Team-Based Learning (TBL) is a student-centred active learning method, requiring less faculty time than other active learning methods. While TBL may have pedagogical value, individual studies present inconsistent findings. The aim of this systematic review was to assess the effectiveness of TBL on improving learning outcomes in health professions education. A peer-reviewed systematic review protocol was registered with the Best Evidence in Medical Education (BEME) organization. After comprehensive literature searching, title and full-text review were completed by two independent reviewers. Included studies assessed TBL and a valid comparator in health professions. Included studies were assessed for methodological quality by two independent reviewers. Studies were categorised by outcomes using the Kirkpatrick framework. Of 330 screened titles, 14 were included. Seven studies reported significant increase in knowledge scores for the TBL group, four reported no difference and three showed improvement but did not comment on statistical significance. Only one study reported significant improvement in learner reaction for the TBL group while another study reported a significant difference favouring the comparator. Despite improvement in knowledge scores, there was mixed learner reaction. This may reflect the increased demands on learners in this student-centred teaching strategy, although further study is needed.

BACKGROUND AND OBJECTIVE: Transcutaneous bilirubin (TcB) devices are widely used for the estimation of serum bilirubin levels in term and near-term infants. Our objective was to review the diagnostic accuracy of TcB devices in preterm infants. METHODS: Medline, Embase, Cochrane library, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched (from database inception date until December 2012). Additional citations were identified by using the bibliographies of selected articles and from conference proceedings. The studies were included if they compared TcB with total serum bilirubin in preterm infants before phototherapy and presented data as correlation coefficients or as Bland-Altman difference plots. Data were extracted by 1 reviewer and checked for accuracy by the second reviewer. An assessment tool (quality assessment of diagnostic accuracy studies) was used for risk of bias assessments. RESULTS: Twenty-two studies met the inclusion criteria; 21 studies reported results as correlation coefficients, with pooled estimates of r = 0.83 for each site of measurement. Pooled estimates in infants <32 weeks’ gestation were similar to the overall preterm population (r = 0.89 [95% confidence interval: 0.82–0.93]). For the 2 commonly used TcB devices (ie, JM103 and BiliCheck), the results were comparable at the forehead site, although the JM103 device exhibited better correlation at the sternum. Analysis of the Bland-Altman plots (13 studies) revealed negligible bias in measurement at the forehead or sternum site by using either the JM-103 or BiliCheck device; however, the JM-103 device exhibited better precision than the BiliCheck (SD for TcB – total serum bilirubin differences: 24.3 and 31.98 µmol/L, respectively). CONCLUSIONS: The TcB devices reliably estimated bilirubin levels in preterm infants and could be used in clinical practice to reduce blood sampling.

Objective This systematic review examines whether frequent emergency department (ED) users experience higher mortality, hospital admissions and outpatient visits than non-frequent ED users. Design We published an a priori study protocol in PROSPERO. Our search strategy combined terms for ‘frequent users’ and ‘emergency department’. At least two independent reviewers screened, selected, assessed quality and extracted data. Third-party adjudication resolved conflicts. Results were synthesised based on median effect sizes. Data sources We searched seven electronic databases with no limits and performed an extensive grey literature search. Eligibility criteria for selecting studies We included observational analytical studies that focused on adult patients, had a comparison group of non-frequent ED users and reported deaths, admissions and/or outpatient outcomes. Results The search strategy identified 4004 citations; 374 were screened by full text and 31 cohort and cross-sectional studies were included. Authors used many different definitions to describe frequent users; the overall quality of the included studies was moderate. Across seven studies examining mortality, frequent users had a median 2.2-fold increased odds of mortality compared with non-frequent users. Twenty-eight studies assessing hospital admissions found a median increased odds of admissions per visit at 1.16 and of admissions per patient at 2.58. Ten studies reported outpatient visits with a median 2.65-fold increased risk of having at least one outpatient encounter post-ED visit. Conclusions Frequent ED users appear to experience higher mortality, hospital admissions and outpatient visits compared with non-frequent users, and may benefit from targeted interventions. Standardised definitions to facilitate comparable research are urgently needed. Review registration number: PROSPERO (CRD42013005855).

Background: Audience response systems (ARS) represent one approach to make classroom learning more active. Although ARS may have pedagogical value, their impact is still unclear. This systematic review aims to examine the effect of ARS on learning outcomes in health professions education. Methods: After a comprehensive literature search, two reviewers completed title screening, full-text review and quality assessment of comparative studies in health professions education. Qualitative synthesis and meta-analysis of immediate and longer term knowledge scores were conducted. Results: Twenty-one of 1013 titles were included. Most studies evaluated ARS in lectures (20 studies) and in undergraduates (14 studies). Fourteen studies reported statistically significant improvement in knowledge scores with ARS. Meta-analysis showed greater differences with non-randomised study design. Qualitative synthesis showed greater differences with non-interactive teaching comparators and in postgraduates. Six of 21 studies reported student reaction; 5 favoured ARS while 1 had mixed results. Conclusion: This review provides some evidence to suggest the effectiveness of ARS in improving learning outcomes. These findings are more striking when ARS teaching is compared to non-interactive sessions and when non-randomised study designs are used. This review highlights the importance of having high quality studies with balanced comparators available to those making curricular decisions.

Background/aims Teleophthalmology is well positioned to play a key role in screening of major chronic eye diseases. Economic evaluation of cost-effectiveness of teleophthalmology, however, is lacking. This study provides a systematic review of economic studies of teleophthalmology screening for diabetic retinopathy (DR), glaucoma and macular degeneration. Methods Structured search of electronic databases and full article review yielded 20 cost-related articles. Sixteen articles fulfilled the inclusion criteria and were retained for a narrative review: 12 on DR, 2 on glaucoma and 2 on chronic eye disease. Results Teleophthalmology for DR yielded the most cost savings when compared with traditional clinic examination. The study settings varied among urban, rural and remote settings, community, hospital and health mobile units. The most important determinant of cost-effectiveness of teleophthalmology was the prevalence of DR among patients screened, indicating an increase of cost savings with the increase of screening rates. The required patient pool size to be screened varied from 110 to 3500 patients. Other factors potentially influencing cost-effectiveness of teleophthalmology were older patient age, regular screening and full utilisation of the equipment. Teleophthalmology for glaucoma was more cost-effective compared with in-person examination. Similarly, increasing number of glaucoma patients targeted for screening yielded more cost savings. Conclusions This economic review provides supportive evidence of cost-effectiveness of teleophthalmology for DR and glaucoma screening potentially increasing screening accessibility especially for rural and remote populations. Special selection of the targeted screening population will optimise the cost-effectiveness of teleophthalmology.