Research Progress of Measuring Tools for Patient Medication Compliance

This paper introduced the content, compilation process, reliability and validity, scoring method of the evaluation tool for patients’ medication compliance at home and abroad, and reviewed the research progress of the tool. The evaluation method, dimension, scoring method, evaluation content and application scope of the tool were compared, so as to provide reference for nurses to comprehensively and accurately evaluate patients’ medication status.

Assessment tools for differential diagnosis of neglect: Focusing on egocentric neglect and allocentric neglect

BACKGROUND There are very few studies on the differential diagnosis between egocentric neglect(EN)and allocentric neglect(AN).AIM To investigate the overall trend of the previously developed assessment tools by conducting a descriptive review of the studies on assessment tools that can perform a differential diagnosis of EN and AN.METHODS The data were collected by using databases such as Google Scholar,PubMed,and ScienceDirect.The most commonly used search terms were“neglect”,“stroke”,“egocentric neglect”,and“allocentric neglect”.RESULTS A total of seven studies that met the inclusion criteria were selected and analyzed.We were able to confirm the research process,test method,and differential diagnosis criteria of the seven presented assessment tools from four studies on paper-based tests and three studies on computerized tests.The majority of the tests were carried out via the cancellation method using stimuli such as everyday objects or numbers.EN distinguished the left from right based on the test paper,while AN distinguished the left from right based on stimuli.In order to perform differential diagnosis,the difference in the number of left and right responses or non-responses was used based on the EN and AN criteria.CONCLUSION It was confirmed that all the seven assessment tools can effectively perform differential diagnosis of EN and AN.This study may provide important data that can be used in clinical practice for differential diagnosis and future intervention planning for neglect patients.

Predictive value of frailty assessment tools in patients undergoingsurgery for gastrointestinal cancer: An observational cohort study

BACKGROUND Few studies have simultaneously compared the predictive value of various frailty assessment tools for outcome measures in patients undergoing gastrointestinal cancer surgery.Therefore,it is difficult to determine which assessment tool is most relevant to the prognosis of this population.AIM To investigate the predictive value of three frailty assessment tools for patient prognosis in patients undergoing gastrointestinal cancer surgery.METHODS This single-centre,observational,prospective cohort study was conducted at the Affiliated Lianyungang Hospital of Xuzhou Medical University from August 2021 to July 2022.A total of 229 patients aged≥18 years who underwent surgery for gastrointestinal cancer were included in this study.We collected baseline data on the participants and administered three scales to assess frailty:The comprehen-sive geriatric assessment(CGA),Fried phenotype and FRAIL scale.The outcome measures were the postoperative severe complications and increased hospital RESULTS The prevalence of frailty when assessed with the CGA was 65.9%,47.6%when assessed with the Fried phenotype,and 34.9%when assessed with the FRAIL scale.Using the CGA as a reference,kappa coefficients were 0.398 for the Fried phenotype and 0.291 for the FRAIL scale(both P<0.001).Postoperative severe complications and increased hospital costs were observed in 29(12.7%)and 57(24.9%)patients,respectively.Multivariate logistic analysis confirmed that the CGA was independently associated with increased hospital costs(odds ratio=2.298,95%confidence interval:1.044-5.057;P=0.039).None of the frailty assessment tools were associated with postoperative severe complications.CONCLUSION The CGA was an independent predictor of increased hospital costs in patients undergoing surgery for gastro-intestinal cancer.

Preschoolers＇ Learning Disabilities Assessment： New Perspectives in Computerized Clinical Tools

This study looks into new perspectives in preschoolers＇ assessment of being at risk for learning disabilities. Precisely, two innovative assessment approaches are examined in order to reveal new research perspectives. The first tool, a traditional approach, is the ＂Early Dyslexia Identification Test＂ and the second tool, a computerized approach, is an lnternet based Speech Pathology Diagnostic Expert System named ＂APLo＂. Both evaluate the sectors of phonological awareness, memory, psychomotor development, pre-writing and pre-reading skills in Greek. The findings o f the current study formulate three directions： （1） the complementary of speech language and learning disorders as a systemic approach, （2） the diagnosis of suspicious factors and compatibilities of learning disabilities even at the preschool age, and （3） the application of alternative methods of assessment aiming for a multidimentional approach with the combined prospect and potential of web tools in the early diagnosis and intervention in learning disabilities.

Genomic Tools for the Impact Assessment of 'Hotspots' for Early Warning of MDR Threats

INTRODUCTION Antimicrobial resistance （AMR） has been a low-priority area of research in most developing countries even though it has much significant therapeutic value. The management of serious infections should include not only the treatment of patients but also the measures to ensure that microorganisms do not spread through hospital premises. Controlling the transfer of organisms among staff, patients, and the environment is important. Research related to antimicrobial use and resistance, regional variation, and intervention policies.

