可持续发展专题

Topics on sustainable development
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Assessing Teledentistry versus In-Person Examinations to Detect Dental Caries: A Systematic Review and Meta-analysis.
Introduction: There is no recent consensus on the effectiveness of teledentistry versus in-person examination in the diagnosis of dental caries, especially after the COVID-19 pandemic. Objective: To assess the diagnostic accuracy of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO #CRD42023410962). Methods: This systematic review and meta-analysis compared the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 and December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA-DTA guidelines, following a review for quality assessment and risk of bias using the QUADAS-2 and JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the MADA package. A descriptive analysis of the sensitivity, specificity, diagnostic odds ratio, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane and Higgins's 2 tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect and reported summary diagnostic odds ratios. Results: Twelve studies met the inclusion criteria and were reviewed and included in the meta-analysis. The diagnostic parameters ranged from 45.6% to 88.3% for sensitivity, 55.2% to 98.3% for specificity, 79% to 92% for positive predictive value, 48% to 97% for negative predictive value, and 70% to 96% for accuracy. The κ scores ranged from 0.46 to 0.89 for teledentistry modalities. Tests for equality of sensitivities and specificities were significant ( < 0.001). The studies were not heterogeneous with Cochran's : 14.502 ( = 0.206) and Higgins's 2 of 24%. The multivariable analysis showed a diagnostic odds ratio based on the DerSimonian-Laird random effect of 35.14, which indicates that the odds of caries detection via teledentistry is 35 times more true positive (i.e., correctly identifying a positive condition) than false positive. Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries.Knowledge Transfer Statement:This systematic review and meta-analysis added to the evidence about using teledentistry assessment as a diagnostically accurate tool to detect dental caries. Using teledentistry dental practices could promote greater access to dental and oral health care in the absence of in-person assessment.
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Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey
Objectives: (i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures. Study Design and Setting: PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included.Results: Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor.Conclusion: GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.& COPY; 2023 Elsevier Inc. All rights reserved.
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Promoting the quality and transparency of health research in China
Background and Objectives: To review the efforts and progress in promoting quality and transparency of health research in China and to discuss how to improve.Methods: We focused on three different types of health research: clinical trials, systematic reviews, and clinical practice guidelines, and summarized China's progress from their registration, implementation, and reporting stages.Results: In the last 3 decades, China's major works include the following: 1) For registration, the trials and CPGs registries have been set up, and released policies to mandate registration and submission of protocols for trials. 2) For implementation, multiple clinical research and EBM centers have been established. The ResMan platform for data management has been created and required researchers to share results data. 3) For reporting, the Chinese EQUATOR Center has been set up. Translations and extensions of the CONSORT, PRISMA, and RIGHT have been published. 4) For traditional Chinese medicine (TCM), specific guidelines for the registration and reporting of TCM research have been developed.Conclusion: China has made progress in promoting research quality and transparency, especially in research registration and reporting. Nevertheless, more can be done in data management and sharing for research implementation, and good publication practices in TCM.(c) 2022 Elsevier Inc. All rights reserved.
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Clinical Epidemiology in China series. Paper 1: Evidence-based medicine in China: An oral history study
Objective: To describe and record the evolution of EBM in China. Study Design and Setting: We conducted the study following the general methodology of oral history. The interviews were done at Lanzhou University, between 18th and 22 nd April 2019 using pre-defined questions. All interviews were videorecorded. Two investigators extracted and analyzed the information from the interviews independently. Results: One international expert and ten Chinese experts participated in the interviews. After the introduction of EBM in China in the mid-1990s, more than 20 EBM centres have been established. According to the interviewees, Gordon Guyatt, David Sackett and lain Chalmers are the international experts who played the most important role in the development of EBM in China. China has contributed to EBM on the international level by conducting systematic reviews, developing reporting checklists, and introducing the principles of EBM into Traditional Medicine. The Chinese Cochrane Centre and the EBM Centre of Lanzhou University were ranked the top two EBM Centres in China by the interviewees. Conclusion: EBM has been developing in China for nearly a quarter of a century. Many achievements have been reached, however, EBM is still facing many challenges in China, including shortages of funding support and personnel, as well as limited local high-quality evidence. (C) 2021 Elsevier Inc. All rights reserved.
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Are implementation interventions effective in promoting the adoption of evidence-based practices in stroke rehabilitation? A Cochrane Review summary with commentary.
