scholarly journals P144: Assessment of the quality of evidence presented at the Canadian Association of Emergency Physicians annual meeting over a five-year period (2013-2017)

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S108-S108
Author(s):  
V. Srivatsav ◽  
B. Zhang ◽  
I. Nadeem ◽  
S. Upadhye ◽  
Michael G. Degroote
Keyword(s):  
Emergency Medicine ◽  
Annual Meeting ◽  
Data Extraction ◽  
Level Of Evidence ◽  
Canadian Association ◽  
Predominant Type ◽  
Significant Difference ◽  
Chi Squared ◽  
Level I ◽  
Economic Analyses

Introduction: The CAEP annual meeting presents the latest evidence for clinical practice, but there has not yet been an appraisal of the abstracts presented at this conference. Therefore, we sought to evaluate the level of evidence of research presented at the annual meeting, and assess for trends over a five-year period (2013-2017). Methods: We conducted a scoping review that included all CAEP abstracts from 2013-2017, obtained through the Canadian Journal of Emergency Medicine. Two reviewers assessed eligibility and extracted data from abstracts individually, with conflicts resolved by a third reviewer. Qualitative research was excluded. Extracted data included type of presentation (ex. oral, poster), sample size, study design and type of study (therapeutic, prognostic, diagnostic, education, quality improvement, or systems-wide/economic analyses research). A level of evidence (LOE) was assigned using the 2011 Oxford Centre for Evidence-Based Medicine criteria. Results: Abstracts from 2014-2017 have been analyzed thus far, 1090 of which were eligible and 990 included. Inter-rater agreement for screening and data extraction was high ( value 0.87 and 0.84 respectively). Systems-wide/economic analyses research was the predominant type of study (28.6%, 283/990), followed by therapeutic (19.9%, 197/990) and education (19.9%, 195/990). The mean LOE was 2.81 (95% CI 2.77,2.85). The highest proportion of studies were of level III evidence (77.7%, 769/990), followed by level II (9.6%, 95/990) and level I evidence (7.8%, 77/990). 72.1% (124/172) of all level I and II abstracts were presented in 2016 and 2017. A significant change in LOE between years was evident (p<0.0001, chi-squared). The greatest proportion of level I and II abstracts were lightning oral (41.9%, 72/172), followed by posters (36.0%, 62/172). The best average LOE was observed for lightning oral (2.64, 95% CI 2.56, 2.72), with the poorest average LOE witnessed for moderated posters (2.90, 95% CI 2.83, 2.97). A significant difference was present in mean LOE between types of presentations (p<0.0001, one-sided ANOVA). Conclusion: The majority of abstracts were level III evidence. The lightning oral sessions had the greatest proportion of level I and II evidence presented. Recent years of the conference have also seen the presentation of a greater number of level I and II evidence, which may suggest a shift towards generating and disseminating higher level evidence in emergency medicine.

scholarly journals LO69: Factors related to the eventual publication of abstracts presented at the Canadian Association of Emergency Physicians annual meeting from 2013-2017

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S31-S31
Author(s):  
V. Srivatsav ◽  
I. Nadeem ◽  
B. Zhang ◽  
S. Upadhye ◽  
Michael G. Degroote
Keyword(s):  
Emergency Medicine ◽  
Canadian Journal ◽  
Publication Rate ◽  
Cochrane Library ◽  
Publication Date ◽  
Level Of Evidence ◽  
Canadian Association ◽  
Significant Difference ◽  
Chi Squared ◽  
Negative Findings

Introduction: Much of the research presented at conference meetings never go on to be published in peer-reviewed literature, thereby limiting the dispersion of these findings to a larger audience. We sought to assess if this was true with regard to CAEP meetings, by establishing the publication rate and factors correlated with publication of CAEP abstracts in peer-reviewed journals from 2013-2017. Methods: We conducted a scoping review that included all CAEP abstracts from 2013-2017, obtained through the Canadian Journal of Emergency Medicine. Two reviewers screened and extracted data from all abstracts individually, with any conflicts resolved by a third reviewer. Data extracted from abstracts included province of authors, sample size, study design, the presence of statistically positive or negative findings, status of publication, date of acceptance to a journal, and journal of publication. Databases searched for publication status included MEDLINE, EMBASE, The Cochrane Library and Ovid Health Star. A level of evidence (LOE) was assigned using the 2011 Oxford Centre for Evidence-Based Medicine criteria. Results: All abstracts (1090) from 2014-2017 have been analyzed thus far. Inter-rater agreement for data extraction was high ( value 0.85). 17.1% (186/1090) of abstracts presented at the conference had a corresponding full text publication in the peer-reviewed literature. Articles were published in 102 different journals, with the greatest number of publications in the Canadian Journal of Emergency Medicine (CJEM) (15.1%, 28/186), followed by Academic Emergency Medicine (10.2%, 19/186). The mean time to publication was 51 weeks (95% CI 43,59). 30.6% (57/186) of published abstracts had statistically positive findings, while 10.8% (20/186) had negative findings. A significant difference was present between publication findings and publication status (p<0.0001, chi-squared). 68.8% (128/186) of published articles were of level III evidence. A statistical difference was found between LOE and publication status (p<0.0001, chi-squared). Conclusion: A large number of abstracts presented at CAEP are presently unpublished. There may be a publication bias in the literature as a greater number of studies with positive findings have been published. Additionally, two-thirds of studies published are of level III evidence. An increasing emphasis should be placed in publishing studies with higher levels of evidence, and more studies with negative findings.

