Both coloured overlays and coloured lenses can improve reading fluency, but their optimal chromaticities differ. Double-masked placebo-controlled trial of precision spectral filters in children who use coloured overlays. Reading Disabilities and the Effects of Colored Filters Randomised controlled trial of the effect of coloured overlays on the rate of reading of people with specific learning difficulties. Prolonged use of coloured overlays for classroom reading. The effects of coloured light filter overlays on reading rates in age-related macular degeneration. Coloured Overlays, Text, and Texture Rate of Reading Test: its reliability, and its validity in the assessment of the effects of coloured overlays. Can you believe what you read in the papers? Effect of magnification lenses on student operator posture. Effect of long-term nutraceutical and dietary supplement use on cognition in the elderly: a 10-year systematic review of randomised controlled trials. Engaging medical librarians to improve the quality of review articles. Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. Intraocular lenses for the treatment of age-related cataracts: an evidence-based analysis. INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions Ovarian ablation in breast cancer, 1896 to 1998: milestones along hierarchy of evidence from case report to Cochrane review Some problems with Cochrane reviews of diet and chronic disease Evidence-based behavioral medicine: What is it and how do we achieve it? Valerian for insomnia: a systematic review of randomized clinical trials. Spine surgery research: on and beyond current strategies. How to write an evidence-based clinical review article. A Systematic Review of the Efficacy of Creative Arts Therapies in the Treatment of Adults With PTSD Digital Education in Health Professions: The Need for Overarching Evidence Synthesis Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research Interventions aimed at increasing research use in nursing: a systematic review “Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review”
Some individuals read more fluently when the text is coloured : i.e. , when coloured sheets of plastic ( overlays ) are placed upon the page , or when coloured lenses are worn . Overlays provide a surface colour whereas lenses mimic a change in the colour of a light source . The neural mechanisms that underlie colour constancy ensure that the chromaticity of overlays and lenses is processed differently by the visual system . We investigated ( 1 ) the relationship between the optimal colours of overlays and lenses , and ( 2 ) how reading rate is affected by a particular colour in overlays and lenses .  In 100 patients we noted ( 1 ) the overlay(s ) chosen from among the 29 combinations of the 10 IOO Intuitive Overlays which sample chromaticity systematic ally and ( 2 ) the chromaticity co-ordinates of the lenses subsequently chosen using the intuitive Colorimeter , a device providing a light source that can be adjusted in hue , saturation and luminance independently . The relationship between the chromaticities of the overlays and the lenses showed considerable variation . In a second study , patients attending the Specific Learning Difficulties clinic at the Institute of Optometry , London , were given overlays to use for two months . Seventeen who derived benefit were examined using the  Intuitive Colorimeter .  Patients were asked to read aloud r and omly ordered common words ( Wilkins Rate of Reading Test ) : ( 1 ) with no colour , ( 2 ) with the chosen overlay , ( 3 ) with lenses matching the chosen overlay and ( 4 ) with lenses matching the Colorimeter setting . The aids increased reading rate significantly only in conditions ( 2 ) and ( 4 ) . There was no significant improvement when lenses matching the overlay colour were used , and under this condition the reading rate was significantly poorer than in conditions ( 2 ) and ( 4 ) . The colour of a lens will improve reading only if it is selected under conditions that mimic a change in the colour of a light source : coloured overlays give no clinical ly reliable guide to optimal lens colour We selected 68 children who reported benefit from individually chosen sheets of coloured plastic placed upon the page when reading , and who used these regularly without prompting . These children viewed text illuminated by coloured light in an apparatus that allowed the separate manipulation of hue ( colour ) and saturation ( depth of colour ) , at constant luminance . Many of the children reported improvements in perception when the light had a chromaticity within a limited range , which was different for each individual . A pair of plastic spectacle lenses ( ' experimental ' lenses ) was dyed so as to provide the appropriate chromaticity under conventional white ( F3 ) fluorescent light . An additional pair was prepared having very similar colour but with a chromaticity outside the range in which perception was reported to improve ( ' control ' lenses ) . Each pair was provided for 1 month in r and om order . The children kept diaries ( 36 completed ) recording symptoms of eye-strain and headache . The children and those responsible for their assessment were unable reliably to distinguish ' experimental ' from ' control ' lenses . Nevertheless , symptoms were less frequent on days when the ' experimental ' lenses were worn ( P < 0.003 ) The efficacy of a controversial treatment , using colored filters to remediate reading disabilities , was measured empirically , with colored overlays placed over reading material on white paper . Irlen 's ( 1983 ) method is to prescribe specific tinted filters as lenses that she cl aims filter specific light frequencies and remove a range of perceptual disorders that adversely affect reading and related learning performance . Irlen calls this condition " scotopic sensitivity " and cl aims it is a significant factor in a high percentage of people with learning disabilities . Ninety-two children with significant reading disabilities were classified as either scotopic or nonscotopic using the Irlen Differential Perceptual Schedule , and were r and omly assigned to one of six treatment groups using colored or clear overlays .  Reading performance ( rate , accuracy , and comprehension ) as measured by the Neale Analysis of Reading Ability ( Neale , 1987 ) and the Formal Reading Inventory ( Wiederholt , 1986 ) improved significantly when the scotopic children read with the preferred colored overlay filter compared to clear or different-colored overlay filters . Nonscotopic children showed no change A r and omised controlled trial has demonstrated that , for selected children with reading difficulties , individually prescribed coloured filters reduce symptoms of asthenopia . In the present study , we investigate the effect of individually prescribed coloured overlays on the rate of reading .  Subjects were 33 children and adults who : had consulted a specific learning difficulties clinic ; had received treatment to normalise any conventional optometric and orthoptic anomalies ; and subsequently reported symptomatic relief from coloured filters .  These subjects carried out the Wilkins Rate of Reading Test ( which assesses visual rather than linguistic factors ) under two conditions : with their chosen coloured overlay and with a control filter . Steps were taken to ensure that a strong placebo effect was associated with the control overlay and , when asked which they preferred , subjects were not significantly more likely to prefer their coloured overlay than the control filter ( p=0.11 ) . Nonetheless , the rate of reading was significantly faster with the coloured overlay than with the control ( p=0.0019 ) . Further analyses support the conclusion that individually prescribed coloured filters can improve reading performance for reasons that can not be solely attributed to conventional optometric factors or to placebo effects Ninety-three children in a primary school and 59 children in two first-year classes of a secondary school were asked individually to observe a paragraph of r and om letters arranged to resemble text , and to compare the perceptual effects on its clarity of coloured plastic sheets overlaid on the text . A total of 29 colours were compared using 10 coloured plastic sheets and 19 pairwise combinations of sheets , one superimposed on another . The result ing colours sample d CIE 1976 hue angle ( huv ) and saturation ( suv ) systematic ally and efficiently . All the children who reported beneficial perceptual effects ( 53 per cent ) were given their preferred overlay or combination of overlays to use as and when they wished . When the children were examined three months later the children tended to choose a colour similar to one they had chosen previously . Ten months later , 22 per cent of those offered the overlaps were still using them of their own volition . These children , but not those who had ceased to use their overlay(s ) , read r and omly ordered simple words more quickly with their overlay than without . In a second independent group of children referred to the Norfolk Sensory Support Service , who used overlays routinely , the reading speed was similar with a grey or clear overlay ; and slower than with the chosen coloured overlay , suggesting that reduction of contrast was not the critical factor . In a third independent group of children in a primary school in Kent , the increase in reading speed with the chosen overlay predicted the children who continued to use their overlay during the ensuing eight weeks PURPOSE To determine the effect of coloured light filter overlays on reading rates for people with age-related macular degeneration ( AMD ) . METHOD Using a prospect i ve clinical trial design , we examined the null hypothesis that coloured light filter overlays do not improve reading rates in AMD when compared to a clear filter .  