Examining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion Is neuropsychological testing useful in the management of sport-related concussion? Alterations in body composition and spasticity following subtetanic neuromuscular electrical stimulation training in spinal cord injury. Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. EFFECTS OF A SEASON OF SUBCONCUSSIVE CONTACT ON CHILD- SCAT3 SCORES IN 8-12 YEAR-OLD MALE ATHLETES. Uses and misuses of the STROBE statement: bibliographic study A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer Concussions in amateur rugby union identified with the use of a rapid visual screening tool Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury - A pilot randomized cross-over trial Rationale and design features of a clinical trial examining the effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis: Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT). SCAT Investigators. Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review protocol Abnormal uterine bleeding in pre-menopausal women. Comparison of tools for assessing the methodological quality of primary and secondary studies in health technology assessment reports in Germany Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Guidelines for randomized clinical trial protocol content: a systematic review The Effects of Exercise on Memory Function Among Young to Middle-Aged Adults: Systematic Review and Recommendations for Future Research Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR) Videogames and Health Improvement: A Literature Review of Randomized Controlled Trials. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Interventions to reduce the incidence of falls in older adult patients in acute care hospitals: a systematic review Methodological quality of systematic reviews in subfertility: a comparison of Cochrane and non-Cochrane systematic reviews in assisted reproductive technologies.
Background Concussion is one of the most commonly occurring injuries in sport today . The Sport Concussion Assessment Tool ( SCAT ) is a commonly used paper neurocognitive tool . To date , little is known about SCAT baseline normative values in youth athletes . Objective The purpose of this study was to determine normative values on the SCAT for male and female youth hockey players . Methods This is a secondary data analysis of pooled data from three prospect i ve cohort studies examining the risk of injury in paediatric ice hockey players aged 9–17 years . A preseason baseline demographic and injury history question naire was completed by each player . Results A total of 4193 players completed SCATs at baseline and were included in the analysis . 781 players ( 18.6 % ) reported a previous history of concussion . Fatigue and low energy followed by headache were the most commonly reported symptoms in all players . The majority of youth players could recite all five words immediately but only three words when delayed . A smaller proportion of the males were able to report the months of the year in reverse order compared with females of a similar age . The median number of digits recited in reverse order was 4 . Conclusions Youth ratings varied between age groups , gender and from previously reported ratings of varsity athletes , possibly reflecting developmental and gender differences . An underst and ing of these differences in youth athletes is important to ensure appropriate performance expectations on the SCAT and when making clinical decisions following a concussion OBJECTIVE Neuropsychological ( NP ) testing has been used for several years as a way of detecting the effects of sport-related concussion in order to aid in return-to-play determinations . In addition to st and ard pencil- and -paper tests , computerized NP tests are being commercially marketed for this purpose to professional , collegiate , high school , and elementary school programs . However , a number of important questions regarding the clinical validity and utility of these tests remain unanswered , and these questions present serious challenges to the applicability of NP testing for the management of sport-related concussion . Our purpose is to outline the criteria that should be met in order to establish the utility of NP instruments as a tool in the management of sport-related concussion and to review the degree to which existing tests have met these criteria . DATA SOURCES A comprehensive literature review of MEDLINE and PsychLit from 1990 to 2004 , including all prospect i ve , controlled studies of NP testing in sport-related concussion . DATA SYNTHESIS The effects of concussion on NP test performance are so subtle even during the acute phase of injury ( 1 - 3 days postinjury ) that they often fail to reach statistical significance in group studies . Thus , this method may lack utility in individual decision making because of a lack of sensitivity . In addition , most of these tests fail to meet other psychometric criteria ( eg , adequate reliability ) necessary for this purpose . Finally , it is unclear that NP testing can detect impairment in players once concussion-related symptoms ( eg , headache ) have resolved . Because no current guideline for the management of sport-related concussion allows a symptomatic player to return to sport , the incremental utility of NP testing remains question able . CONCLUSIONS / RECOMMENDATIONS Despite the theoretic rationale for the use of NP testing in the management of sport-related concussion , no NP tests have met the necessary criteria to support a clinical application at this time . Additional research is necessary to establish the utility of these tests before they can be considered part of a routine st and ard of care , and concussion recovery should be monitored via the st and ard clinical examination and subjective symptom checklists until NP testing or other methods are proven effective for this purpose The objective of this prospect i ve cohort study was to investigate alterations in body composition variables and spasticity following subtetanic neuromuscular electrical stimulation ( NMES ) training in an adult population with spinal cord injury ( SCI ) . Fourteen sedentary adults with SCI ( thoracic [T]4-T11 ; American Spinal Injury Association Impairment Scale A/B ; time since injury : 10.17 + /- 11.17 yr ) were recruited from the National SCI data base .  