Background: Systematic reviews and meta-analyses of test accuracy studies are increasingly being recognised as central in guiding clinical practice. However, there is currently no dedicated and comprehensive software for meta-analysis of diagnostic data. In this article, we present Meta-DiSc, a Windows-based, user-friendly, freely available (for academic use) software that we have developed, piloted, and validated to perform diagnostic meta-analysis.
Objective To evaluate the effects of dietary and lifestyle interventions in pregnancy on maternal and fetal weight and to quantify the effects of these interventions on obstetric outcomes.Design Systematic review and meta-analysis. Data sources Major databases from inception to January 2012 without language restrictions.Study selection Randomised controlled trials that evaluated any dietary or lifestyle interventions with potential to influence maternal weight during pregnancy and outcomes of pregnancy. Data synthesisResults summarised as relative risks for dichotomous data and mean differences for continuous data. ResultsWe identified 44 relevant randomised controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. With all interventions combined, there were no significant differences in birth weight (mean difference −50 g, −100 to 0 g) and the incidence of large for gestational age (relative risk 0.85, 0.66 to 1.09) or small for gestational age (1.00, 0.78 to 1.28) babies between the groups, though by itself physical activity was associated with reduced birth weight (mean difference −60 g, −120 to −10 g). Interventions were associated with a reduced the risk of pre-eclampsia (0.74, 0.60 to 0.92) and shoulder dystocia (0.39, 0.22 to 0.70), with no significant effect on other critically important outcomes. Dietary intervention resulted in the largest reduction in maternal gestational weight gain (3.84 kg, 2.45 to 5.22 kg), with improved pregnancy outcomes compared with other interventions. The overall evidence rating was low to very low for important outcomes such as pre-eclampsia, gestational diabetes, gestational hypertension, and preterm delivery.Conclusions Dietary and lifestyle interventions in pregnancy can reduce maternal gestational weight gain and improve outcomes for both mother and baby. Among the interventions, those based on diet are the most effective and are associated with reductions in maternal gestational weight gain and improved obstetric outcomes. IntroductionObesity is a growing threat to women of childbearing age. Half the population is either overweight (body mass index (BMI) 25.0-29.9) or obese (BMI ≥30).1 In Europe and the United States, 20-40% of women gain more than the recommended weight during pregnancy.2 Increased maternal weight or excessive weight gain in pregnancy is associated with adverse pregnancy outcomes.3 Half the women who die during pregnancy, childbirth, or puerperium in the United Kingdom are either obese or overweight. 4 For the offspring, maternal obesity is a major risk factor for childhood obesity, which persists into adulthood independent of other factors. 5 Obesity costs the UK National Health Service (NHS) around £0.5bn a year and the UK economy a further £2.3bn in indirect costs. 6 The antenatal period, with opportunities for regular con...
Objective To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates. Design Systematic review of randomised and non-randomised controlled trials and before and after comparison studies. Data sources Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI. Study selection 23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method. Main outcome measures Knowledge, critical appraisal skills, attitudes, and behaviour. Results Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour. Conclusion Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.
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