Reading rates for 12 subjects with non-exudative AMD , associated with a relative scotoma and central fixation ( mean age 81 years , SD 5.07 years ) were determined using the Rate of Reading Test ( printed , nonsense , lower case sans serif , stationary text ) with 10 different , coloured light filter overlays ( Intuitive Overlays ) ; figures in brackets are percentage transmission values ) ; rose ( 78 % ) , pink ( 78 % ) , purple ( 67 % ) , aqua ( 81 % ) , blue ( 74 % ) , lime-green ( 86 % ) , mint-green ( 85 % ) , yellow ( 93 % ) , orange ( 83 % ) and grey ( 71 % ) . A clear overlay ( Roscolene # 00 ) ( 360 cdm-2 ) with 100 % transmittance was used as a control . RESULTS Anova indicated that there was no statistically significant difference in reading rates with the coloured light filter overlays compared to the clear filter . Furthermore , chi-squared analysis indicated that the rose , purple and blue filters had a significantly poorer overall ranking in terms of reading rates compared to the other coloured and clear light filters . CONCLUSION Coloured light filter overlays are unlikely to provide a clinical ly significant improvement in reading rates for people with non-exudative AMD associated with a relative scotoma and central fixation In four studies children were asked to read aloud a passage of r and omly ordered common words with and without a coloured sheet of plastic ( overlay ) placed upon the page . The  children 's rate of reading increased with the overlay , for some children more than for others . The children were also asked to undertake a test of texture segmentation in which targets consisting of a structured texture had to be distinguished from within a r and om background texture . The texture segmentation was improved when the overlay was used , again for some children more than for others . The improvement in texture segmentation was , in general , correlated with the improvement in rate of reading . Slower readers were generally poorer at texture segmentation . The implication s for reading , for texture segmentation , and for clinical tests of vision are discussed A simple reading test that can be undertaken by disabled readers is described . The test is suitable for use in the optometric clinic , taking less than 2 minutes to administer per passage . Test-retest scores are acceptably reliable . The test reveals increases in the speed of reading when coloured overlays are used both ( 1 ) in children who have made long-term use of coloured overlays for reading , and ( 2 ) in children who will subsequently do so The number of reports of clinical trials grows by hundreds every week . However , this does not mean that people making decisions about healthcare are finding it easier to obtain reliable knowledge for these decisions . Some of the information is unreliable . Systematic review s are helping to resolve this by bringing together the research on a topic , appraising and summarising it . But the quality of these review s depends greatly on the quality of the studies , and this usually means the quality of their reports . If there are fundamental flaws within a study , such as the use of inappropriate ' r and omisation ' techniques in the context of review s of the effects of interventions , the review ers will not be able to fix these . Worse still , if they are not aware of underlying flaws , they might make incorrect judgements about the quality of the research in their review . A study by Wu and colleagues of ' r and omised trials ' from China provides a reminder of the cautious approach needed by users of scientific articles . They contacted the authors of more than 2000 research articles , which purported to be reports of r and omised trials ; and concluded that ten of every 11 studies cl aim ing to be a r and omised trial probably did not use r and om allocation . Better education of research ers , peer review ers and editors about what is , and is not , a properly r and omised trial is needed ; along with better reporting of the details for how participants were allocated to the different interventions . Systematic review ers must be cautious in making assumptions about the conduct of trials based on simple phrases about the trial methodology , rather than a full description of the methods actually used . It 's not that you ca n't believe anything that you read in the papers , just that you can not believe everything A distinct body of literature supports the association between clinical postures of the dental practitioner and work-related musculoskeletal disorders ( WRMD ) . Several aids or devices have been tested to improve clinical posture in the interest of decreasing WRMD . The use of magnification lenses while performing dental procedures may increase the quality of work and decrease the likelihood of musculoskeletal problems . To date , only anecdotal and personal opinions had existed regarding the benefits of using magnification lenses , and no empirical evidence had authenticated the contention that use of magnification lenses exerts a positive change in operator posture . The objective of this study was to assess the effect magnification lenses had on the posture of dental hygiene students . Using a r and omized crossover design , research ers videotaped nineteen senior dental hygiene students performing an intra-oral procedure with and without the use of magnification lenses . The tapes were then evaluated by a panel of five dental hygiene educators calibrated in the use of Branson 's Posture Assessment Instrument ( PAI ) . Results of a paired t-test indicate that the posture of the students while wearing magnification lenses was more acceptable ( p=.019 ) than when wearing traditional safety glasses . Results of this study indicate a quantifiable change in acceptability of posture for clinicians wearing magnification lenses  and suggest that the