Four adhesive electrodes ( 175 cm2 each ) were placed bilaterally on the proximal and distal quadriceps and hamstrings muscle groups and subtetanic contractions were elicited using a h and held NMES device .  Lean body mass ( LBM ) and other body composition variables were measured using dual-energy X-ray absorptiometry . Spasticity was measured using the Spinal Cord Assessment Tool for Spastic Reflexes ( SCATs ) and visual analog scales . Verbal and written feedback was obtained to subjectively evaluate spasticity . LBM and spasticity measurements were taken before and after an 8 wk NMES training program in order to assess change . A statistically significant increase in lower-limb LBM , i.e. , muscle tissue ( p > 0.001 ) , and a reduction in SCATs ( p < 0.001 ) score , indicating reduced spasticity , was observed . Subjective responses were positive . Improvements in body composition and SCATs scores indicate that subtetanic NMES training elicits favorable responses and may have important clinical implication s for an SCI population > “ There are known knowns . These are things we know that we know . There are known unknowns . That is to say , there are things that we now know we do n't know . But there are also unknown unknowns . These are things we do not know we do n't know . ” > > —United States Secretary of Defense Donald Rumsfeld ( February 2002 ) > “ Thought is the wind , knowledge the sail , and mankind the vessel . ” > > August Hare ( 1792–1834 ) The international resuscitation community , under the auspices of the International Liaison Committee on Resuscitation ( ILCOR ) , has performed an exhaustive review of the published literature related to resuscitation and emergency cardiovascular care ( ECC ) . We had the opportunity to build on the detailed process developed over the past decade that facilitated the publication of the international consensus statement on therapeutic hypothermia1 and the Consensus on Cardiopulmonary Resuscitation ( CPR ) and ECC Science With Treatment Recommendations in 2005 (C2005).2 The overall process has been informed by the increasing evidence base behind good , systematic literature review s.3,4 There are , however , many questions that have never been addressed in a r and omized controlled trial , and much of the supporting scientific literature is at lower levels of evidence ( LOEs ) . In total , 356 worksheet authors from 29 countries throughout the world completed 411 worksheets on 277 topics . The information from these worksheets , with additional iterations from the writing groups and editorial board , makes up the evidence base from which the 2010 International Consensus on CPR and ECC Science with Treatment Recommendations ( CoSTR ) document is derived . As has been the process since the evidence evaluation for Guidelines 2000,5 volunteers from around the world were asked to perform systematic review s of the literature . These review s were conducted according to st and ardized instructions in completing the evidence worksheet template , and these worksheets were subsequently review ed in a detailed iterative process ( see www . ILCOR.org).6 A revised worksheet template ( based on that BACKGROUND Each year , over 173,000 children and adolescents visit emergency departments due to sports and recreation related concussions , an increase of 60 % over the last decade due to the rise in the number of children participating in sport . While numerous authors have sought to address the epidemiology of concussions across multiple age groups who participate in contact sports , a recent review of literature did not reveal a substantial amount of published articles that addressed the issue of subconcussive contact . Multiple tools have been developed to assess acute episodes of concussion . Among the assessment protocol s many include an assessment of balance , short and long term memory recall , and balance . The Child-SCAT3 was design ed specifically to evaluate concussions in children 5 - 12 years of age . OBJECTIVE The purpose of this study was to determine the effect of a season of subconcussive contact on  Child-SCAT3  scores in 8 - 12 year old males compared to their age matched peers who participated in non-contact sports .  A secondary purpose was to evaluate how scores of the sub- components of the Child-SCAT3 compare between contact and non-contact athletes . DESIGN A prospect i ve cohort study was performed of 71 male athletes ( 58 football , 13 baseball ) ages 8 - 12 ( contact mean age 10.30 years , SD 1.20 ; non-contact mean age 10.03 years , SD 1.26 ) over the course of a season . METHODS Portions of The Child-SCAT3 were administered and scored in pre-adolescent athletes prior to and following a season of participation in football ( contact sport group ) and baseball ( non-contact sport group ) . The outcome measures of interest included the portions related to Cognitive ability , Balance , and Coordination . RESULTS No statistically significant differences were found in group , time or time and group interaction for any of the utilized portions of the Child-SCAT3 . Statistically significant differences were found between groups for preseason cognitive orientation and postseason immediate memory . Cognitive orientation and coordination were also found to be statistically significantly improved across both groups over the course of the season . LIMITATIONS This study was potentially limited by the number of control subjects tested . CONCLUSIONS A season of subconcussive contact in football was not detrimental to cognitive and balance scores on the Child-SCAT3 . LEVEL OF EVIDENCE 3 Objectives Appropriate reporting is central to the application of findings from research to clinical practice . The Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) recommendations consist of a checklist of 22 items that provide guidance on the reporting of cohort , case – control and cross-sectional studies , in order to facilitate critical appraisal and interpretation of results . STROBE was published in October 2007 in several journals including The Lancet , BMJ , Annals of Internal Medicine and PLoS Medicine . Within the framework of the revision of the STROBE recommendations , the authors examined the context and circumstances in which the STROBE statement was used in the past . Design The authors search ed the Web of Science data base in August 2010 for articles which cited STROBE and examined a r and om sample of 100 articles using a st and ardised , piloted data extraction form . The use of STROBE in observational studies and systematic review s ( including meta-analyses ) was classified as appropriate or inappropriate . The use of STROBE to guide the reporting of observational studies was considered appropriate . Inappropriate uses included the use of STROBE as a tool to assess the method ological quality of studies or as a guideline on how to design and conduct studies . Results The authors identified 640 articles that cited STROBE . In the r and om sample of 100 articles , about half were observational studies ( 32 % ) or systematic review s ( 19 % ) . Comments , editorials and letters accounted for 15 % , method ological articles for 8 % , and recommendations and narrative review s for 26 % of articles . Of the 32 observational studies , 26 ( 81 % ) made appropriate use of STROBE , and three uses ( 10 % ) were considered inappropriate . Among 19 systematic review s , 10 ( 53 % ) used STROBE inappropriately as a tool to assess study quality . Conclusions The STROBE reporting recommendations are frequently used inappropriately in systematic review s and meta-analyses as an instrument to assess the method ological quality of observational studies Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered AIM To use the King-Devick ( KD ) test and Sports Concussion Assessment Tool 2 ( SCAT2 ) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation . METHODS A prospect i ve observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zeal and . Every player completed a pre-competition question naire on concussion history , a baseline PCSS and two trials of the KD before they participated in any match activities . RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player . There were 22 concussive incidents recorded over the duration of the competition ( 46 per 1000 match hours ) . Five concussive incidents were witnessed ( 11 per 1000 match hours ) and 17 unrecognised concussive incidents were identified with the KD ( 37 per 1000 match hours ) . Witnessed concussions recorded , on average , a longer KD on the day of injury ( 5.5±2.4s ) than unrecognised concussions ( 4.4±0.9s ) when compared with their baseline KD . DISCUSSION The KD was able to identify players that had not shown , or reported , any signs or symptoms of a concussion but who had meaningful head injury . The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates . This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Objective : Spasticity following spinal cord injury ( SCI ) can impair function and affect quality of life . This study compared the effects of transcutaneous electrical nerve stimulation ( TENS ) and functional electrical stimulation ( FES ) on lower limb spasticity in patients with SCI . Design : Double blind r and omized crossover design . Setting : Neuro-rehabilitation unit , Manipal University , India . Participants : Ten participants ( age : 39 ± 13.6 years , C1–T11 , 1–26 months post SCI ) with lower limb spasticity were enrolled in this study . Interventions : Participants were administered electrical stimulation with TENS and FES ( duration - 30 minutes ) in a cross over manner separated by 24 hours . Outcome Measures : Spasticity was measured using modified Ashworth scale ( MAS ) [ for hip abductors , knee extensors and ankle plantar flexors ] and spinal cord assessment tool for spastic reflexes ( SCATS ) . Assessment s were performed at baseline , immediately , 1 hour , 4 hours , and 24 hours post intervention . Results : A between group analysis did not show statistically significant differences between FES and TENS ( P > 0.05 ) . In the within group analyses , TENS and FES significantly reduced spasticity up to 4 hours in hip adductors and knee extensors ( P < 0.01 ) . SCATS values showed significant reductions at 1 hour ( P = 0.01 ) following TENS and 4 hours following FES ( P = 0.01 ) . Conclusion : A single session of electrical stimulation with FES and TENS appears to have similar anti-spasticity effects that last for 4 hours . The findings of this preliminary study suggest that both TENS and FES have the potential to be used as therapeutic adjuncts to relieve spasticity in the clinic . In addition , FES may have better effects on patients presenting with spastic reflexes BACKGROUND In the treatment of coronary atherosclerotic artery disease ( CAD ) , the mechanisms by which lipid lowering , a proven therapy , produces beneficial clinical effects remain unclear . Moreover , although potential mechanisms of benefit are well known and increasingly applied clinical ly , there are no conclusive data from clinical trials study ing primarily the antiischemic effects of angiotensin-converting enzyme ( ACE ) inhibition in patients with normal heart function . The Simvastatin/Enalapril Coronary Atherosclerosis Trial ( SCAT ) is design ed to clarify some of these issues in CAD patients with normal or mildly elevated cholesterol . DESIGN AND OBJECTIVES : SCAT is a three- to five-year , multicentre , r and omized , double-blind , placebo controlled , 2 x 2 factorial trial evaluating the effects of cholesterol lowering therapy by simvastatin and /or ACE inhibition by enalapril on anatomic coronary atherosclerosis progression assessed by quantitative coronary angiography in CAD