scholarly journals Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 30-45 ◽  
Author(s):  
Ketan Yerneni ◽  
John F Burke ◽  
Pranathi Chunduru ◽  
Annette M Molinaro ◽  
K Daniel Riew ◽  
...  
Keyword(s):  
Safety Profile ◽  
Meta Analysis ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Level I ◽  
High Level

ABSTRACT BACKGROUND Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE To review the medical literature on the safety of outpatient ACDF. METHODS We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P &lt; .001), mortality (P &lt; .001), and hospitalization duration (P &lt; .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.

scholarly journals 1102. Ertapenem vs. Nonertapenem Antibiotics in Colorectal Surgery: A Stewardship Opportunity

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S391-S391
Author(s):  
Tiffany LaDow ◽  
Karen B Brust ◽  
Kiumars Zolfaghari ◽  
John Midturi
Keyword(s):  
Colorectal Surgery ◽  
Antibiotic Prophylaxis ◽  
Surgical Site Infections ◽  
Negative Resistance ◽  
Large Sample Size ◽  
Significant Difference ◽  
Chi Squared ◽  
Central Texas ◽  
Level I ◽  
American Society

Abstract Background The optimal regimen for antibiotic prophylaxis in colorectal surgery is not well defined. The aim of this study was to determine whether nonertapenem antibiotic prophylaxis in colorectal surgery is associated with increased rates of surgical site infections (SSI), defined by both deep and incisional infections, compared with ertapenem prophylaxis. Secondary aims were to identify differences in C. difficile infection rates at 60 days between the two groups. Methods This was a single-center retrospective study from November 2016 to December 2018 at a 600-bed teaching hospital equipped with a Level I Trauma Center in Central Texas. National Healthcare Safety Network (NHSN) criteria for colorectal surgical site infection (SSI) were used to identify eligible patients. Patients under 18 years or lacking pre-operative antibiotic documentation were excluded. SSI and C. difficile rates between the two prophylactic strategies were compared using Chi-squared and Fisher’s exact tests as appropriate. Results A total of 761 patients were included in the analysis. There were 87 patients in the ertapenem group and 674 patients in the nonertapenem group. Antibiotics included in the nonertapenem group were cefazolin (32%), ceftriaxone (22%), or ciprofloxacin (15%) plus metronidazole, and other antibiotics (31%). Baseline characteristics including age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and number of surgical procedures were similar for both groups. The overall SSI rate was 4.7% and the 60-day C. difficile rate was 3.9%. No significant differences were found between ertapenem and nonertapenem groups in SSI rates (5.8% vs. 4.6%, P = 0.6) or 60-day incidence of C. difficile (6.9% vs. 3.6%, P = 0.1). Conclusion Our study, with a large sample size and a low overall incidence of SSI, did not find a significant difference in either SSI rates or 60-day C. difficile rates between ertapenem and nonertapenem prophylaxis in colorectal surgery. Given the rise of Gram-negative resistance, this study highlights an important opportunity for carbapenem stewardship. Disclosures All authors: No reported disclosures.

Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?

2018 ◽  
Vol 12 (5) ◽  
pp. 391-395
Author(s):  
Isabel E-Hui Chu ◽  
Weranja Ranasinghe ◽  
Madeleine Nina Jones ◽  
Philip McCahy
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Treatment Options ◽  
Cost Effective ◽  
Renal Stones ◽  
Level Of Evidence ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Chi Squared ◽  
Recovery Times ◽  
Operative Costs

Introduction: Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia. Materials and methods: A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis. Results: There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209). Conclusions: Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.

scholarly journals Back to Basics: Could the Preoperative Skin Antiseptic Agent Help Prevent Biofilm-Related Capsular Contracture?