use of such lenses in dental education may be warranted Nutraceuticals have generated interest as a way to mitigate the cognitive decline in older adults . The aim of this systematic review was to determine the evidence for these cl aims from the scientific literature in r and omised , double-blinded , controlled trials ( duration : ≥1 year ; participants : n≥100 ; age(mean ) : ≥65 years ) . Following Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines , we search ed four electronic data bases ( PubMed , Scopus , CINAHL and Web of Science ) and identified twenty-five studies published between the 15·June·2006 and 14·June·2016 . Interventions included B-vitamins , n-3 fatty acids , antioxidant vitamins and herbs . Of the B-vitamin studies , four found benefits to cognition with supplementation . The first of these B-vitamin studies , in individuals with mild cognitive impairment ( n 266 ; duration = 2 years ) , included benefit to executive function ( P=0·015 ) and improvements in the Mini-Mental State Examination ( MMSE ) among participants with baseline homocysteine above 11·3 µmol/l ( P<0·001 ) . In the same sample , the second study found cognitive benefits  of B-vitamins dependent on the higher baseline plasma n-3 fatty acid status . The third B-vitamin study ( n 900 ; duration = 2 years ) reported improved performance in immediate ( P=0·046 ) and delayed recall ( P=0·013 ) , whereas the fourth study ( n 856 ; duration = 2 years ) reported slower rate of cognitive decline in the MMSE ( P=0·05 ) . One study investigating DHA treatment ( n 402 ; duration = 1·5 years ) revealed the slower rate of cognitive change in apoE e4 non-carriers ( P=0·03 ) . As only five included studies revealed notable benefits , presently based on the specific compounds explored here , there is not compelling evidence to support the use nutraceuticals to improve cognition in the elderly . Future long-term trials of nutraceuticals should investigate interactions with lifestyle , blood biomarkers and genetic risk factors Review articles published in JAMA summarize various aspects of medical practice and are written by known authorities . An expert ’s opinion about a topic has value , but often more can be learned by that expert ’s assessment of all the pertinent literature . When reading individual research articles , readers could miss subtle features of the studies that are more apparent to an expert clinician research er . Readers benefit from the expert ’s explanation of the validity and applicability of individual studies . When authors summarize the literature , a natural tendency is to select articles supporting their views . To minimize this potential for bias , JAMA editors ask authors to systematic ally review the literature and comment on as much of it as is practical . Extensive literature search es can be difficult to perform , given the complexity of the search process and authors ’ time constraints . It is also unlikely that a content expert will be familiar with the intricacies of more than one data base . Empirical evidence provides a strong rationale for search ing multiple data bases . 1,2 For this reason , collaborating with medical librarians is recommended when writing review articles . A general approach for this collaboration is presented in the Box . Preliminary search es conducted by a librarian can help refine the question and determine its feasibility and scope . These initial screening search es can also inform the development of the review ’s prospect i ve inclusion and exclusion criteria . The choice of data base depends on several factors . Most important is the content ( topic ) OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies OBJECTIVE The objective of the report is to examine the comparative effectiveness and cost-effectiveness of various intraocular lenses ( IOLs ) for the treatment of  age-related cataracts .  CLINICAL NEED TARGET POPULATION AND CONDITION A cataract is a hardening and clouding of the normally transparent crystalline lens that may result in a progressive loss of vision depending on its size , location and density . The condition is typically bilateral , seriously compromises visual acuity and contrast sensitivity and increases glare . Cataracts can also affect people at any age , however , they usually occur as a part of the natural aging process . The occurrence of cataracts increases with age from about 12 % at age 50 years , to 60 % at age 70 . In general , approximately 50 % of people 65 year of age or older have cataracts . Mild cataracts can be treated with a change in prescription glasses , while more serious symptoms are treated by surgical removal of the cataract and implantation of an IOL . In Ontario , the estimated prevalence of  cataracts increased from 697,000 in 1992 to 947,000 in 2004 ( 35.9 % increase , 2.4 % annual increase ) . The number of cataract surgeries per 1,000 individuals at risk of cataract increased from 64.6 in 1992 to 140.4 in 1997 ( 61.9 % increase , 10.1 % annual increase ) and continued to steadily increase to 115.7 in 2004 ( 10.7 % increase , 5.2 % increase per year ) . DESCRIPTION OF TECHNOLOGY/THERAPY IOLs are classified either as monofocal , multifocal , or accommodative . Traditionally , monofocal ( i.e .. fixed