patients with preserved left ventricular function and total cholesterol levels between 4.1 and 6.2 mmol/L. PATIENTS Of 460 patients ( age 61 + /- 9 years ; 409 males , 51 females ) enrolled between June 1991 and July 1995 , 230 were r and omized to simvastatin and 230  to placebo , and 229 to enalapril and 231 to placebo . Average baseline total cholesterol level was 5.20 + /- 0.61 mmol/L , high density lipoprotein cholesterol was 0.99 + /- 0.25 mmol/L , low density lipoprotein cholesterol was 3.36 + /- 0.57 mmol/L and triglycerides were 1.82 + /- 0.75 mmol/L. The trial will be completed in June 1998 . SIGNIFICANCE Insights gained from this long term angiographic trial will lead to a better underst and ing of the mechanisms of benefits of these two treatments , both alone and in combination . Of particular interest is that this trial will be able to examine a suspected beneficial interaction , if present , between these two treatments Background Cluster r and omised trials ( CRTs ) are a key instrument to evaluate public health interventions , particularly in low- and middle-income countries ( LMICs ) . Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned . Evaluation of implementation fidelity ( IF ) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions . Current CRT reporting guidelines offer no guidance on IF assessment . We will systematic ally review the scientific literature to study current practice s concerning the assessment of IF in CRTs of public health interventions in LMICs . Methods We will include  CRTs of public health interventions in LMICs that planned or assessed IF in either the trial protocol or the main trial report ( or an associated document ) . Search strategies use Medical Subject Headings ( MESH ) and text words related to CRTs , developing countries , and public health interventions . The electronic data base search was developed first for MEDLINE and adapted for the following data bases : EMBASE , CINAHL , PubMed , and EMB Review s , to identify CRT reports in English , Spanish , or French published on or after January 1 , 2012 . To ensure availability of a study protocol , we will include CRTs reporting a registration number in the abstract . For each included study , we will compare planned versus reported assessment of IF , and consider the dimensions of IF studied , and data collection methods used to evaluate each dimension . Data will be synthesis ed using quantitative and narrative techniques . Risk of bias for individual studies will be assessed using the Cochrane Collaboration Risk of Bias Tool criteria and additional criteria related to CRT methods . We will investigate possible sources of heterogeneity by performing subgroup analysis . This review was not eligible for inclusion in the PROSPERO registry . Discussion Fidelity assessment may be a key tool for making studies more reliable , internally valid , and externally generalizable . This review will provide a portrait of current practice s related to the assessment of intervention fidelity in CRTs and offer suggestions for improvement . Results will be relevant to research ers , those who finance health interventions , and for decision-makers who seek the best evidence on public health interventions BACKGROUND Abnormal uterine bleeding is the direct cause of a significant health care burden for women , their families , and society as a whole . Up to 30 % of women will seek medical assistance for this problem during their reproductive years . This guideline replaces previous clinical guidelines on the topic and is aim ed to enable health care providers with the tools to provide the latest evidence -based care in the diagnosis and the medical and surgical management of this common problem . OBJECTIVE To provide current evidence -based guidelines for the diagnosis and management of  abnormal uterine bleeding ( AUB ) among women of reproductive age . OUTCOMES Outcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB . METHODS Members of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada , type of practice , subspecialty expertise , and general gynaecology background . The committee review ed relevant evidence in the English medical literature including published guidelines . Recommendations were established as consensus statements . The final document was review ed and approved by the Executive and Council of the SOGC . RESULTS This document provides a summary of up-to- date evidence regarding diagnosis , investigations , and medical and surgical management of AUB . The result ing recommendations may be adapted by individual health care workers when serving women with this condition . CONCLUSIONS Abnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age . St and ardization of related terminology , a systematic approach to diagnosis and investigation , and a step-wise approach to intervention is necessary . Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions . EVIDENCE Published literature was retrieved through search es of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary ( e.g. uterine hemorrhage , menorrhagia ) and key words ( e.g. menorrhagia , heavy menstrual bleeding , abnormal uterine bleeding ) . Results were restricted to systematic review s , r and omized control trials/controlled clinical trials , and observational studies written in English and published from January 1999 to March 2011 . Search es were up date d on a regular basis and incorporated in the guideline to February 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology-related agencies , clinical practice guideline collection s , clinical trial registries , and national and international medical specialty societies . VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care ( Table ) . BENEFITS , HARMS , AND COSTS Implementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding , their families , and society . The economic cost of implementing these guidelines in the Canadian health care system was not considered Health care policy background Findings from scientific studies form the