Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. METHODS: We searched four databases from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. RESULTS: Our search identified 1799 studies, of which 18 studies (2002-2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses. DISCUSSION: Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs. PROSPERO REGISTRATION NUMBER: CRD42018100004.

Learn something new in 20 minutes: Bite Size sessions to support research and teaching.

The School of Health and Related Research (ScHARR) at The University of Sheffield run an innovative series of informal 20-minute Bite Size sessions to help staff and students teach, research, collaborate and communicate more effectively. The sessions have two clear strands: one focused on teaching and the other on research. The remit is not to teach people how to use something in their work or study, but to let them know why they should use it and how they can employ it. By introducing participants to the possibilities and how they can apply ideas and technologies in their work and study in an enthusiastic manner, it is possible to send them away with at least the intention to explore and experiment. The evidence shows that this organic approach is working--staff and students are starting to use many of the tools that Bite Size has covered. Any kind of widespread change within organisations can be hard to deliver, but by bringing champions on your side and delivering sessions in a convenient, informal and timely manner; good practice and ideas can spread naturally.

The SPECTRAL project: a training needs analysis for providers of clinical question answering services.

PURPOSE: To characterise the training needs of those providing clinical question answering services (CQAS). PARTICIPANTS: Seventeen specialist UK staff working in CQAS, 21 from general health library UK staff and eight international respondents. METHODOLOGY: A literature review examined documented training needs for CQAS staff. A follow-up questionnaire examined prior training and experience and identified training needs for the surveyed staff. RESULTS/OUTCOMES: Ninety per cent of CQAS staff had worked in health services for 3 years or longer. Training received in preparation for the CQAS role comprised literature searching (including the PRECEPT/ADEPT and cochrane library courses) and critical appraisal. Skills considered 'essential' for clinical question answering were 'literature searching' (100%), 'understanding the context of clinical questions', 'bibliographic databases', 'evidence-based sources' and 'the Internet' (all 93%). Main training needs for specialist CQAS staff include management and organisation of CQAS and technical skills in interpretation and presentation. DISCUSSION/CONCLUSION: CQAS staff require a formal training programme. Most CQAS staff considered that this should be a mandatory requirement.

Supporting 'Best Research for Best Health' with best information.

BACKGROUND: This article describes the potential role for National Health Service (NHS) libraries in supporting health research. The content is partly based on the proceedings of the 'Best Information for Best Research for Best Health' event at University of Leicester in November 2006. OBJECTIVES: With reference to the UK Department of Health's Research and Development (R&D) strategy, Best Research for Best Health and the Cooksey Review of public funding of health research, the article seeks to identify areas where NHS library and information staff can become involved in supporting the research process. METHODS: The authors examined the challenges and opportunities that these reports offer and looked at two areas where library and information services (LIS) staff can potentially expand their services-supporting researchers at every stage of the research process and transferring research into practice. RESULTS: Staff in NHS libraries need to create an environment in which their role in the research process is recognized and valued. LIS staff can develop roles within the research process and thereby improve the robustness and validity of research outputs. Training and development of LIS staff is a key priority and can be taken forward despite the limitations of budgets and staffing levels. CONCLUSIONS: A proactive and assertive approach is needed to achieve a cultural shift within NHS library practice from supporting research from the outside, to being fully integrated within the research process.

Public involvement at the design stage of primary health research: a narrative review of case examples.

OBJECTIVE: To review published examples of public involvement in research design, to synthesise the contributions made by members of the public, as well as the identified barriers, tensions and facilitating strategies. DESIGN: Systematic literature search and narrative review. FINDINGS: Seven papers were identified covering the following topics: breast-feeding, antiretroviral and nutrition interventions; paediatric resuscitation; exercise and cognitive behavioural therapy; hormone replacement therapy and breast cancer; stroke; and parents' experiences of having a pre-term baby. Six papers reported public involvement in the development of a clinical trial, while one reported public involvement in the development of a mixed methods study. Group meetings were the most common method of public involvement. Contributions that members of the public made to research design were: review of consent procedures and patient information sheets; outcome suggestions; review of acceptability of data collection procedures; and recommendations on the timing of potential participants into the study and the timing of follow-up. Numerous barriers, tensions and facilitating strategies were identified. CONCLUSIONS: The issues raised here should assist researchers in developing research proposals with members of the public. Substantive and methodological directions for further research on the impact of public involvement in research design are set out.