivations for performing scholarly prepublication peer review: A scoping review.

Prepublication peer review is a cornerstone of science. Overburdened reviewers invest millions of hours in this voluntary activity. In this scoping review, we aimed at identifying motivations for performing prepublication peer review of scholarly manuscripts. Original research studies investigating actual peer reviewers' motivations were included. We excluded modeling studies, studies related to other types of peer review, guidelines, peer review processes in particular journals. Medline, WoS, and Scopus were searched in February 2016, with no language or time limitations, and the search was updated in July 2019. The search yielded 5,250 records, and 382 were chosen for full text analysis, out of which 10 were appropriate for synthesis. Reference snowballing identified one eligible study. Eleven studies were appropriate for synthesis: four qualitative, four mixed qualitative/quantitative, and three qualitative studies, published from 1998 to 2018, involving 6,667 respondents. Major internal incentive was "communal obligations and reciprocity." Major external incentives were "career advancement," "being recognized as an expert," and "building relationships with journals and editors." Major disincentive was the "lack of time." Editors could incentivize peer review process by choosing highest quality articles, improving communication with peer reviewers, in order to make the process of peer review as short and efficient as possible. The gaps in research concern disincentives to review.

Essential medicines availability is still suboptimal in many countries: a scoping review.

OBJECTIVES: To identify uses of WHO Model list of essential medicines (EMs) and summarize studies examining EM and national EM lists (NEMLs). STUDY DESIGN AND SETTING: In this scoping review, we searched PubMed, Scopus, WHO website and WHO Regional Databases for studies on NEMLs, reimbursement medicines lists, and WHO EML, with no date or language restrictions. RESULTS: Three thousand one hundred forty-four retrieved documents were independently screened by two reviewers; 100 full-text documents were analyzed; 37 contained data suitable for quantitative and qualitative analysis on EMs availability (11 documents), medicines for specific diseases (13 documents), and comparison of WHO EML and NEMLs (13 documents). From the latter, two documents analyzed the relevance of evidence from Cochrane systematic reviews for medicines that were on NEMLs but not on the WHO EML. EMs availability is still suboptimal in low-income countries. Availability of children formulations and EMs for specific diseases such as chronic, cancer, pain, and reproductive health is suboptimal even in middle-income countries. CONCLUSION: WHO EML can be used as a basic set of medicines for different settings. More evidence is needed into how NEMLs can contribute to better availability of children formulations, pain, and cancer medicines in developing countries.

Setting the IMPACT (IMProve Access to Clinical Trial data) Observatory baseline.

INTRODUCTION: The aim of the IMPACT (IMProving Access to Clinical Trial data) Observatory is to assess the transformation of clinical trials (CT) related to the evolution of sharing of CT data. The objective of this study is to establish a baseline for monitoring CT data sharing by the Observatory. MATERIALS AND METHODS: In this scoping review we searched for publications that address sharing, dissemination, transparency or reuse of CT data published prior to December 31st 2000. Two authors screened titles and abstracts of 1204 records received by Medline searches and added 47 publications from direct discovery. Four researchers extracted, coded, and analyzed the predefined information from 102 selected papers. RESULTS: We found a growing recognition of the importance of data sharing prior to 2001. However, there were numerous obstacles including the ambiguity of the concept of data sharing, the absence of specific terminology and the lack of an "open" culture. By the end of 2000, data, metadata, and evidence based medicine were defined. Data sharing, registries, databases and re-analyses of individual patient data (IPD) emerged. The use of systematic reviews and IPD meta-analysis in decision making was promoted. Most arguments for broader data sharing came from oncology, paediatrics, rare diseases, AIDS, pregnancy, perinatal medicine, and media reporting related scandals. CONCLUSIONS: Our findings indicate that the year 2000 could be used as a baseline for monitoring the evolution of CT data sharing as basic prerequisites were set in place, including greater understanding that CT data sharing is essential for decision making and the advancements of the Internet.

Intravenous drugs abuse as the main risk factor of increasing hepatitis C infection prevalence in prisoners in Zenica, Bosnia and Herzegovina.