basis for evidence -based health policy decisions . Scientific background Quality assessment s to evaluate the credibility of study results are an essential part of health technology assessment reports and systematic review s. Quality assessment tools ( QAT ) for assessing the study quality examine to what extent study results are systematic ally distorted by confounding or bias ( internal validity ) . The tools can be divided into checklists , scales and component ratings . Research questions What QAT are available to assess the quality of interventional studies or studies in the field of health economics , how do they differ from each other and what conclusions can be drawn from these results for quality assessment s ? Methods A systematic search of relevant data bases from 1988 onwards is done , supplemented by screening of the references , of the HTA reports of the German Agency for Health Technology Assessment ( DAHTA ) and an internet search . The selection of relevant literature , the data extraction and the quality assessment are carried out by two independent review ers . The substantive elements of the QAT are extracted using a modified criteria list consisting of items and domains specific to r and omized trials , observational studies , diagnostic studies , systematic review s and health economic studies . Based on the number of covered items and domains , more and less comprehensive QAT are distinguished . In order to exchange experiences regarding problems in the practical application of tools , a workshop is hosted . Results A total of eight systematic method ological review s is identified as well as 147 QAT : 15 for systematic review s , 80 for r and omized trials , 30 for observational studies , 17 for diagnostic studies and 22 for health economic studies . The tools vary considerably with regard to the content , the performance and quality of operationalisation . Some tools do not only include the items of internal validity but also the items of quality of reporting and external validity . No tool covers all elements or domains . Design -specific generic tools are presented , which cover most of the content criteria . Discussion The evaluation of QAT by using content criteria is difficult , because there is no scientific consensus on the necessary elements of internal validity , and not all of the generally accepted elements are based on empirical evidence . Comparing QAT with regard to contents neglects the operationalisation of the respective parameters , for which the quality and precision are important for transparency , replicability , the correct assessment and interrater reliability . QAT , which mix items on the quality of reporting and internal validity , should be avoided . Conclusions There are different , design -specific tools available which can be preferred for quality assessment , because of its wider coverage of substantive elements of internal validity . To minimise the subjectivity of the assessment , tools with a detailed and precise operationalisation of the individual elements should be applied . For health economic studies , tools should be developed and complemented with instructions , which define the appropriateness of the criteria . Further research is needed to identify study characteristics that influence the internal validity of studies Background Patients admitted to the intensive care unit with critical illness often experience significant physical impairments , which typically persist for many years following resolution of the original illness . Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit , following discharge to the ward and beyond hospital discharge . Multiple systematic review s have been published appraising the exp and ing evidence investigating these physical rehabilitation interventions , although there appears to be variability in review methodology and quality . We aim to conduct an overview of existing systematic review s of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery . Methods / design This protocol has been developed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol ( PRISMA -P ) guidelines . We will search the Cochrane Systematic Review Data base , Data base of Abstract s of Review s of Effectiveness , Cochrane Central Register of Controlled Trials , MEDLINE , Excerpta Medica Data base and Cumulative Index to Nursing and Allied Health Literature data bases . We will include systematic review s of r and omised controlled trials of adult patients , admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery . Data extraction will include systematic review aims and rationale , study types , population s , interventions , comparators , outcomes and quality appraisal method . Primary outcomes of interest will focus on findings reflecting recovery of physical function . Quality of reporting and method ological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Review s tool . Discussion We anticipate the findings from this novel overview of systematic review s will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery . Systematic review registration PROSPERO CRD42015001068 OBJECTIVES With the aim to facilitate a more comprehensive review process in public health including patient safety , we established a tool that we have termed ICROMS ( Integrated quality Criteria for the Review Of Multiple Study design s ) , which unifies , integrates and refines current quality criteria for a large range of study design s including qualitative research . STUDY DESIGN Review , pilot testing and expert consensus . METHODS The tool is the result of an iterative four phase process over two years : 1 ) gathering of established criteria for assessing controlled , non-controlled and qualitative study design s ; 2 ) pilot testing of a first version in two systematic review s on behavioural change in infection prevention and control and in antibiotic prescribing ; 3 ) further refinement and adding of additional study design s in the context of the European Centre for Disease Prevention and Control funded