focusing power ) IOLs are available as replacement lenses but their implantation can cause a loss of the eye 's accommodative capability ( which allows variable focusing ) . Patients thus usually require eyeglasses after surgery for reading and near vision tasks . Multifocal IOLs aim to improve near and distant vision and obviate the need for glasses . Potential disadvantages include reduced contrast sensitivity , halos around lights and glare . Accommodating IOLs are design ed to move with ciliary body contraction during accommodation and , therefore , offer a continuous range of vision ( i.e. near , intermediate and distant vision ) without the need for glasses . Purported advantages over multifocal IOLs include the avoidance of haloes and no reduction in contrast sensitivity .  Polymethyl methacrylate ( PMMA ) was the first material used in the fabrication of IOLs and has inherent ultraviolet blocking abilities . PMMA IOLs are inflexible , however , and require a larger incision for implantation compared with newer foldable silicone ( hydrophobic ) and acrylic ( hydrophobic or hydrophilic ) lenses . IOLs can be further sub-classified as being either aspheric or spheric , blue/violet filtered or non-filtered or 1- or 3-piece . METHODS OF EVIDENCE -BASED ANALYSIS : A literature search was conducted from January 2003 to January 2009 that included OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment /Centre for Review and Dissemination . Inclusion Criteria Exclusion Criteria adult patients with age-related cataracts systematic review s , r and omized controlled trials ( RCTs ) PRIMARY OUTCOMES distance visual acuity ( best corrected distance visual acuity ) , near visual acuity ( best distance corrected near visual acuity ) SECONDARY OUTCOMES contrast sensitivity , depth of field , glare , quality of life , visual function , spectacle dependence , posterior capsule opacification .  studies with fewer than 20 eyesIOLs for non-age related cataractsIOLs for presbyopia studies with a mean follow-up < 6months studies reporting insufficient data for analysis COMPARISONS OF INTEREST : The primary comparison of interest was accommodative vs. multifocal vs. monofocal lenses . Secondary comparisons of interest included : tinted vs. non-tinted lensesaspheric vs. spheric lensesmultipiece vs. single piece lensesbio material A ( e.g. acrylic ) vs. bio material B ( e.g. silicone ) lensessharp vs. round edged lensesThe quality of the studies was examined according to the GRADE Working Group criteria for grading quality of evidence for interventional procedures . SUMMARY OF FINDINGS The conclusions of the systematic review of IOLs for age-related cataracts are summarized in Executive Summary Table 1 . CONSIDERATIONS FOR THE ONTARIO HEALTH SYSTEM : Procedures for crystalline lens removal and IOL insertion are insured and listed in the Ontario Schedule of Benefits .If a particular lens is determined to be medically necessary for a patient , the cost of the lens is covered by the hospital budget . If the patient chooses a lens that has enhanced features , then the hospital may choose to charge an additional amount above the cost of the usual lens offered . An IOL manufacturer stated that monofocal lenses comprise approximately 95 % of IOL sales in Ontario and premium lenses ( e.g. , multifocal/accomodative ) consist of about 5 % of IOL sales . A medical consultant stated that all types of lenses are currently being used in Ontario ( e.g. , multifocal , monofocal , accommodative , tinted , nontinted , spheric , and aspheric ) . Nonfoldable lenses , rarely used in routine cases , are primarily used for complicated cataract implantation situations . ES Table 1 : Conclusions for the Systematic Review of IOLs for Age-Related CataractsComparison Conclusion GRADE Quality Multifocal vs. monofocal Objective Outcomes Significant improvement in BDCUNVANo significant difference in BCDVAInconclusive evidence for contrast sensitivityInconclusive evidence for glareSubjective Outcomes Inconclusive evidence for visual satisfactionSignificant increase in glare/halosSignificant increase in freedom from spectaclesmoderatemoderatelowvery lowlowlow/moderatelow/moderateAccommodative vs. multifocal/monofocalInconclusive due to Insufficient limited evidence for any effectiveness outcome very lowHydrophilic acrylic vs. other material s ( hydrophobic acrylic , silicone)Significant increase in PCO scoreLowSharp edged compared to round edgedSignificant reduction in PCO scoreLowOne piece compared to three pieceNo significant difference in PCO scorelowHydrophobic acrylic compared to siliconeNo significant difference in PCO scoremoderateAspherical modified prolate anterior surface compared to sphericalNo significant difference in VASignificant reduction in contrast sensitivityvery lowvery lowBlue light filtering compared to non blue-light filteringNo significant difference in BCDVANo significant difference in contrast sensitivityNo significant difference in HRQLlowlowhigh/moderateBCDVA refers to best corrected distance visual acuity ; BDCUNVA , best distance corrected unaided near visual acuity ; HRQL , health related quality of life ; PCO , posterior capsule opacification ; VA , visual acuity & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy One of the earliest r and omised trials of a treatment for cancer was of ovarian ablation  for breast cancer . Apart from surgical removal of the tumour , this is the oldest treatment still used in breast cancer . Its use was first reported in the Lancet in 1896,1 but not until the 1940s was it first assessed in r and omised trials and it was nearly a century before the Early Breast Cancer Trialists ' Collaborative Group provided a reliable estimate of its effect on resectable breast cancer.2 Now , 50 years after its completion , the first r and omised trial of ovarian ablation has been included in the first of the collaborative group 's overviews to be prepared as a Cochrane review .3 Here I describe this journey along a hierarchy of evidence and show why the research is still relevant . # # # Summary points The hierarchy of evidence needed to determine treatment efficacy ranges from case reports , through case series and comparison with historical groups , to r and omised trials and systematic review s Over the past 100 years the investigation of  ovarian ablation for women with breast cancer has progressed along this hierarchy The first case report was published in 1896 and the first r and omised trial began in 1948 Not until 1992 did a systematic review show this treatment to be clearly effective David Byar described an eight point hierarchy for the quality of evidence needed to determine a treatment 's efficacy . This leads from anecdotal case reports , through case series and comparison with historical groups , to r and omised trials and systematic review s.4 Olkin added a ninth point : a meta- analysis in which individual patient data from each relevant trial are collected and analysed.5 He described this as being in the “ realms of luxury , ” but several examples now exist.6 Occasionally , the evidence that a treatment is effective becomes apparent without needing to The sum of evidence -based nutrition has to be more than a Cochrane-type meta- analysis of r and omised controlled trials ( RCTs ) . Most of the evidence base in nutrition is observational , especially cohort studies . RCTs of diet change through to disease outcome are uncommon and the change has usually been addition or removal of only a single food component . Trials with whole diets through to disease outcome are rare and dietary changes made by individuals are unlikely to be an exact copy of the prescription . It is hard to even imagine a trial in which half ( r and omised ) of a large group of middle-aged people agree to avoid vegetables for 5 y and be followed up to see who will develop cancer . Most of the USA 's health cl aims , permitted by the Food and Drug Administration , are not supported by RCTs . But where controlled trials of nutritional change and disease outcome have been achieved , they must be review ed very carefully . Two Cochrane review s on diet and cardiovascular disease ( CVD ) , published in the widely read British Medical Journal ( BMJ ) , were criticised after their publication and the conclusions have not been subsequently adopted by expert committees . The first of these review s was ‘ Dietary fat and prevention of CVD : a systematic review ’ . The second was ‘ Systematic review of long term effects of advice to reduce dietary salt in adults ’ . A critique of these two Cochrane review s is presented here as a contribution to our discussion of the potential of Cochrane methodology to the reliability of knowledge about diet and disease The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Objective : To systematic ally review the evidence for the effects of the herb valerian ( Valeriana officinalis ) on  insomnia  , based on r and omized , placebo-controlled , double-blind trials . Background : Valerian has long been advocated and used for promoting sleep but until quite recently evidence was solely anecdotal . However , during the last two decades a number of clinical trials have been conducted . Material s and methods : Systematic literature search es were performed to locate r and omized , placebo-controlled , double-blind trials measuring the effect of  valerian monopreparations on sleep in human participants . Data were extracted in a st and ardized manner and method ological quality was assessed by the Jadad score . Results : Nine trials were located meeting the selection criteria . The findings of the studies were contradictory and there was great inconsistency between trials in terms of patients , experimental design and procedures and method ological quality . Conclusion : The evidence for valerian as a treatment for  insomnia  is inconclusive . There is a need for rigorous trials to determine its efficacy BACKGROUND CONTEXT Systematic review s of the literature are powerful tools in evidence -based medicine . However , the design and report of systematic review s in spinal surgery contain many aspects amenable to improvement . PURPOSE To discuss the issues especially relevant for systematic review s in spinal surgery . METHODS From our experience of systematic review s and meta-analyses of clinical trials in  spinal surgery  , we infer guidance for the design and execution of systematic literature review s. RESULTS There are many difficulties associated with the design