Designing a search strategy to identify and retrieve articles onevidence-based health care using MEDLINE

Thepractice of evidence-based health care requires that information on methodology be identifiedfrom databases such as MEDLINE. Up until this year there have been no designated medicalsubject headings (MeSH) for evidence-based health care. ‘EVIDENCE-BASEDMEDICINE’ appears as a MeSH term from 1997. The absence of designated MeSH forthis concept prior to 1997 provides a challenge to the searcher. This paper describes the creationof a MEDLINE search strategy to retrieve articles on the methods of evidence-based health carepublished prior to the introduction of the new term, where an optimal combination of free-textand MeSH terms is required to identify relevant material. The study examines both free-text andsubject heading searching and attempts an optimal balance of sensitivity and specificity. It beginsby examining separate free-text and subject heading searches. Sensitivity of the subject headingsearch was 33% and specificity 80%, while the free-text search produced asensitivity of 50% and a specificity of 67%. The final strategy, combining bothapproaches, was more successful with sensitivity reaching between 82 and 90% andspecificity 83%. It is therefore possible to devise a search strategy to retrieve articles on themethods of evidence-based health care with relatively successful rates of sensitivity andspecificity. The limitations of MEDLINE, however, necessitate the use of additional approachesin identifying articles on the methods of evidence-based health care.     

Modern dietary guidelines for healthy pregnancy; maximising maternal and foetal outcomes and limiting excessive gestational weight gain

Abstract

Maternal dietary habits influence maternal and foetal health, representing a pathway for intervention to maximise pregnancy outcomes. Advice on energy intake is provided on a trimester basis, with no additional calories required in the first trimester and an additional 340?kcal?d^?1 and 452?kcal?d^?1 needed for the second and third trimesters. Energy intake depends on pre-gravid body mass index (BMI); underweight women are recommended an increase of 150, 200 and 300?kcal?d^?1 during the first, second and third trimester, normal weight women an increase of 0, 350 and 500?kcal?d^?1 and obese women an increase of 0, 450 and 350?kcal?day^?1. The recommendations for carbohydrate and protein intake are 175?g?d^?1 and 0.88–1.1?g?kgBM?d^?1, with no change to fat intake. The number of pre-gravid obese women is rising; therefore, we need to regulate weight in women of childbearing age and limit gestational weight gain to within the recommended ranges [overweight women 6.8–11.3?kg and obese women 5.0–9.1?kg]. This can be achieved using nutritional interventions, as dietary changes have been shown to help with gestational weight management. As pregnancy has been identified as a risk factor for the development of obesity, normal weight women should gain 11.5–16.0?kg during pregnancy. While some research has shown that dietary interventions help to regulate gestational weight gain and promote postpartum weight loss to some extent, future research is needed to provide safe and effective guidelines to maximise these effects, while benefitting maternal and foetal health.     

The effect of 14 weeks of vitamin D3 supplementation on antimicrobial peptides and proteins in athletes

Heavy training is associated with increased respiratory infection risk and antimicrobial proteins are important in defence against oral and respiratory tract infections. We examined the effect of 14 weeks of vitamin D₃ supplementation (5000 IU/day) on the resting plasma cathelicidin concentration and the salivary secretion rates of secretory immunoglobulin A (SIgA), cathelicidin, lactoferrin and lysozyme in athletes during a winter training period. Blood and saliva were obtained at the start of the study from 39 healthy men who were randomly allocated to vitamin D₃ supplement or placebo. Blood samples were also collected at the end of the study; saliva samples were collected after 7 and 14 weeks. Plasma total 25(OH)D concentration increased by 130% in the vitamin D₃ group and decreased by 43% in the placebo group (both P = 0.001). The percentage change of plasma cathelicidin concentration in the vitamin D₃ group was higher than in the placebo group (P = 0.025). Only in the vitamin D₃ group, the saliva SIgA and cathelicidin secretion rates increased over time (both P = 0.03). A daily 5000 IU vitamin D₃ supplement has a beneficial effect in up-regulating the expression of SIgA and cathelicidin in athletes during a winter training period, which could improve resistance to respiratory infections.     

The relationship between individual instructional characteristics and the overall assessment of teaching effectiveness across different instructional contexts

There is an ongoing debate in the student evaluation of teaching literature about whether an overall rating or factorial dimensions of teaching effectiveness should be used in personnel decisions. Marsh and his colleagues have advocated the use of a weighted average approach to computing overall evaluations. A policy-capturing experiment was carried out where students in three different instructional contexts made overall evaluations of hypothetical instructors based on a manipulation of the teaching factors in Marsh's SEEQ. The results indicated (1) amount learned was consistently the most important factor affecting overall evaluations; (2) course difficulty was consistently the least important factor affecting overall evaluations; and (3) there was a strong similarity among the three groups in the relative importance of the various teaching factors in arriving at an overall evaluation. The implications of this research are discussed, as well as directions for future research.     

Factors underlying students' decisions to use mobile devices in clinical settings

University policies prohibiting use of mobile devices by medical students during clinical placements are contradicted by regular use by physicians. Consequently, many students use their mobile devices, which can be beneficial for learning but may put patient privacy at risk. This study explores the reasons underlying students' decisions about using mobile devices in clinical settings. We used a mixed-methods sequential explanatory design involving a questionnaire and focus groups. Qualitative data from the questionnaire and focus groups was analysed through thematic analysis. We found students were aware of the risks mobile devices posed to professionalism and medical practice. Despite prohibitions, many made individual decisions to use mobile devices because the benefits outweighed the risks. These students were influenced by an organised, strategic approach to learning and a motivation to comply with the beliefs and behaviours of their medical teams and conform to physicians' directives in order to participate in their community of practice. Many students appear to be transferring everyday use of mobile devices to clinical settings. There is a need to understand and promote aspects of learning that are enhanced by mobile devices in clinical settings, while articulating clear guidelines and boundaries compatible with the professional behaviour expected of students.     

Considerations for the use of functional principal components analysis in sports biomechanics: examples from on-water rowing

The proliferation of new biomechanical technology in laboratory and field settings facilitates the capture of data-sets consisting of complex time-series. An understanding of the appropriate statistical approaches for analysing and interpreting these data-sets is required and the functional data analysis (FDA) family of statistical techniques has emerged in the biomechanical literature. Given the use of FDA is currently in its infancy with biomechanical data, this paper will form the first of a two part series aiming to address practical issues surrounding the application of FDA techniques in biomechanics. This work focuses on functional principal components analysis (fPCA), which is explored using existing literature and sample data from an on-water rowing database. In particular methodological considerations for the implementation of fPCA such as temporal normalisation of data, removal of unwanted forms of variation in a data-set and documented methods for preserving the original temporal properties within a set of curves are explored in detail as a part of this review. Limitations and strengths of the technique are outlined and recommendations are provided to encourage the appropriate use of fPCA within the field of applied sports biomechanics.     

Self-efficacy and outcome expectancy in beginning weight training class: their relations to students' behavioral intention and actual behavior

This study was an initial attempt to investigate the relationships among self-efficacy, outcome expectancy, behavioral intention, and actual behavior over time in a beginning weight training class. A total of 109 participants completed questionnaires assessing their self-efficacy, outcome expectancy, and intentions for future weight training. Their attendance and workout logs were calculated as a measure of actual behavior. Correlation analyses revealed significant positive relationships among all the variables during both program periods. Multiple regression analyses indicated that outcome expectancy initially played a more important role than self-efficacy in predicting behavioral intention and actual behavior. However, self-efficacy appeared more influential at midprogram. Findings of this study can enhance our understanding of the determining factors for individuals' motivated behaviors in college physical activity classes.