project ' Systematic review and evidence -based guidance on organisation of hospital infection control programmes ' ( SIGHT ) ; 4 ) scrutiny by the pan-European expert panel of the SIGHT project , which had the objective of ensuring robustness of the systematic review . RESULTS ICROMS includes established quality criteria for r and omised studies , controlled before- and -after studies and interrupted time series , and incorporates criteria for non-controlled before- and -after studies , cohort studies and qualitative studies . The tool consists of two parts : 1 ) a list of quality criteria specific for each study design , as well as criteria applicable across all study design s by using a scoring system ; 2 ) a ' decision matrix ' , which specifies the robustness of the study by identifying minimum requirements according to the study type and the relevance of the study to the review question . The decision matrix directly determines inclusion or exclusion of a study in the review . ICROMS was applied to a series of systematic review s to test its feasibility and usefulness in the appraisal of multiple study design s. The tool was applicable across a wide range of study design s and outcome measures . CONCLUSION ICROMS is a comprehensive yet feasible appraisal of a large range of study design s to be included in systematic review s addressing behaviour change studies in patient safety and public health . The tool is sufficiently flexible to be applied to a variety of other domains in health-related research . Beyond its application to systematic review s , we envisage that ICROMS can have a positive effect on research ers to be more rigorous in their study design and more diligent in their reporting Background All r and omized clinical trials ( RCTs ) require a protocol ; however , numerous studies have highlighted protocol deficiencies . Reporting guidelines may improve the content of research reports and , if developed using robust methods , may increase the utility of reports to stakeholders . The objective of this study was to systematic ally identify and review RCT protocol guidelines , to assess their characteristics and methods of development , and to compare recommendations . Methods We conducted a systematic review of indexed literature ( MEDLINE , EMBASE and the Cochrane Methodology Register from inception to September 2010 ; reference lists ; related article features ; forward citation search ing ) and a targeted search of supplementary sources , including a survey of major trial funding agencies in six countries . Records were eligible if they described a content guideline in English or French relevant to RCT protocol s. Guidelines were excluded if they specified content for protocol s for trials of specific procedures or conditions or were intended to assess trial quality . We extracted guideline characteristics and methods . Content was mapped for a subset of guidelines that described development methods or had institutional endorsement . Results Forty guidelines published in journals , books and institutional reports were included in the review ; seven were specific to RCT protocol s. Only eight ( 20 % ) described development methods which included informal consensus methods , pilot testing and formal validation ; no guideline described all of these methods . No guideline described formal consensus methods or a systematic retrieval of empirical evidence to inform its development . The guidelines included a median of 23 concepts per guideline ( interquartile range ( IQR ) = 14 to 34 ; range = 7 to 109 ) . Among the subset of guidelines ( n = 23 ) for which content was mapped , approximately 380 concepts were explicitly addressed ( median concepts per guideline IQR = 31 ( 24,80 ) ; range = 16 to 150 ) ; most concepts were addressed in a minority of guidelines . Conclusions Existing guidelines for RCT protocol content varied substantially in their recommendations . Few reports described the methods of guideline development , limiting comparisons of guideline validity . Given the importance of protocol s to diverse stakeholders , we believe a systematic ally developed , evidence -informed guideline for clinical trial protocol s is needed Objective : To systematic ally summarize the experimental effects of exercise on cognitive-related memory function among young to middle-aged adults , which has yet to be done in the literature . Data Source : PubMed . Study Inclusion and Exclusion Criteria : Studies were included if they were published in the English language , indexed in PubMed , employed an experimental study design ( eg , traditional parallel group r and omized controlled trial : either acute intervention or chronic/training intervention study ) , and conducted among human adults . Studies were excluded if nonhumans ( ie , animal models ) were studied , if children/adolescents ( < 18 years ) or older adults ( > 50 years ) were evaluated , and if select chronic diseases ( eg , diabetes and dementia ) were present . Data Extraction : A systematic review approach was employed . Data Synthesis : An extraction table was created synthesizing the key results , and recommendations for future research are emphasized . Results : Among the 17 evaluated studies , 2 were published before the year 2000 ( ie , 1998 and 1999 ) , 2 were published in 2007 , and the remaining 13 were published in the years 2011 and beyond . This highlights the emergence of this research topic within this age-group ( young to middle-aged adults ) . Among the 17 evaluated studies , 14 were conducted among healthy sample s , with 3 conducted among those with a diagnosis of depression . Among the 17 studies , 4 employed a chronic training protocol , with 13 utilizing an acute exercise protocol . Among the 3 experimental studies in the depressed population , all demonstrated a favorable effect of exercise on memory function . Among the 14 trials in the nondepressed population , 10 ( 71 % ) demonstrated a favorable effect of exercise on some aspect of memory function . Conclusion : Acute and