Systematic reviews and meta-analysis with sub-groups - A commentary.

As the outcomes of systematic reviews and meta-analysis are used to inform clinical practice it is imperative that the review and meta-analysis conducted is accurate and rigorous. In this commentary the authors wish to review the recommended approaches to be used when conducting a meta-analysis of quantitative data in a systematic review and outline the common errors and risks. The authors of this commentary aim to highlight the consequence of potential errors when conducting a meta-analysis using sub-groups with an example from a systematic review published in Research in Social and Administrative Pharmacy in 2019.

Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial.

BACKGROUND: Adherence Therapy is a candidate intervention to promote consistent medication taking in people with type 2 diabetes. The aim of this study was to establish the feasibility of conducting a randomized controlled trial of adherence therapy in people with type 2 diabetes who were non-adherent with medication. METHODS: The design is an open-label, single-center, randomized controlled feasibility trial. Participants were randomly allocated to receive either eight sessions of telephone-delivered adherence therapy or treatment as usual. Recruitment occurred during the COVID-19 pandemic. Outcome measures-adherence, beliefs about medication, and average blood glucose (sugar) levels (HbA1c)-were administered at baseline and after 8 weeks (TAU group) or at the completion of the treatment (AT group). Feasibility outcomes included the number of people approached to participate in the trial and the numbers that consented, completed study measures, finished treatment with adherence therapy, and dropped out of the trial. Fieldwork for this trial was conducted in the National Guard Hospital, a tertiary care provider, in the Kingdom of Saudi Arabia. RESULTS: Seventy-eight people were screened, of which 47 met eligibility criteria and were invited to take part in the trial. Thirty-four people were excluded for various reasons. The remaining thirteen who consented to participate were enrolled in the trial and were randomized (AT, n = 7) (TAU, n = 6). Five (71%) of the seven participants in the adherence therapy arm completed treatment. Baseline measures were completed by all participants. Week 8 (post-treatment) measures were completed by eight (62%) participants. Dropout may have been linked to a poor understanding of what was involved in taking part in the trial. CONCLUSIONS: It may be feasible to conduct a full RCT of adherence therapy, but careful consideration should be given to developing effective recruitment strategies, consent procedures, rigorous field testing, and clear support materials. TRIAL REGISTRATION: The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000827134, on the 7th of June 2019.

Effectiveness of Adherence Therapy in Adults with Type 2 Diabetes: A Systematic Review.

Adherence therapy has been shown to be an effective adjunct treatment in long-term conditions including hypertension. The purpose of this study is to review and critically appraise evidence on the effectiveness of adherence therapy as an intervention in adults with type 2 diabetes. A systematic search of clinical trials published between 2005 and January 2020 in databases was undertaken in October 2018 and updated in August 2020. Inclusion criteria were any clinical trials where the population under investigation was adults with type 2 diabetes and the experimental intervention was adherence therapy. Version 2 of the Cochrane risk of bias was used to determine the quality of the included studies. No studies met our inclusion criteria. However, four studies that we excluded at full text screening tested some of the components (e.g., problem solving) of adherence therapy. As is recommended when reporting empty reviews, those studies were synthesized to determine if useful information can be extracted. That no trials of adherence therapy have been reported in type 2 diabetes establishes a potentially important gap in knowledge. This review was registered in PROSPERO (registration number: CRD42019115216) after the initial searches were completed.

A study protocol for a feasibility trial of telephone-delivered Adherence Therapy for adults with type 2 diabetes.

AIMS: Adherence therapy is a candidate intervention to improve medication adherence and clinical outcomes in patients with type 2 diabetes. The feasibility of conducting a trial of adherence therapy in this population has not been established. The objective of this study is therefore to test the feasibility of conducting a randomized controlled trial of adherence therapy in a Middle Eastern context. DESIGN: A single-centre randomized controlled feasibility trial of adherence therapy in patients with type 2 diabetes. METHODS: We will undertake an initial cultural adaptation of a telephone-delivered form of adherence therapy in four patients in a Middle Eastern context. Our subsequent feasibility trial will aim to recruit 40 non-adherent diabetic patients that will be randomly allocated to receive eight weekly 30-min telephone adherence therapy sessions delivered by a diabetes educator versus treatment as usual. Key outcomes of interest include the number of patients invited to take part in the trial that consent to participate and then go on to complete treatment. RESULT: The findings of this study will determine the feasibility of undertaking a full randomized controlled trial of adherence therapy in patients with type 2 diabetes.

Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies.

BACKGROUND: Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors. METHODS: A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met. RESULTS: A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies. DISCUSSION: The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116373.

Association between subthreshold depression and self-care behaviour in people with type 2 diabetes: a protocol for systematic review of observational studies.

BACKGROUND: Depression is a common comorbidity in type 2 diabetes. Studies have consistently shown that major depression is associated with decreased diabetic self-care behaviour. People with subthreshold depression experience greater functional impairment, have a poorer quality of life and use health services more than those without depressive symptoms. Although subthreshold depression impacts self-care behaviour, the relationship between subthreshold depression and diabetes self-care behaviour has not been systematically reviewed. The objective of this systematic review is to determine the association between subthreshold depression and self-care behaviour in adults with type 2 diabetes. METHODS: This protocol will follow the guideline of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 (PRISMA-P-2015). A systematic search of literature will be conducted for observational studies reporting the association between subthreshold depression and self-care behaviour in adults aged 18 years or over and diagnosed with type 2 diabetes. Electronic databases including MEDLINE, EMBASE, PsycINFO, Emcare and CINAHL will be searched using predefined search terms. Title and abstract, full-text screening and data extraction of identified articles will be done by two reviewers independently. Discrepancies will be resolved by a third author. The methodological quality of the included studies will be assessed using The Joanna Briggs Institute (JBI) risk of bias tools. The review results will be presented in the form of narrative synthesis, and if sufficient studies are available and variability among the studies is low, a random effects meta-analysis will be done to quantify the result. DISCUSSION: This review will synthesise evidence on the association between subthreshold depression and self-care behaviour in type 2 diabetic adults. The findings will be useful to researchers and policymakers to determine the most effective approach to overall diabetes management. The review will also identify research gaps in the current literature and provide direction for future research in this area of study. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018116373.

HEALTH AWARENESS AMONG FEMALE UNDERGRADUATE MEDICAL STUDENTS IN SAUDI ARABIA.

This study was conducted to assess the level of health awareness (HA) among students attending three undergraduate programs in the Colleges of Applied Medical Sciences (CAMS) in Riyadh, Saudi Arabia (SA). A modified self-reported survey was utilized to measure HA demonstrating four domains: Nutrition (NU), Personal Health (PH), Physical Exercise (PE), and Body Build (BB). The questionnaire was distributed to 302 female students attending the first semester of the academic year 2014-2015 BS degree in Radiology Sciences (RS), Clinical Laboratory (CL), and Health Education (HE) departments. Bloom's taxonomy was utilized to describe the three cognitive levels. Synthesizing, creating, and evaluating were grouped to represent high level indicators; applying cognitive skills only revealed an intermediate level; while memorizing and listing demonstrated low levels. In a 5-point Likert scale, the overall mean (M) of HA among CAMS students was 3.82 with the highest among students attending HE (M = 3.89). The domain of PH ranked first with a high average (M = 4.30). There were significant differences (α = 0.05), in the level of HA in PH and BB domains, among students in terms of program specialty only, but no such significant differences were found for other characteristics. The study recommended incorporating health promotion concepts within teaching curricula and conducting health and education campaigns by health education institutions.