Aim To determine the prevalence of hepatitis C virus infection (HCV) among prisoners in Zenica prison, and to investigate the relation between HCV and risky behaviors: intravenous drugs use (IDU), tattooing, promiscuity. Methods This cross-sectional study conducted at the High Security Penitentiary in Zenica involved 200 convicted persons who gave their consents for the research. Their blood was tested by AraGen Hepatitis C Test. Risky behaviors (IDU, tattooing, promiscuity) were tested by an anonymous self-administered questionnaire. Results The prevalence of HCV was 13% (26/200). There was a statistically significant correlation of HCV infection and drug abuse before imprisonment (p=0.00), injection drug abuse before imprisonment (p=0.00), tattooing in prison (p=0.03) and having sex with homosexual partners (p=0.00). Conclusion The prevalence of HCV in prisoners at Zenica prison was significantly higher than in the general Bosnia and Herzegovina population. Intravenous drugs use had highest risk for HCV infection among prisoners.

Anatomic variations of posterior paranasal sinuses and optic nerve.

Aim To define direct anatomical relations of the sphenoidal (alae minores), ethmoidal sinuses and optic nerve, with an emphasis on determining the effect of age on pneumatisation and dehiscence. Methods This retrospective, descriptive study involved 60 consecutive patients: 30 patients younger than 30 and30 patients older than 60 years of age. All patients underwent computerized tomography(CT). The relationship of the optic nerve and the sphenoidal and ethmoidal sinuses was classified. The presence of dehiscence in the bone structures, forming the optic canal, was checked. Dehiscence was defined as absence of visible bone density located between the sinus and the optic nerve. Protrusion of the optic nerve into the sphenoidal sinus was defined as optic nerve surrounded by pneumatised space. Results The most common type of relation between the optic nerve and sphenoidal sinus was type I, where the optic nerve was immediately adjacent to the lateral or superior wall of the sphenoidal sinus, without impression on the sinus wall. Dehiscence was documented in 15 (25%) cases, it was more common in older patients (8, 27%) than in younger ones (7, 23%). The pneumatisation processes were more frequent in patients over 60 (5, 17%) than in those younger than 30 years (4, 13%). Conclusion Surgeons and ophthalmologists should be aware of high frequency of dehiscence of sphenoidal sinus walls when treating adult patients in our population, especially when evaluating risks and complications of surgical procedures or when diagnosing inflammatory or tumorous processes in the close vicinity of posterior paranasal sinuses.

IMPACT Observatory: tracking the evolution of clinical trial data sharing and research integrity.

INTRODUCTION: The opening of research data is emerging thanks to the increasing possibilities of digital technology. The opening of clinical trial (CT) data is a part of this process, expected to have positive scientific, ethical, health, and economic impacts thus contributing to research integrity. The January 2016 proposal by the International Council of Medical Journal Editors triggered ample discussion about CT data sharing and reconfirmed the need for an ongoing assessment of its dynamics. The IMProving Access to Clinical Trials data (IMPACT) Observatory aims to play such a role, and assess the data sharing culture, policies, and practices of key players, the impact of their interventions on CTs, and contribute to a transformation of research. The objective of this paper is to present the IMPACT Observatory as well as share some of its preliminary findings. MATERIALS AND METHODS: Methods include a scoping study of research, surveys, interviews, and an environmental scan of research data repositories. RESULTS: Our preliminary findings indicate that although opening of CT data has not yet been achieved, its evolution is encouraging. Initiatives by key players contribute to increasing of CT data sharing, and many barriers are shrinking or disappearing. CONCLUSIONS: The major barrier is the lack of data sharing standards, from preparing data for public sharing to its curatorship, findability and access. However, experiences accumulated by sharing CT data according to "upon request" or "open" mechanisms could inform the development of such standards. The Vivli, CORBEL-ECRIN and Open Trials projects are currently working in this direction.

Transition from paternalism to shared decision making - a review of the educational environment in Bosnia and Herzegovina and Croatia.

UNLABELLED: In this article we will review the benefits of a system built on partnership of physicians and their patients, highlight some of the factors which impede this transition, and propose ways to address these factors. Also, we are going to analyze the educational environment in Bosnia and Herzegovina and Croatia concerning ethics and communication skills. Personal responsibility of patients for their health should be reflected in their joint involvement in health decisions with their physicians. Patients, insecure about their individual competence surrounding their health decisions, tend to shy away from responsibility, whereas physicians, pressured by the responsibilities of the profession, do not always show sensitivity to all of the patient's concerns. They often treat illnesses instead of patients. A more open and collaborative relationship between the patient and the physician through shared decision making would be a better alternative. In the end, the patient ultimately decides whether a health intervention was satisfactory in fulfilling his or her specific needs. Transition from a paternalistic to a mutual relationship between doctors and patients has already begun. In an era of intense information sharing, shared decision making is a sensitive, ethical, legal, and political concept which needs empathic doctors with well-developed communication skills to integrate their clinical knowledge with patient-centered care. CONCLUSION: Transition from paternalistic to partner relation between physicians and patients is moving slowly ahead in Croatia and Bosnia and Herzegovina. Educational environment is improving but needs intense efforts to develop further.

FIRST BH COCHRANE SYMPOSIUM HELD.

The first BH Cochrane Symposium was held on 12 October 2015 in Sarajevo, Bosnia and Herzegovina (BH), organized by the Agency for Quality and Accreditation in Healthcare in Federation of BH (AKAZ) and Medical Faculty University of Sarajevo. A group of ten national and international experts presented the Cochrane organization and systematic reviews, as well as the IMPACT Observatory, development of guidelines in BH, and the role of AKAZ. Examples of the development and use of Cochrane reviews in evidence informed decision making in health as well as research integrity were presented and discussed. Major BH decision makers and interested professionals from all over BH participated in a symposium and its lively discussion, especially from the perspective of Cochrane and its activities in BH, and the collaboration with the Croatian Cochrane. It can be expected that this symposium will inspire further growth of participation and use of Cochrane in BH and increase the awareness of various aspects of evidence informed medicine and research integrity.

Cochrane and its prospects in Bosnia and Herzegovina: Relying on Cochrane Croatia.

UNLABELLED: In this article we describe Cochrane and its products: Cochrane systematic reviews (CSRs) and other Cochrane evidence. Cochrane is a unique, international, non-profit organisation that offers health care providers, health care consumers and other decision makers unbiased and highly reliable information on health, which is pivotal for conscientious and responsible decision making in overall healthcare. Cochrane offers the highest ranked evidence in Evidence Based Medicine (EBM)--systematic reviews. Currently, CSRs are freely available in BH, and therefore, they ought to be widely used, and understood. We will present the new Cochrane Strategy to 2020, which was the main topic of the 6th Croatian Cochrane Symposium (CroCoS), as well as explore prospects for spreading Cochrane activities to Bosnia and Herzegovina (BH), through collaboration with Cochrane Croatia. BH has no officially organized Cochrane activity, as yet. We hope that this article will raise awareness about Cochrane in BH, help promote its activities, and deepen the existing collaboration with Cochrane Croatia. There are already some changes being introduced concerning Cochrane--at least, in one half, the Federation of BH (FBH). Two documents symbolising official recognition of policy changes towards Cochrane have recently been published in the Official Gazette of FBH. CONCLUSION: Since founding a BH Cochrane Branch would be costly and difficult to achieve in a complicated environment, such as the one we have, BH could use the good will, experience, knowledge, and translated educational, training and web materials of Cochrane Croatia, particularly given the language similarities, to promote evidence based medicine in BH.

Analysis of evidence supporting the Federation of Bosnia and Herzegovina reimbursement medicines lists: role of the WHO Essential Medicines List, Cochrane systematic reviews and technology assessment reports.

PURPOSE: We compared recently introduced Basic Medicines Lists of the Federation of Bosnia and Herzegovina (BH) (FBH Basic Lists (FBLs)) with the World Health Organization (WHO) Essential Medicines List (EML) and the evidence supporting the inclusion of additional medicines on FBLs. METHODS: The sources of data included the 18th edition of the EML and the following FBLs: 2013 Hospital List, 2013 A List in Outpatient Setting, and 2012 List financed by the Federal Solidarity Fund. For medicines found on FBLs but not on EML, we searched the Cochrane Database of Systematic Reviews (CSR) and public health technology assessment (HTA) reports for evidence. RESULTS: FBLs had 134 medicines and 17 combinations that were not on EML, as well as 9 medicines deleted and 4 rejected from EML. EML had 82 medicines and 10 combinations of medicines not included in FBLs. Out of 125 medicines on FBLs but not on EML, 52 (42%) had good CSR evidence supporting their inclusion (n = 38) or exclusion (n = 14). For the rest (n = 74), we found 24 favourable HTA reports. For the total of 89 medicines (27%) listed on FBLs, we found no evidence (EML, CSR, HTA reports) good enough to justify their inclusion in FBLs. CONCLUSIONS: In circumstances of scarce financial resources, greater reliance on well-established, proven list is crucial. Independent, unbiased, high-quality evidence such as WHO EML, CSR and HTA reports (national or international with local adaptations) should be used when deciding on medicine reimbursement.