chronic exercise appears to play a pronounced effect on memory function  among young to middle-aged adults . Implication s and recommendations for future research are outlined in this systematic review Background Health interventions fall along a spectrum from simple to more complex . There is wide interest in methods for review ing ‘ complex interventions ’ , but few transparent approaches for assessing intervention complexity in systematic review s. Such assessment s may assist review authors in , for example , systematic ally describing interventions and developing logic models . This paper describes the development and application of the intervention Complexity Assessment Tool for Systematic Review s ( iCAT_SR ) , a new tool to assess and categorise levels of intervention complexity in systematic review s. Methods We developed the iCAT_SR by adapting and extending an existing complexity assessment tool for r and omized trials . We undertook this adaptation using a consensus approach in which possible complexity dimensions were circulated for feedback to a panel of method ologists with expertise in complex interventions and systematic review s. Based on these inputs , we developed a draft version of the tool . We then invited a second round of feedback from the panel and a wider group of systematic review ers . This informed further refinement of the tool . Results The tool comprises ten dimensions : ( 1 ) the number of active components in the intervention ; ( 2 ) the number of behaviours of recipients to which the intervention is directed ; ( 3 ) the range and number of organizational levels targeted by the intervention ; ( 4 ) the degree of tailoring intended or flexibility permitted across sites or individuals in applying or implementing the intervention ; ( 5 ) the level of skill required by those delivering the intervention ; ( 6 ) the level of skill required by those receiving the intervention ; ( 7 ) the degree of interaction between intervention components ; ( 8) the degree to which the effects of the intervention are context dependent ; ( 9 ) the degree to which the effects of the interventions are changed by recipient or provider factors ; ( 10 ) and the nature of the causal pathway between intervention and outcome . Dimensions 1–6 are considered ‘ core ’ dimensions . Dimensions 7–10 are optional and may not be useful for all interventions . Conclusions The iCAT_SR tool facilitates more in-depth , systematic assessment of the complexity of interventions in systematic review s and can assist in undertaking review s and interpreting review findings . Further testing of the tool is now needed OBJECTIVE There are potential benefits of playing videogames for health improvement such as increasing knowledge about health-related issues by playing educational games and fighting a sedentary lifestyle by playing exergames . The number of systematic review articles about " videogames " and " health improvement " is limited . Therefore , the purpose of this study is to review those r and omized controlled trials ( RCTs ) with the topic of " videogames " and " health improvement . " MATERIAL S AND METHODS Several electronic data bases were search ed for RCTs testing  videogames on health outcomes that were published in English between January 2000 and April 2012 . RESULTS Forty-five articles met the eligibility criteria and were categorized into five groups : ( 1 ) videogames and patient pain and stress reduction ( nine articles ) , ( 2 ) videogames and  patient behavioral change  ( 19 articles ) , ( 3 ) videogames and patient rehabilitation  ( eight articles ) , ( 4 ) videogames as diagnostic tools ( three articles ) , and ( 5 ) videogames and cognitive ability ( six articles ) . CONCLUSIONS Most of the articles have shown promising results in using videogames within various fields of healthcare . Although exergames are the most prominent choice regarding health improvement , videogames have the potential to be used as a pain management tool , diagnostic tool , or educational tool . They also can be used as a facilitator in physical rehabilitation or cognitive loss prevention . More RCTs are needed to fully uncover the benefits of using videogames for improving patients ' health A key component of the Cochrane Collaboration 's risk of bias tool for critically evaluating r and omised trials is the consideration of whether baseline characteristics of the treatment groups being compared are systematic ally different . Considered under the domain of ' selection bias ' , this is currently evaluated by looking at the methods of r and omisation and specifically at the generation of the r and omised allocation sequence and the concealment of this sequence during the process of r and omisation . Assessment of the actual similarity of baseline variables across groups in demographic and clinical characteristics is seldom performed . Even when performed , the link with selection bias is sometimes not considered . Methods of r and omisation and allocation concealment are often poorly reported in published trials , yet baseline data tables are presented in a large majority of trial reports . In this article , we propose that assessment of trial baseline data should form a key and prominent part of selection bias judgements when using the risk of bias tool . We outline the possible benefits from using this approach , including reduced uncertainty in systematic review conclusions , reduced risk of chance findings being ascribed to treatment effects and better use of available evidence by a more considered approach to evaluating studies using imperfect r and omisation and allocation methods Background Falls can have a considerable impact on a patients ' well being , they can result in serious physical and emotional injury , poor quality of life and increased length of hospital stay . Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment . Objective The objective of this review was to present the best available evidence for the effectiveness of interventions design ed to reduce the incidence of falls in older adult patients in acute care hospitals . Inclusion Criteria Types of Studies Only r and omised controlled trials ( RCTs ) assessing the effectiveness of risk assessment or other interventions that aim ed to minimise the number of falls were included . Types of Participants Participants were older adult in patients ( defined as aged 65 years or over ) in acute care hospitals . Types of Interventions This review focused on interventions design ed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients . These interventions were compared to either st and ard practice , which included any method or technique already in place at the facility , or no intervention . Types of Outcome measures The primary outcome was the number of patient falls during hospitalisation . Search Strategy A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic data bases . A three‐step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured . Assessment of Quality The method ological quality of included studies was assessed by two review ers , who appraised each study independently , using st and ardised Joanna Briggs Institute ( JBI ) critical appraisal tools Data Collection and Analysis Data was extracted from the studies that were identified as meeting the criteria for method ological quality using the st and ard JBI data extraction tools . Due to the heterogeneity of population s and interventions , meta‐analyses were not possible and results are presented in narrative form . Results and Conclusions Seven studies were included in the review . The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse . There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit . Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities . Implication s for Practice There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult in patients : ˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card , an exercise program , an education program and the use of hip protectors after approximately 45 days ˙ a one‐on‐one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen , recommended interventions encompassing local advice and a summary of the evidence There is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors , as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery . Implication s for Research Better design ed RCTs that distinguish subgroups of population s ( for example people with or without cognitive impairment ) and that targets interventions at specific groups is required . Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted STUDY QUESTION Are there differences in the method ological quality of Cochrane systematic review s ( CRs ) and non-Cochrane systematic review s ( NCRs ) of assisted reproductive technologies ? SUMMARY ANSWER CRs on assisted reproduction are of higher method ological quality than similar review s published in other journals . WHAT IS KNOWN ALREADY The quality of systematic review s varies . STUDY DESIGN , SIZE AND DURATION This was a cross-sectional study of 30 CR and 30 NCR systematic review s that were r and omly selected from the eligible review s identified from a literature search for the years 2007 - 2011 . MATERIAL S , SETTING AND METHODS We extracted data on the reporting and method ological characteristics of the included systematic review s. We assessed the method ological quality of the review s using the 11-domain Measurement Tool to Assess the Method ological Quality of Systematic Review s ( AMSTAR ) tool and subsequently compared CR and NCR systematic review s. MAIN RESULTS AND THE ROLE OF CHANCE The AMSTAR quality assessment found that CRs were superior to NCRs . For 10 of 11 AMSTAR domains , the requirements were met in > 50 % of CRs , but only 4 of 11 domains showed requirements being met in > 50 % of NCRs . The strengths of CRs are the a priori study design , comprehensive literature search , explicit lists of included and excluded studies and assessment s of internal validity . Significant failings in the CRs were found in duplicate study selection and data extraction ( 67 % meeting requirements ) , assessment for publication bias ( 53 % meeting requirements ) and reporting of conflicts of interest ( 47 % meeting requirements ) . NCRs were more likely to contain method ological weaknesses as the majority of the domains showed < 40 % of review s meeting requirements , e.g. a priori study design ( 17 % ) , duplicate study selection and data extraction ( 17 % ) , assessment of study quality ( 27 % ) , study quality in the formulation of conclusions ( 23 % ) and reporting of conflict of interests ( 10 % ) . LIMITATIONS , REASONS FOR CAUTION The AMSTAR assessment can only judge what is reported by authors . Although two of the five authors are involved in the production of CRs , the risk of bias was reduced by not involving these authors in the assessment of the systematic review quality . WIDER IMPLICATION S OF THE FINDINGS Not all systematic review s are equal . The reader needs to consider the quality of the systematic review when they consider the results and the conclusions of a systematic review . STUDY FUNDING /COMPETING INTEREST(S ) There are no conflicts with any commercial organization . Funding was provided for the students by the summer studentship programme of the Faculty of Medical and Health Sciences of the University of Auckl and
Summary / conclusions The SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available .
There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC , with and without baseline data .
The addition of an oculomotor examination seems indicated , although the most valid method for assessing oculomotor function is not clear .
Video-observable signs of concussion show promise , but there is insufficient evidence to warrant widespread use at this time
Objectives Several iterations of the Sport Concussion Assessment Tool ( SCAT ) have been published over the past 16 years .
Our goal was to systematic ally review the literature related to the SCAT and provide recommendations for improving the tool .