2018 ◽  
Vol 39 (8) ◽  
pp. 848-859 ◽  
Author(s):  
Jenny Carvajal ◽  
Melissa Carvajal ◽  
Gilma Hernández
Keyword(s):  
Breast Augmentation ◽  
Capsular Contracture ◽  
Bacterial Biofilm ◽  
Skin Microbiome ◽  
Level Of Evidence ◽  
Clinical Safety ◽  
Skin Preparation ◽  
Significant Difference ◽  
Chi Squared ◽  
Healthcare Epidemiology

AbstractBackgroundCapsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.ObjectivesThe authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.MethodsIn June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.ResultsPearson’s chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.ConclusionsCHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.Level of Evidence: 3

The Canadian Association of Radiologists Guidelines for the Prevention of Contrast-induced Nephropathy: A Critical Appraisal

2011 ◽  
Vol 62 (4) ◽  
pp. 238-242 ◽  
Author(s):  
Luigi Lepanto ◽  
An Tang ◽  
Jessica Murphy-Lavallée ◽  
Jean-Sébastien Billiard
Keyword(s):  
Risk Reduction ◽  
Data Extraction ◽  
Stakeholder Involvement ◽  
Route Of Administration ◽  
Contrast Induced Nephropathy ◽  
Level Of Evidence ◽  
University Of Oxford ◽  
Iodinated Contrast ◽  
Canadian Association ◽  
Ionic Contrast

Objective The purpose of this study is to critically appraise the Canadian Association of Radiologists (CAR) guidelines on the prevention of contrast-induced nephropathy (CIN). Methods The Appraisal of Guidelines Research and Evaluation (AGREE) tool is a questionnaire that consists of 23 key items organized in 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, editorial independence). Four radiologists read the guidelines and completed the questionnaire independently. To assess the quality of the evidence, the articles listed in the bibliography were reviewed, and the following data were collected and tabulated: the type of contrast, the administration route, and the level of evidence (Centre for Evidence Based Medicine, University of Oxford). Results The highest score was for scope and purpose (92%), whereas the lowest scores were for rigor of development (50%) and applicability (40%). The score for the remaining domains were the following: stakeholder involvement (59%), clarity and presentation (69%), and editorial independence (63%). Although the bibliography of the CAR guidelines list 46 articles, only 33 were deemed pertinent to support the recommendations related to risk stratification or risk reduction of CIN. Only 3 articles dealt specifically with intravenous injection of iodinated contrast. Four articles dealt with ionic contrast, and, in 17 references, the contrast type was not specified. The best evidence (level 1) was in support of risk-reduction recommendations, but, in 8 of the 9 articles cited, the route of administration studied was exclusively intra-arterial. Conclusion It would be appropriate to revisit the topic of CIN and formulate new guidelines. A formal systematic review of the literature should be undertaken and the data extraction should specifically address contrast type and route of administration, as well as the applicability of any recommendations.

scholarly journals Trends in Publication and Levels of Evidence in Foot and Ankle International From 2000-2015

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Matthew Griffith ◽  
Edward Han ◽  
Joshua Hattaway ◽  
Jeannie Huh
Keyword(s):  
Scientific Quality ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Publication Rates ◽  
Orthopaedic Literature ◽  
Chi Squared ◽  
Commercial Sources ◽  
Level I ◽  
Study Type

Category: Other Introduction/Purpose: As the movement towards evidence-based medicine grows and publication rates rise each year, critical analysis of the orthopaedic literature has become increasingly important. To aid readers in assessing the scientific quality of published research, Foot and Ankle International (FAI) began assigning levels of evidence to all clinical articles in 2008. The purpose of this study was to analyze trends in the characteristics and levels of evidence of articles published in FAI between 2000 and 2015. Methods: All articles published in FAI from 2000, 2005, 2010, and 2015 were reviewed and categorized into article type (clinical, basic science, review, or technical tip). Each clinical article was assigned a level of evidence (I-V) and study type (prognostic, therapeutic, economic, or diagnostic). Descriptive information was gathered pertaining to: country of origin, authorship, and funding. Statistical analysis was performed using chi-squared tests to detect any trends in levels of evidence and publication characteristics. Results: 647 articles were reviewed from 2000 to 2015. There was a statistically significant increase in the publication of clinical articles (70% to 83%; p=0.013). The publication of levels I and II evidence significantly increased (2.44% to 13.53%; p=0.002). Although levels III-V evidence also increased (65% to 70.6%, p=1.014), this was not statistically significant. Publications originated from 39 countries, with a significant increase in the proportion of international papers (32.8% to 48%%; p=0.007). The proportion of articles authored by Podiatrists during the study period significantly decreased (3.73% to 1.74%, p=0.035). Finally, there was an increase in funding disclosures during the study period; funding from grants or professional groups rose from 2.44% to 15.9% (p<0.001) and reported funding from commercial sources rose from 0% to 9.41% (p=0.002). Conclusion: The proportion of level I and II studies published in FAI significantly increased from 2000 to 2015. The publication of clinical research rose, with a majority being therapeutic studies. There was a significant increase in articles published by international authors and a significant decrease in articles published by DPMs. During the same time period, there was a rise in the proportion of articles reporting the use of outside funding, both professional and commercial.

