Conducting two evidence syntheses in six weeks - experiences with and evaluation of a pilot project.

BACKGROUND: Evidence synthesis organisations are trying to meet commissioners' needs for rapid responses to their evidence synthesis commissions. In this project we piloted an intensive process, working to complete evidence syntheses within six-weeks, rather than the standard lead time of 4-6 months. Our objective was to explore how researchers experience working intensively, identify barriers and facilitators, and determine how a more intensive approach to evidence synthesis could be more systematically introduced in the future. METHODS: In a pre-planning phase, an intensive work group was established, and two commissions were selected for this pilot project. The evidence synthesis process was divided into two phases: planning and intensive. The planning phase, involved scheduling the intensive phase, exploring new digital tools, and identifying peer reviewers. The intensive phase encompassed the entire evidence synthesis process. Two review teams were formed, each with a team lead supported by a process lead and leadership contact point. Throughout the project, teams engaged in reflective meetings to evaluate and adjust processes as needed. RESULTS: During the planning phase, teams identified significant uncertainties regarding scopes, research questions, and inclusion criteria. To address this, they engaged with commissioners earlier than originally planned, clarified these aspects, and prepared protocols. Despite some minor deviations from the original plan, both reviews were completed on schedule, with one team expanding their scope due to the absence of eligible studies. Teams operated flexibly, held regular meetings, and found the process seamless due to fewer interruptions. Machine learning tools facilitated rapid study selection. The process lead role, created to guide and evaluate the project, proved beneficial, providing structure and support, although clearer role delineation with the leadership contact point could have improved efficiency. CONCLUSIONS: Overall, the intensive process fostered focus and productivity, allowing teams to manage short-term deliverables effectively. The researchers preferred working intensively with one evidence synthesis over being involved with many projects at the same time. They felt that time use was more effective, and they were able to complete the tasks in a focused way. However, there are several implications that should be considered before implementing an intensive approach in future evidence syntheses.

Optimizing the literature search: coverage of included references in systematic reviews in Medline and Embase.

Objective: The aim of this study was to investigate if the included references in a set of completed systematic reviews are indexed in Ovid MEDLINE and Ovid Embase, and how many references would be missed if we were to constrict our literature searches to one of these sources, or the two databases in combination. Methods: We conducted a cross-sectional study where we searched for each included reference (n = 4,709) in 274 reviews produced by the Norwegian Institute of Public Health to find out if the references were indexed in the respective databases. The data was recorded in an Excel spreadsheet where we calculated the indexing rate. The reviews were sorted into eight categories to see if the indexing rate differs from subject to subject. Results: The indexing rate in MEDLINE (86.6%) was slightly lower than in Embase (88.2%). Without the MEDLINE records in Embase, the indexing rate in Embase was 71.8%. The highest indexing rate was achieved by combining both databases (90.2%). The indexing rate was highest in the category "Physical health - treatment" (97.4%). The category "Welfare" had the lowest indexing rate (58.9%). Conclusion: Our data reveals that 9.8% of the references are not indexed in either database. Furthermore, in 5% of the reviews, the indexing rate was 50% or lower.

Prehospital Tourniquets in Civilians: A Systematic Review.

OBJECTIVES: Terrorist attacks and civilian mass-casualty events are frequent, and some countries have implemented tourniquet use for uncontrollable extremity bleeding in civilian settings. The aim of this study was to summarize current knowledge on the use of prehospital tourniquets to assess whether their use increases the survival rate in civilian patients with life-threatening hemorrhages from the extremities. DESIGN: Systematic literature review in Medline (Ovid), Embase (Ovid), Cochrane Library, and Epistemonikos was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. The search was performed in January 2019. SETTING: All types of studies that examined use of tourniquets in a prehospital setting published after January 1, 2000 were included. PRIMARY/SECONDARY OUTCOMES: The primary outcome was mortality with and without tourniquet, while adverse effects of tourniquet use were secondary outcomes. RESULTS: Among 3,460 screened records, 55 studies were identified as relevant. The studies were highly heterogeneous with low quality of evidence. Most studies reported increased survival in the tourniquet group, but few had relevant comparators, and the survival benefit was difficult to estimate. Most studies reported a reduced need for blood transfusion, with few and mainly transient adverse effects from tourniquet use. CONCLUSION: Despite relatively low evidence, the studies consistently suggested that the use of commercial tourniquets in a civilian setting to control life-threatening extremity hemorrhage seemed to be associated with improved survival, reduced need for blood transfusion, and few and transient adverse effects.