Later school start times for supporting the education, health, and well-being of high school students.

BACKGROUND: A number of school systems worldwide have proposed and implemented later school start times as a means of avoiding the potentially negative impacts that early morning schedules can have on adolescent students. Even mild sleep deprivation has been associated with significant health and educational concerns: increased risk for accidents and injuries, impaired learning, aggression, memory loss, poor self-esteem, and changes in metabolism. Although researchers have begun to explore the effects of delayed school start time, no one has conducted a rigorous review of evidence to determine whether later school start times support adolescent health, education, and well-being. OBJECTIVES: We aimed to assess the effects of a later school start time for supporting health, education, and well-being in high school students.Secondary objectives were to explore possible differential effects of later school start times in student subgroups and in different types of schools; to identify implementation practices, contextual factors, and delivery modes associated with positive and negative effects of later start times; and to assess the effects of later school start times on the broader community (high school faculty and staff, neighborhood, and families). SEARCH METHODS: We conducted the main search for this review on 28 October 2014 and updated it on 8 February 2016. We searched CENTRAL as well as 17 key electronic databases (including MEDLINE, Embase, ERIC, PsycINFO, and Sociological Abstracts), current editions of relevant journals and organizational websites, trial registries, and Google Scholar. SELECTION CRITERIA: We included any randomized controlled trials, controlled before-and-after studies, and interrupted time series studies with sufficient data points that pertained to students aged 13 to 19 years and that compared different school start times. Studies that reported either primary outcomes of interest (academic outcomes, amount or quality of sleep, mental health indicators, attendance, or alertness) or secondary outcomes (health behaviors, health and safety indicators, social outcomes, family outcomes, school outcomes, or community outcomes) were eligible. DATA COLLECTION AND ANALYSIS: At least two review authors independently determined inclusion and exclusion decisions through screening titles, abstracts, and full-text reports. Two review authors independently extracted data for all eligible studies. We presented findings through a narrative synthesis across all studies. When two or more study samples provided sufficient information to permit effect size calculations, we conducted random-effects meta-analyses to synthesize effects across studies. MAIN RESULTS: Our search located 17 eligible records reporting on 11 unique studies with 297,994 participants; the studies examined academic outcomes, amount and quality of sleep, mental health indicators, attendance, and student alertness. Overall, the quality of the body of evidence was very low, as we rated most studies as being at high or unclear risk of bias with respect to allocation, attrition, absence of randomization, and the collection of baseline data. Therefore, we cannot be confident about the effects of later school start times.Preliminary evidence from the included studies indicated a potential association between later school start times and academic and psychosocial outcomes, but quality and comparability of these data were low and often precluded quantitative synthesis. Four studies examined the association between later school start times and academic outcomes, reporting mixed results. Six studies examined effects on total amount of sleep and reported significant, positive relationships between later school start times and amount of sleep. One study provided information concerning mental health outcomes, reporting an association between decreased depressive symptoms and later school start times. There were mixed results for the association between later school start times and absenteeism. Three studies reported mixed results concerning the association between later school start times and student alertness. There was limited indication of potential adverse effects on logistics, as the qualitative portions of one study reported less interaction between parents and children, and another reported staffing and scheduling difficulties. Because of the insufficient evidence, we cannot draw firm conclusions concerning adverse effects at this time.It is important to note the limitations of this evidence, especially as randomized controlled trials and high-quality primary studies are difficult to conduct; school systems are often unwilling or unable to allow researchers the necessary control over scheduling and data collection. Moreover, this evidence does not speak to the process of implementing later school starts, as the included studies focused on reporting the effects rather than exploring the process. AUTHORS' CONCLUSIONS: This systematic review on later school start times suggests several potential benefits for this intervention and points to the need for higher quality primary studies. However, as a result of the limited evidence base, we could not determine the effects of later school start times with any confidence.

Predicting Intracerebral Hemorrhage Growth With the Spot Sign: The Effect of Onset-to-Scan Time.

BACKGROUND AND PURPOSE: Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign. METHODS: We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates. RESULTS: Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours (P<0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased (P=0.004), with positive predictive values decreasing from 53% to 33%. CONCLUSIONS: The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.

A systematic review and meta-analysis of acute severe complications of pediatric anesthesia.

BACKGROUND: Quantification of acute severe complications of pediatric anesthesia is essential to plan clinical guidelines and educational curricula. AIM: Our aim was to identify complications in terms of frequency and outcomes. METHODS: We defined acute severe complications as an unexpected perioperative event, which without intervention by the anesthesiologist within 30 min may lead to disability or death. A systematic search was performed using MEDLINE, EMBASE, and CINAHL. Screening and data extraction were performed independently. Assessment of bias was conducted using GRADE guidelines. RESULTS: Of 3002 abstracts, 25 met all inclusion criteria. The most common acute severe complications in pediatric anesthesia are related to airway management and respiratory system, followed by cardiovascular events. There was a great variation in reporting the methods, particularly poor definitions of diagnostic criteria for complications. Data were heterogeneous and pooled estimates may not be generalizable. Some studies failed to define potential source of bias, explain how missing data were addressed, describe acute severe complications, and had incomplete postoperative follow-up. CONCLUSION: The data on pediatric anesthesia acute severe complications are poorly defined with large variation in the specificity of diagnostic reporting even within studies. We suggest that it is vital for future studies in this area to be based on a standardized system of diagnostic reporting (possibly with a hierarchical system of coding) with adequate description of population details to describe heterogeneity of data.

Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review.

OBJECTIVE: This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities. INTRODUCTION: Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population. INCLUSION CRITERIA: This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care. METHODS: This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors). RESULTS: The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision. CONCLUSIONS: To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.

Interprofessional team-based primary health care for adults with intellectual and developmental disabilities: a scoping review protocol.

OBJECTIVE: This review aims to examine the state of the evidence for interprofessional team-based primary health care for adults with intellectual and developmental disabilities. INTRODUCTION: Adults with intellectual and developmental disabilities have complex health needs, as well as experience health service inequities. Interprofessional primary healthcare teams offer access to comprehensive primary health care and are recommended as an approach to improve the health of this population. At present, limited information is available regarding what services interprofessional primary healthcare teams provide and how services are evaluated specific to the care of adults with intellectual and developmental disabilities. INCLUSION CRITERIA: This review will consider all studies that reference individuals with intellectual and developmental disabilities who are 18 years and over. It will consider all studies that refer to interprofessional healthcare provision within a primary healthcare team context. Interprofessional care is the term that will be used to describe services provided by interprofessional health providers (e.g. nurses, dietitians, social workers) in these teams. Work completed by physicians and nurses within traditional general practices will be excluded. METHODS: This review will be conducted according to the JBI methodology for scoping reviews. It will consider quantitative, qualitative and mixed methods study designs for inclusion. In addition, systematic reviews, program descriptions, clinical reviews and opinion papers will be considered. The review will consider all studies published since 2000 in English or French. All duplicates will be removed from identified citations. A data extraction tool will assist reviewers to identify and synthesize findings from selected papers.

The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review.

PURPOSE: Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. METHOD: Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. RESULTS: Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. CONCLUSIONS: Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

The use of Delphi and Nominal Group Technique in nursing education: A review.

OBJECTIVES: Consensus methods are used by healthcare professionals and educators within nursing education because of their presumed capacity to extract the profession's' "collective knowledge" which is often considered tacit knowledge that is difficult to verbalize and to formalize. Since their emergence, consensus methods have been criticized and their rigour has been questioned. Our study focuses on the use of consensus methods in nursing education and seeks to explore how extensively consensus methods are used, the types of consensus methods employed, the purpose of the research and how standardized the application of the methods is. DESIGN AND DATA SOURCES: A systematic approach was employed to identify articles reporting the use of consensus methods in nursing education. The search strategy included keyword search in five electronic databases [Medline (Ovid), Embase (Ovid), AMED (Ovid), ERIC (Ovid) and CINAHL (EBSCO)] for the period 2004-2014. We included articles published in English, French, German and Greek discussing the use of consensus methods in nursing education or in the context of identifying competencies. REVIEW METHOD: A standardized extraction form was developed using an iterative process with results from the search. General descriptors such as type of journal, nursing speciality, type of educational issue addressed, method used, geographic scope were recorded. Features reflecting methodology such as number, selection and composition of panel participants, number of rounds, response rates, definition of consensus, and feedback were recorded. RESULTS: 1230 articles were screened resulting in 101 included studies. The Delphi was used in 88.2% of studies. Most were reported in nursing journals (63.4%). The most common purpose to use these methods was defining competencies, curriculum development and renewal, and assessment. Remarkably, both standardization and reporting of consensus methods was noted to be generally poor. Areas where the methodology appeared weak included: preparation of the initial questionnaire; the selection and description of participants; number of rounds and number of participants remaining after each round; formal feedback of group ratings; definitions of consensus and a priori definition of numbers of rounds; and modifications to the methodology. CONCLUSIONS: The findings of this study are concerning if interpreted within the context of the structural critiques because our findings lend support to these critiques. If consensus methods should continue being used to inform best practices in nursing education, they must be rigorous in design.

References that anyone can edit: review of Wikipedia citations in peer reviewed health science literature.

OBJECTIVES: To examine indexed health science journals to evaluate the prevalence of Wikipedia citations, identify the journals that publish articles with Wikipedia citations, and determine how Wikipedia is being cited. DESIGN: Bibliometric analysis. STUDY SELECTION: Publications in the English language that included citations to Wikipedia were retrieved using the online databases Scopus and Web of Science. DATA SOURCES: To identify health science journals, results were refined using Ulrich's database, selecting for citations from journals indexed in Medline, PubMed, or Embase. Using Thomson Reuters Journal Citation Reports, 2011 impact factors were collected for all journals included in the search. DATA EXTRACTION: Resulting citations were thematically coded, and descriptive statistics were calculated. RESULTS: 1433 full text articles from 1008 journals indexed in Medline, PubMed, or Embase with 2049 Wikipedia citations were accessed. The frequency of Wikipedia citations has increased over time; most citations occurred after December 2010. More than half of the citations were coded as definitions (n = 648; 31.6%) or descriptions (n=482; 23.5%). Citations were not limited to journals with a low or no impact factor; the search found Wikipedia citations in many journals with high impact factors. CONCLUSIONS: Many publications are citing information from a tertiary source that can be edited by anyone, although permanent, evidence based sources are available. We encourage journal editors and reviewers to use caution when publishing articles that cite Wikipedia.

Lifestyle interventions targeting body weight changes during the menopause transition: a systematic review.

OBJECTIVE: To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition. METHODS: A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively. RESULTS: Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns. CONCLUSIONS: High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity.