No abstract

BackgroundChildren (<15 years) are vulnerable to TB disease following infection, but no systematic review or meta-analysis has quantified the effects of HIV-related immunosuppression or antiretroviral therapy (ART) on their TB incidence.ObjectivesDetermine the impact of HIV infection and ART on risk of incident TB disease in children.MethodsWe searched MEDLINE and Embase for studies measuring HIV prevalence in paediatric TB cases (‘TB cohorts’) and paediatric HIV cohorts reporting TB incidence (‘HIV cohorts’). Study quality was assessed using the Newcastle-Ottawa tool. TB cohorts with controls were meta-analysed to determine the incidence rate ratio (IRR) for TB given HIV. HIV cohort data were meta-analysed to estimate the trend in log-IRR versus CD4%, relative incidence by immunological stage and ART-associated protection from TB.Results42 TB cohorts and 22 HIV cohorts were included. In the eight TB cohorts with controls, the IRR for TB was 7.9 (95% CI 4.5 to 13.7). HIV-infected children exhibited a reduction in IRR of 0.94 (95% credible interval: 0.83–1.07) per percentage point increase in CD4%. TB incidence was 5.0 (95% CI 4.0 to 6.0) times higher in children with severe compared with non-significant immunosuppression. TB incidence was lower in HIV-infected children on ART (HR: 0.30; 95% CI 0.21 to 0.39). Following initiation of ART, TB incidence declined rapidly over 12 months towards a HR of 0.10 (95% CI 0.04 to 0.25).ConclusionsHIV is a potent risk factor for paediatric TB, and ART is strongly protective. In HIV-infected children, early diagnosis and ART initiation reduces TB risk.Trial registration numberCRD42014014276.

Purpose: To characterise the training needs of those providing clinical question answering services (CQAS). Participants: Seventeen specialist UK staff working in CQAS, 21 from general health library UK staff and eight international respondents. Methodology: A literature review examined documented training needs for CQAS staff. A follow-up questionnaire examined prior training and experience and identified training needs for the surveyed staff. Results ⁄ outcomes: Ninety per cent of CQAS staff had worked in health services for 3 years or longer. Training received in preparation for the CQAS role comprised literature searching (including the PRE-CEPT ⁄ADEPT and COCHRANE library courses) and critical appraisal. Skills considered 'essential' for clinical question answering were 'literature searching' (100%), 'understanding the context of clinical questions', 'bibliographic databases', 'evidence-based sources' and 'the Internet' (all 93%). Main training needs for specialist CQAS staff include management and organisation of CQAS and technical skills in interpretation and presentation. Discussion ⁄ conclusion: CQAS staff require a formal training programme. Most CQAS staff considered that this should be a mandatory requirement. Key messagesImplications for Practice d CQAS training needs to be embodied in formal programmes meeting the needs of each specific CQAS setting: a standardised training programme should be mandatory. d Training provision needs to recognise the ongoing development of CQAS roles. CQAS specialists are increasingly involved in different stages of the evidence process and general health library staff are migrating towards CQAS provision. d Innovative courses should be developed for existing staff relating to management, audit and quality assurance of services and communication and interpretation of results. d Training needs of future CQAS should focus on critical appraisal and methodological filters, with appropriate methods of delivery selected to meet different constituents of the CQAS skill set. d There is a need to change attitudes of clinicians towards the potential of CQAS and to train them to ask questions. This will strengthen the overall relationship between clinicians and CQAS providers. Implications for Policyd There is a need to establish a CQAS training programme including clinical, information, technical and managerial elements. d Accreditation of CQAS training programmes should be considered. Standardised training could be a key driver for development and accreditation of programmes.

No abstract

BackgroundMany patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed.MethodsWe searched four databases from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding.ResultsOur search identified 1799 studies, of which 18 studies (2002–2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses.DiscussionNearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs.PROSPERO registration numberCRD42018100004.

ABSTRACT. The Information Resources team within the School of Health and RelatedResearch (ScHARR) at the University of Sheffield has a long-standing interest in the application of new and emerging Web 2.0 technologies for research, learning and teaching. In early 2008, members of the group began to discuss the development of customized web portals, also referred to as personal start pages, to aggregate various streams of specialist information relevant to researchers within the School and in the wider National Health Service (NHS) research community. This paper documents the background to the portals, their development, and reflects on the challenges and issues the team encountered.

Review of public funding of health research, the article seeks to identify areas where NHS library and information staff can become involved in supporting the research process. Methods: The authors examined the challenges and opportunities that these reports offer and looked at two areas where library and information services (LIS) staff can potentially expand their services-supporting researchers at every stage of the research process and transferring research into practice. Results: Staff in NHS libraries need to create an environment in which their role in the research process is recognized and valued. LIS staff can develop roles within the research process and thereby improve the robustness and validity of research outputs. Training and development of LIS staff is a key priority and can be taken forward despite the limitations of budgets and staffing levels. Conclusions: A proactive and assertive approach is needed to achieve a cultural shift within NHS library practice from supporting research from the outside, to being fully integrated within the research process.

The School of Health and Related Research (ScHARR) at The University of Sheffield run an innovative series of informal 20-minute Bite Size sessions to help staff and students teach, research, collaborate and communicate more effectively. The sessions have two clear strands: one focused on teaching and the other on research. The remit is not to teach people how to use something in their work or study, but to let them know why they should use it and how they can employ it. By introducing participants to the possibilities and how they can apply ideas and technologies in their work and study in an enthusiastic manner, it is possible to send them away with at least the intention to explore and experiment. The evidence shows that this organic approach is working -staff and students are starting to use many of the tools that Bite Size has covered. Any kind of widespread change within organisations can be hard to deliver, but by bringing champions on your side and delivering sessions in a convenient, informal and timely manner; good practice and ideas can spread naturally.H.S.