Awareness, knowledge, use, and attitudes toward evidence based medicine in a developing country: survey of physicians in a canton in Bosnia and Herzegovina.

AIM: To assess awareness, knowledge, use, and attitudes toward evidence-based medicine (EBM) and The Cochrane Library (CL) among physicians from Zenica-Doboj Canton (ZDC), Bosnia and Herzegovina. METHODS: In this cross-sectional study, a self-administered anonymous questionnaire was sent by post to all state owned health institutions (2 hospitals and 11 Primary Health Care Institutions) in ZDC. The main outcome measures were physicians' awareness of the Cochrane, awareness and use of CL, access to EBM databases, and access to internet at work. 358 of 559 physicians responded (63.69%). RESULTS: 23.18% of respondents stated they had access to EBM databases, but only 3.91% named the actual EBM databases they used. The question on the highest level of evidence in EBM was correctly answered by 35.7% respondents, 34.64% heard about Cochrane and 32.68% heard about the CL. They obtained information about CL mostly on the internet and from colleagues, whereas the information about EBM was obtained mainly during continuous medical education. CONCLUSION: Although the attitudes toward EBM are positive, there is a low awareness of EBM among physicians in ZDC. Open access to the CL should be used more. Educational interventions in popularizing EBM and Cochrane are needed to raise awareness both among students and practicing physicians, and finally among lay audience.

Clinical importance of independent prognostic factors for renal parenchymal carcinoma and a possibility of predicting the treatment outcome.

AIM: To determine the influence of independent predictors (nuclear grade, patient's general condition, tumor size) on survival of patients suffering from renal cancer. METHODS: The study included 158 patients treated for renal parenchymal carcinoma in the period between 01. 01. 1998 and 31. 12. 2011. The patients' general condition was evaluated using the ECOG staging system. Nuclear grade (NG) was assessed by the Fuhrman criteria. Prognostic factors were tested applying the Cox regression analysis and based on the significance independent predictors were determined. RESULTS: The total survival rate of patients with renal parenchymal carcinoma was 81.2% after one year, 77.6% after 5 years and 70.4% after 10 years. In patients with NG 1 the survival rate after 5 years was 100%, whereas the survival in patients with NG2, 3 and 4 was 98%, 48% and 0%, respectively. The survival rate in patients with ECOG 0 and 1 after 5 years was 100%, while in patients with ECOG 2 and 3 stage of the disease the survival rate was 68% and 25%, respectively. In patients with a tumor node less than 40 mm, ten-year survival rate was100%, whereas the ten-year survival rate in patients with the tumor node sized 40 to 70 mm was 87%, and in patients with the tumor node over 70 mm ten-year survival rate was 66%. CONCLUSION: Multivariate analysis has established that the size of the tumor node, patient's general condition and nuclear grade are independent predictors of disease outcome.

Clinical importance of dependent prognostic factors for renal parenchymal carcinoma and a possibility of predicting the treatment outcome.

AIM: To determine an influence of dependent predictors (clinical presentation, stage, pH type) on survival of patients suffering from renal carcinoma. METHODS: The research included 158 patients who had been treated for carcinoma of renal parenchyma in the period between 1 January 1998 and 31 December 2011. A disease stage was determined according to the guidelines of the American Joint Committee on Cancer (AJCC). Prognostic factors were tested by the Cox regression analysis, and dependent prognostic factors were determined based on significance. RESULTS: Patient survival was significantly different in relation to the clinical presentation of the disease (p less than 0.0001). Length of patient survival significantly differs with regard to the clinical stage of the disease (p less than 0.0001). The length of patient survival significantly differs depending on a pathohistological type of cancer (p=0.0027) and after five years it was much longer for patients with the conventional cancer type as compared with the chromophobe type, 80.3% vs. 61.5%, respectively. The total survival rate of patients with renal parenchymal cancer is 81.2% after one year, 77.6% after 5 years and 70.4% after 10 years. CONCLUSION: The manner of detection, clinical stage and pathohistological type of the disease did not meet requirements for independent predictors. Success of the therapeutic treatment depends on the manner of the renal cell carcinoma presentation, pathohistological type and tumor stage.