Person:

Mita, Carol

Objective For health information technology tools to fully inform evidence-based decisions, recommendations must be reliably assessed for quality and strength of evidence. We aimed to create an annotation framework for grading recommendations regarding appropriate use of diagnostic imaging examinations.

Methods The annotation framework was created by an expert panel (clinicians in three medical specialties, medical librarians, and biomedical scientists) who developed a process for achieving consensus in assessing recommendations, and evaluated by measuring agreement in grading the strength of evidence for 120 empirically selected recommendations using the Oxford Levels of Evidence.

Results Eighty-two percent of recommendations were assigned to Level 5 (expert opinion). Inter-annotator agreement was 0.70 on initial grading (κ = 0.35, 95% CI, 0.23-0.48). After systematic discussion utilizing the annotation framework, agreement increased significantly to 0.97 (κ = 0.88, 95% CI, 0.77-0.99).

Conclusions A novel annotation framework was effective for grading the strength of evidence supporting appropriate use criteria for diagnostic imaging exams.

Objective: Acupuncture has become popular and widely practiced in many countries around the world. Despite the large amount of acupuncture-related literature that has been published, broader trends in the prevalence and scope of acupuncture research remain underexplored. The current study quantitatively analyzes trends in acupuncture research publications in the past 20 years. Methods: A bibliometric approach was used to search PubMed for all acupuncture-related research articles including clinical and animal studies. Inclusion criteria were articles published between 1995 and 2014 with sufficient information for bibliometric analyses. Rates and patterns of acupuncture publication within the 20 year observational period were estimated, and compared with broader publication rates in biomedicine. Identified eligible publications were further analyzed with respect to study type/design, clinical condition addressed, country of origin, and journal impact factor. Results: A total of 13,320 acupuncture-related publications were identified using our search strategy and eligibility criteria. Regression analyses indicated an exponential growth in publications over the past two decades, with a mean annual growth rate of 10.7%. This compares to a mean annual growth rate of 4.5% in biomedicine. A striking trend was an observed increase in the proportion of randomized clinical trials (RCTs), from 7.4% in 1995 to 20.3% in 2014, exceeding the 4.5% proportional growth of RCTs in biomedicine. Over the 20 year period, pain was consistently the most common focus of acupuncture research (37.9% of publications). Other top rankings with respect to medical focus were arthritis, neoplasms/cancer, pregnancy or labor, mood disorders, stroke, nausea/vomiting, sleep, and paralysis/palsy. Acupuncture research was conducted in 60 countries, with the top 3 contributors being China (47.4%), United States (17.5%), and United Kingdom (8.2%). Retrieved articles were published mostly in complementary and alternative medicine (CAM) journals with impact factors ranging between 0.7 and 2.8 in the top 20 journals, followed by journals specializing in neuroscience, pain, anesthesia/analgesia, internal medicine and comprehensive fields. Conclusion: Acupuncture research has grown markedly in the past two decades, with a 2-fold higher growth rate than for biomedical research overall. Both the increases in the proportion of RCTs and the impact factor of journals support that the quality of published research has improved. While pain was a consistently dominant research focus, other topics gained more attention during this time period. These findings provide a context for analyzing strengths and gaps in the current state of acupuncture research, and for informing a comprehensive strategy for further advancing the field.

Context: The association between linear growth faltering and child development outcomes is generally well-recognized; however, the relationship between metrics of acute undernutrition and development has received less attention. Objectives: We aimed to quantify the association between acute undernutrition in childhood with development outcomes in low- and middle-income countries (LMIC). Methods: We conducted a systematic literature review of observational studies that assessed the association between metrics of acute undernutrition, including body mass index-for-age z-score (BMIZ), mid-upper arm circumference (MUAC), weight-for-height/length z-score (WHZ/WLZ), wasting (WHZ/ WLZ <-2), and severe acute malnutrition (SAM) among children under 5 years of age with cognitive, motor, language, and socio-emotional development assessed to 19 years of age. We estimated the pooled correlation and standardized mean difference (SMD) for cross-sectional and longitudinal studies. Results: A total of 113 studies from 40 LMICs were identified. Metrics of acute undernutrition were associated with lower cognitive and motor development outcomes. In longitudinal studies that reported multivariable-adjusted estimates for the cognitive domain, SAM was associated with -1.06 SD lower scores (95% CI: -1.41, -0.72) as compared to non-SAM children. SAM was also associated with lower motor scores in longitudinal studies with unadjusted estimates (SMD: -0.42; 95% CI: -0.68, -0.15). In longitudinal studies with multivariable estimates, wasting was associated with lower motor scores (SMD: -0.30; 95% CI: -0.54, -0.06), but there was no association with language (SMD: -0.08; 95% CI: -0.24, 0.07) and prosocial development scores (SMD: -0.18; 95% CI: -0.38, 0.02). Conclusion: Metrics of acute undernutrition in childhood were consistently associated with lower development scores, and the magnitude appeared stronger for children with SAM or wasting.