Background: Stroke is the leading cause of disability among neurological disorders. Evidence-based practices to reduce disability are presumed to be associated with more favorable outcomes. Objective: To assess whether implementation interventions are effective at increasing uptake of evidence-based practices in stroke rehabilitation. Methods: The Cochrane Review by Cahill et al. (2020) is summarized. Results: The effectiveness of implementation interventions on health professionals' use of evidence- based practices is uncertain. Conclusions: There is an urgent need for future research investigating the utility of implementation interventions to ensure the uptake of evidence by health professionals for the benefit of stroke survivors.
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Collaborative writing applications in support of knowledge translation and management during pandemics: A scoping review.
Objectives: This study aimed to: (1) Map existing evidence about the use of collaborative writing applications (CWAs) during pandemics; (2) Describe CWAs' positive and negative effects on knowledge translation (KT) and knowledge management (KM) during pandemics; and (3) Inventory the barriers and facilitators that affect CWAs' use to support KT and KM during pandemics. Materials and methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews, we conducted a scoping review of the literature reporting the use of CWAs during pandemics published between 2001 and 2021. Two reviewers undertook the screening, study selection and qualitative thematic analysis. Results: We identified a total of 46 studies. CWAs were used for the following two purposes: KT and KM (23 of 46) anddisease surveillance and infodemiology (20 of 46). Three studies addressed both purposes. Influenza was the focus of most studies (15 of 46), followed by COVID-19 (10 of 46).We identified and classified 24 barriers and 66 facilitators into four categories (factors related to the CWAs, users' knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 74 positive and 7 negative effects that were classified into processes and outcomes. Conclusion: CWAs offer the potential to accelerate KT and KM during pandemics. Their scalability and adaptability to different contexts makes them well suited to support the urgent KT and KM needed in the context of rapidly changing knowledge during pandemics. While their speed and cost as disease surveillance systems compare favorably with existing surveillance systems, the primary challenge is to ensure the accuracy of information shared.
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Clinical Epidemiology in China series. Paper 2: Promoting GRADE at the national level: The experience from China
Objective: To share the experience of promoting GRADE in China. Study design and setting: We designed the study and collected data on the following three aspects of the GRADE in China: the key activities related to GRADE, the main achievements of the GRADE, and potential challenges and future opportunities. Results: Three GRADE centres have been established in China since 2011. Seventeen articles of the GRADE working group have been translated and published in Chinese, and 31 articles have been written by Chinese scientists in Chinese to introduce and interpret the GRADE approach so far. More than 50 GRADE workshops and meetings have been held by GRADE centres in China, covering two-thirds of all provinces and autonomous regions of China. The percentages of societies from the Chinese Medical Association (CMA) and the Chinese Medical Doctor Association (CMDA) that used the GRADE system to develop guidelines were 30% and 18%, respectively. Conclusion: Over the past decade, China has made progress in promoting the GRADE system and Chinese GRADE centres have made a significant contribution.
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Extending the RIGHT statement for reporting adapted practice guidelines in healthcare: the RIGHT-Ad@pt Checklist protocol
Introduction The adaptation of guidelines is an increasingly used methodology for the efficient development of contextualised recommendations. Nevertheless, there is no specific reporting guidance. The essential Reporting Items of Practice Guidelines in Healthcare (RIGHT) statement could be useful for reporting adapted guidelines, but it does not address all the important aspects of the adaptation process. The objective of our project is to develop an extension of the RIGHT statement for the reporting of adapted guidelines (RIGHT-Ad@pt Checklist). Methods and analysis To develop the RIGHT-Ad@pt Checklist, we will use a multistep process that includes: (1) establishment of a Working Group; (2) generation of an initial checklist based on the RIGHT statement; (3) optimisation of the checklist (an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review by guideline developers and users and a final assessment of adapted guidelines); and (4) approval of the final checklist. At each step of the process, we will calculate absolute frequencies and proportions, use content analysis to summarise and draw conclusions, discuss the results, draft a report and refine the checklist. Ethics and dissemination We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). We will disseminate the RIGHT-Ad@pt Checklist by publishing into a peer-reviewed journal, presenting to relevant stakeholders and translating into different languages. We will continuously seek feedback from stakeholders, surveil new relevant evidence and, if necessary, update the checklist. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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