scholarly journals Trends in Publication and Levels of Evidence in Foot & Ankle International From 2000 to 2015

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093141
Author(s):  
Matthew Griffith ◽  
Edward Han ◽  
Joshua Hattaway ◽  
Jeannie Huh
Keyword(s):  
Clinical Research ◽  
Basic Science ◽  
Scientific Quality ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Publication Rates ◽  
Chi Squared ◽  
Commercial Sources ◽  
Level I ◽  
Study Type

Background: As the movement toward evidence-based medicine grows and publication rates rise each year, critical analysis of the orthopedic literature has become increasingly important. To aid readers in assessing the scientific quality of published research, Foot & Ankle International ( FAI) began assigning levels of evidence to all clinical articles in 2008. The purpose of this study was to analyze trends in the characteristics and levels of evidence of articles published in FAI between 2000 and 2015. Methods: All articles published in FAI from the years 2000, 2005, 2010, and 2015 were reviewed and categorized into article type (clinical, basic science, review, or technical tip). Each clinical article was assigned a level of evidence (I-V) and study type (prognostic, therapeutic, economic, or diagnostic). Descriptive information was gathered pertaining to country of origin, author credentials, and funding. Statistical analysis was performed using chi-squared tests to detect any trends in levels of evidence and publication characteristics. Results: A total of 647 articles were reviewed. From 2000 to 2015, there was a statistically significant increase in the publication of clinical research articles (70% to 83%; P = .013), while the number of basic science articles decreased (29% to 17%; P = .013). Of the clinical articles, there was a significant increase in therapeutic studies (41% to 58%; P = .003). During the study period, the publication of Level I and II evidence significantly increased (2% to 14%; P = .002). Although Level III and V evidence also increased (65% to 71%, P > .99), this was not found to be statistically significant. Publications originated from a total of 39 countries, with a significant increase in the proportion of international papers (33% to 48%; P = .007) over the study period. The proportion of articles authored by Doctors of Podiatric Medicine (DPMs) during the study period significantly decreased (4% to 2%, P = .035). Finally, the percentage of studies that disclosed the use of outside funding increased during the study period, with reported funding from grants or professional groups rising from 3% to 16% ( P < .001) and reported funding from commercial sources rising from 0% to 9% ( P = .002). Conclusion: The proportion of Level I and II studies published in FAI significantly increased from 2000 to 2015. The publication of clinical research rose, with a majority being therapeutic studies. There was a significant increase in articles published by international authors and a significant decrease in articles published by DPMs. During the same time period, there was a rise in the proportion of articles reporting the use of outside funding, both professional and commercial.

scholarly journals Level of Evidence of Dental Research in Saudi Arabia (2000–2020)

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mona Rajeh ◽  
Waad Khayat
Keyword(s):  
Systematic Review ◽  
Saudi Arabia ◽  
International Collaboration ◽  
Web Of Science ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Dental Research ◽  
Significant Difference ◽  
Level I

Objectives. The level of evidence (LOE) of Saudi dental research from 2000 to 2020 was evaluated, and factors associated with the LOE were determined. Methods. This study was a systematic review. PubMed, Web of Science, and Medline databases were utilized to retrieve available dental articles published in English between January 2000 and May 2020. The inclusion criteria consisted of clinical studies conducted in Saudi Arabia with at least one Saudi dental affiliation. The retrieved eligible articles were evaluated independently by two reviewers using a modified Oxford LOE scale. The LOE of the studies was compared between the last two decades. Results. Of the 7237 articles identified, 1557 articles met the inclusion criteria. Approximately 78% of the published articles reported Level IV evidence. A higher trend toward Level I, II, and III publications has occurred in recent years (i.e., 2010–2020). However, no statistically significant difference existed in LOE proportions between the two decades. The presence of international collaboration and high journals’ impact factor was significantly associated with a higher LOE. Conclusion. Most published dental research studies were low LOE studies (i.e., Level IV). National and international collaboration is highly encouraged as this is a factor, according to our findings, that would be a positive addition toward publishing dental research of a higher LOE in Saudi Arabia.

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