Meta-analysis is a popular and frequently used statistical technique used to combine data from several studies and reexamine the effectiveness of treatment interventions. As the number of articles using meta-analysis increases, understanding of the benefits and drawbacks of the technique is essential.Well-conducted systematic reviews of randomized controlled trials are regarded as representing a high level of evidence. 28Practicing in an evidence-based manner is a recognized goal for the profession. Systematic reviews are used to answer questions 7,10,40 about the evidence supporting or refuting the effectiveness or efficacy of an intervention. When certain conditions are met, a systematic review may be extended to include a metaanalysis, a statistical procedure used to numerically summarize the included studies' treatment effect.56 A meta-analysis provides a single, overall measure of the treatment effect, enhancing the clinical interpretation of findings across several studies. Because of its increasing use, T T SYNOPSIS: With the focus on evidencebased practice in healthcare, a well-conducted systematic review that includes a meta-analysis where indicated represents a high level of evidence for treatment effectiveness. The purpose of this commentary is to assist clinicians in understanding meta-analysis as a statistical tool using both published articles and explanations of components of the technique. We describe what meta-analysis is, what heterogeneity is, and how it affects metaanalysis, effect size, the modeling techniques of meta-analysis, and strengths and weaknesses of meta-analysis. Common components like forest plot interpretation, software that may be used, special cases for meta-analysis, such as subgroup analysis, individual patient data, and meta-regression, and a discussion of criticisms, are included. Ther 2011;41(7):496-504. doi:10.2519/jospt.2011 high level of evidence, and enhanced clinical interpretation of treatment effects, interpreting a meta-analysis is an important skill for physical therapists. The purpose of this commentary is to expand on existing articles describing meta-analysis interpretation, 6,13,14,42,61 discuss differences in the results of a meta-analysis based on the treatment questions, explore special cases in the use of meta-analysis, and provide physical therapists guidance in interpreting a meta-analysis. J Orthop Sports Phys WHY META-ANALYSIS

Context:Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia.Objective:To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors.Data Sources:Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015.Study Selection:Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related.Study Design:Systematic review with meta-analysis.Level of evidence:Level 4.Data Extraction:Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality.Results:Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity.Conclusion:Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation with the hip in flexion are risk factors for the development of MTSS.

In the context of controlling the current outbreak of Ebola virus disease (EVD), the World Health Organization claimed that 'critical determinant of epidemic size appears to be the speed of implementation of rigorous control measures', i.e. immediate followup of contact persons during 21 days after exposure, isolation and treatment of cases, decontamination, and safe burials. We developed the Surveillance and Outbreak Response Management System (SORMAS) to improve efficiency and timeliness of these measures. We used the Design Thinking methodology to systematically analyse experiences from field workers and the Ebola Emergency Operations Centre (EOC) after successful control of the EVD outbreak in Nigeria. We developed a process model with seven personas representing the procedures of EVD outbreak control. The SORMAS system architecture combines latest In-Memory Database (IMDB) technology via SAP HANA (in-memory, relational database management system), enabling interactive data analyses, and established SAP cloud tools, such as SAP Afaria (a mobile device management software). The user interface consists of specific front-ends for smartphones and tablet devices, which are independent from physical configurations. SORMAS allows real-time, bidirectional information exchange between field workers and the EOC, ensures supervision of contact follow-up, automated status reports, and GPS tracking. SORMAS may become a platform for outbreak management and improved routine surveillance of any infectious disease. Furthermore, the SORMAS process model may serve as framework for EVD outbreak modelling.

Understanding how search terms map to MeSH terms and using the PubMed search strategy can enable physical therapists to take full advantage of available MeSH terms and should result in more-efficient and better-informed searches.

Background and Purpose. The Guide to Physical Therapist Practice (Guide) recommends that heart rate (HR) and blood pressure (BP) measurement be included in the examination of new patients. The purpose of this study was to survey physical therapy clinical instructors to determine the frequency of HR and BP measurement in new patients and in patients already on the physical therapists' caseload. The use of information obtained from HR and BP measures in decision making for patient care and the effects of practice setting and academic preparation on the measurement and use of HR and BP also were examined. Subjects and Methods. A sample of 597 subjects was selected from a list of 2,663 clinical instructors at the clinical education sites of the 2 participating universities. Clinical instructors from a variety of practice settings were surveyed. A 26-item survey questionnaire was mailed to the clinical instructors. Results. Usable survey questionnaires were received from 387 respondents (64.8%); 43.4% reported working in an outpatient facility. The majority of the respondents strongly agreed or agreed (59.5%) that measurement of HR and BP should be included in physical therapy screening. When asked if routinely measuring HR and BP during clinical practice is essential, opinions were nearly split (strongly agree or agreeϭ45.0%, strongly disagree or disagreeϭ43.7%, no opinionϭ11.3%). More than one third (38.0%) of the respondents reported never measuring HR in the week before the survey as part of their examination of new patients. A slightly larger percentage (43.0%) reported never measuring BP of new patients in the week before the survey. Conversely, 6.0% and 4.4% of the respondents reported always measuring HR and BP, respectively, of new patients in the week before the survey. When given a list of reasons why HR and BP were not routinely measured in their clinical practice, respondents most frequently chose "not important for my patient population" (52.3%). Relationships were found between practice setting and frequency of HR and BP measurement in new patients. Discussion and Conclusion. Practices related to HR and BP measurement reported by this sample of clinical instructors do not meet the recommendations for physical therapy care described in the Guide. [Frese EM, Richter RR, Burlis TV. Self-reported measurement of heart rate and blood pressure in patients by physical therapy clinical instructors. Phys Ther. 2002Ther. :82:1192Ther. -1200 Key Words: Blood pressure, Clinical instructor, Heart rate, Measurement, Survey. W e believe the need for physical therapists to measure heart rate (HR) and blood pressure (BP) has increased for several reasons. First, high BP is a serious health concern in the United States. One in 4 adults has high BP, almost one third (31.6%) of people with high BP are not aware they have the condition, and 26.2% of people taking BP medications do not have their high BP under control. 1 A recent study of adults living in a socioeconomically prosperous community showed that 39% of the part...