as well as conduct of clinical trials and consequently appraising evidence in spinal surgery . New treatments should be compared with the gold st and ard before other comparisons are investigated . Studies should present data as thoroughly as possible regarding all subgroups and follow-up moments , possibly in supplementary material . To provide the highest level of evidence , systematic review s should be as rigorously design ed as possible . CONCLUSIONS Gathering information on clinical effectiveness in spinal surgery can be improved both at the clinical study level and at the systematic review level . Alternatives to r and omized controlled trials such as comparative studies can be valuable tools on the clinical effectiveness of treatments in spinal surgery . The experience reflected in this article can support the scientific efforts in this field Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points Objective : There is a growing body of literature supporting the use of creative arts therapies ; however , the efficacy of creative arts therapies in the treatment of  posttraumatic stress disorder ( PTSD )  has not been systematic ally evaluated . The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy , art therapy , dance/movement therapy , and drama therapy , in the treatment of PTSD . Method : Ten data bases were search ed for peer- review ed literature published from inception to December 2016 . Studies were included in the review if they used a r and omized controlled trial ( RCT ) , a pseudo RCT , or a controlled study design ; tested the efficacy of one of the creative arts therapies described above ; and reported changes to PTSD diagnosis or symptomatology . Results : From an initial yield of 1,918 records , 1,653 records were screened on title and abstract and 125 were screened at full-text . Seven studies met the inclusion criteria for review , with four studies investigating art therapy , two studies investigating music therapy , and a final study investigating drama therapy . Individual studies were initially rated on a st and ardized quality and bias checklist , and then GRADE was used to rate the overall evidence for each intervention . The evidence for music therapy , art therapy , and drama therapy  was ranked as low to very low , with no studies found for dance/movement therapy . Generally , the quality of the trials was very poor . Future directions for this field of research are to improve the scientific quality of the research trials in this area Synthesizing evidence from r and omized controlled trials of  digital health education  poses some challenges . These include a lack of clear categorization of digital health education in the literature ; constantly evolving concepts , pedagogies , or theories ; and a multitude of methods , features , technologies , or delivery setting s. The Digital Health Education Collaboration was established to evaluate the evidence on digital education in health professions ; inform policymakers , educators , and students ; and ultimately , change the way in which these professionals learn and are taught . The aim of this paper is to present the overarching methodology that we use to synthesize evidence across our digital health education review s and to discuss challenges related to the process . For our research , we followed Cochrane recommendations for the conduct of systematic review s ; all review s are reported according to the PRISMA ( Preferred Reporting Items for Systematic Review s and Meta-Analyses ) guidance . This included assembling experts in various digital health education fields ; identifying gaps in the evidence base ; formulating focused research questions , aims , and outcome measures ; choosing appropriate search terms and data bases ; defining inclusion and exclusion criteria ; running the search es jointly with librarians and information specialists ; managing abstract s ; retrieving full-text versions of papers ; extracting and storing large data sets , critically appraising the quality of studies ; analyzing data ; discussing findings ; drawing meaningful conclusions ; and drafting research papers . The approach used for synthesizing evidence from digital health education trials is commonly regarded as the most rigorous benchmark for conducting systematic review s. Although we acknowledge the presence of certain biases ingrained in the process , we have clearly highlighted and minimized those biases by strictly adhering to scientific rigor , method ological integrity , and st and ard operating procedures . This paper will be a valuable asset for research ers and method ologists undertaking systematic review s in digital health education In perinatal psychiatry , r and omized controlled trials are often not feasible on ethical grounds . Many studies are observational in nature , while others employ large data bases not design ed primarily for research purpose s. Quality assessment of the result ing research is complicated by a lack of st and ardized tools specifically for this purpose . The aim of this paper is to describe the  Systematic Assessment of Quality in Observational Research ( SAQOR )  , a quality assessment tool our team devised for a series of systematic review s and meta‐analyses of evidence ‐based literature regarding risks and benefits of antidepressant medication during pregnancy . Copyright © 2011 John Wiley & Sons , Background There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians . However , most work has focused on medical practice s ; and nursing is not well represented in existing systematic review s. The purpose of this article is to report findings from a systematic review of interventions aim ed at increasing research use in nursing . Objective To assess the evidence on interventions aim ed at increasing research use in nursing . Methods A systematic review of research use in nursing was conducted using data bases ( Medline , CINAHL , Healthstar , ERIC , Cochrane Central Register of Controlled Trials , and Psychinfo ) , grey literature , ancestry search ing ( Cochrane Data base of Systematic Review s ) , key informants , and manual search ing of journals . R and omized controlled trials and controlled before- and after- studies were included if they included nurses , if the intervention was explicitly aim ed at increasing research use or evidence -based practice , and if there was an explicit outcome to research use . Method ological quality was assessed using pre-existing tools . Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy . Results Over 8,000 titles were screened . Three r and omized controlled trials and one controlled before- and after- study met the inclusion criteria . The method ological quality of included studies was generally low . Three investigators evaluated single interventions . The most common intervention was education . Investigators measured research use using a combination of surveys ( three studies ) and compliance with guidelines ( one study ) . Research er-led educational meetings were ineffective in two studies . Educational meetings led by a local opinion leader ( one study ) and the formation of multidisciplinary committees ( one study ) were both effective at increasing research use . Conclusion Little is known about how to increase research use in nursing , and the evidence to support or refute specific interventions is inconclusive . To advance the field , we recommend that investigators : ( 1 ) use theoretically informed interventions to increase research use , ( 2 ) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use , as well as , measuring patient outcomes relevant to the intervention , and ( 3 ) use more robust and method ologically sound study design s to evaluate interventions . If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use Background Calcaneal apophysitis , also commonly known as sever ’s disease , is a condition seen in children usually aged between 8–15 years . Conservative therapies , such as taping , heel lifts and orthotic intervention are accepted management practice s for calcaneal apophysitis , though there is very little high quality research examining the efficacy of such treatment modalities . Previous narrative literature review s and opinion pieces provide some evidence for the use of heel raises or orthoses . The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity . Methods A search strategy completed by two review ers examined nine data bases from inception to May 2012 . Search terms included heel pain , children , adolescent , calcaneal apophysitis , sever ’s disease , treatment , and management ( full text publications , human studies ) . Systematic review s , r and omised control trials , case series , and case studies were included . The reference lists of the selected articles were also examined . The methodology , quality and risk of bias was examined and assessed using the PEDro scale . Results Nine articles were retrieved including three clinical trials involving r and omisation , two case series , two retrospective case review s , and two case reports . Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature . Numerous treatment options were reported throughout the literature , though few were examined against a control or alternate treatment option in well- design ed trials . The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises . Health practitioners should view these results with caution , as there were apparent method ological problems with the employed study design and limited follow-up of participants . Conclusion There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis . Further research is needed to generate higher quality evidence with larger sample sizes , and vali date d measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis
While many studies report improvements with coloured lenses , the effect size is generally small and /or similar to the improvement found with a placebo condition .
Consistent with previous review s and advice from several professional bodies , we conclude that the use of coloured lenses or overlays to ameliorate reading difficulties can not be endorsed and that any benefits reported by individuals in clinical setting s are likely to be the result of placebo , practice or Hawthorne effects
PURPOSE There are many anecdotal cl aims and research reports that coloured lenses and overlays improve  reading performance .
Here we present the results of a systematic review of this literature and examine the quality of the evidence .