AB106. ORVIS: a directory of tools for vision rehabilitation

Background:The ORVIS infrastructure aims to facilitate the development and availability of valid and adapted tools that will allow functional,perceptual,cognitive and psychological evaluation of low vision clients by researchers and clinicians who work in low vision and visual impairment rehabilitation.Methods:The tools developed or documented within ORVIS Infrastructure are tests or questionnaires which allow,or will allow to assess-in an accurate and reliable manner-characteristics related to visual impairment.The tools in development are:(I)questionnaire de repérage des hallucinations visuelles liées au syndrome de Charles-Bonnet(QR-SCB);(II)repérage des personnesâgées présentant des INDices de déficience VISUELle(IndiVisuel);(III)mesure de l’impact de la déficience visuelle dans les activités quotidiennes(MIDVAQ)and(IV)M’EYE read test.The directory documents 14 tools and offers-within a descriptive sheet-characteristics,components and metrological properties as supported by cited scientific studies.Results:The ORVIS Infrastructure,which aims at the development and availability of assessment tools,fills researchers’and clinicians’needs for measurement tools that are valid,effective and appropriate for use with a visually impaired clientele.Such tools are,especially in French,little known and hard to find,and represent a precious resource for those who want to evaluate the efficacy of treatments or interventions.Conclusions:ORVIS is available at www.orvis.vision.Between November 2015 and September 2017,the directory has been accessed 1,383 times by 952 unique visitors.

Postoperative accurate pain assessment of children and artificial intelligence: A medical hypothesis and planned study

Although the pediatric perioperative pain management has been improved in recent years,the valid and reliable pain assessment tool in perioperative period of children remains a challenging task.Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults,but also because there is a lack of effective and specific assessment tool for children.In addition,exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae.The short-term sequelae can induce a series of neurological,endocrine,cardiovascular system stress related to psychological trauma,while long-term sequelae may alter brain maturation process,which can lead to impair neurodevelopmental,behavioral,and cognitive function.Children’s facial expressions largely reflect the degree of pain,which has led to the developing of a number of pain scoring tools that will help improve the quality of pain mana-gement in children if they are continually studied in depth.The artificial inte-lligence(AI)technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks,which can effectively identify and systematically analyze various subtle features of children’s facial expressions.Based on the construction of a large database of images of facial expressions in children with perioperative pain,this study proposes to develop and apply automatic facial pain expression recognition software using AI technology.The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.

Fragile hearts:Unveiling the crucial layers of frailty in elderly patients undergoing percutaneous coronary interventions

Wang and Liu's systematic review of frailty among elderly patients undergoing percutaneous coronary intervention(PCI)revealed that patients with frailty have significantly higher risks of all-cause and in-hospital death,major undesirable cardiovascular events,and major haemorrhage.Frailty is associated with adverse events,prolonged hospital stays,increased complications,and elevated mortality risk due to diminished physiological reserves.Integrating frailty into risk assessment tools is crucial,and gait speed has emerged as a key predictor of frailty.Recognizing the impact of frailty leads to personalized and informed decisionmaking,and frailty assessments should be performed.This holistic approach can inform tailored interventions,thereby optimizing outcomes for this vulnerable population undergoing PCI.

Integrated Hydrological Modeling of the Godavari River Basin in Maharashtra Using the SWAT Model: Streamflow Simulation and Analysis

Hydrological modeling plays a crucial role in efficiently managing water resources and understanding the hydrologic behavior of watersheds. This study aims to simulate daily streamflow in the Godavari River Basin in Maharashtra using the Soil and Water Assessment Tool (SWAT). SWAT is a process-based hydrological model used to predict water balance components, sediment levels, and nutrient contamination. In this research, we used integrated remote sensing and GIS data, including Digital Elevation Models (DEM), land use and land cover (LULC) maps, soil maps, and observed precipitation and temperature data, as input for developing the SWAT model to assess surface runoff in this large river basin. The Godavari River Basin under study was divided into 25 sub-basins, comprising 151 hydrological response units categorized by unique land cover, soil, and slope characteristics using the SWAT model. The model was calibrated and validated against observed runoff data for two time periods: 2003-2006 and 2007-2010 respectively. Model performance was assessed using the Nash-Sutcliffe efficiency (NSE) and the coefficient of determination (R2). The results show the effectiveness of the SWAT2012 model, with R2 value of 0.84 during calibration and 0.86 during validation. NSE values also ranged from 0.84 during calibration to 0.85 during validation. These findings enhance our understanding of surface runoff dynamics in the Godavari River Basin under study and highlight the suit-ability of the SWAT model for this region.

Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.

Research Progress of Minimally Destructive Medicine Applied to Multimorbidity

Objective:To review the research status and progress of minimally disruptive medicine(MDM)with a view and to provide a theoretical basis for reducing the treatment burden of patients with multimorbidity.Methods:"Minimal Destructive Medicine"was used as searching term in HowNet Database and Wanfang Database,and"Minimally Disruptive Medicine"was used as searching term in PubMed database.The literature was reviewed for a review of the concepts of minimally destructive medicine(MDM),four basic principles,care models,and tools and strategies for clinical implementation.Results:MDM was developed for the coexistence burden of chronic diseases.It had formed a detailed and detailed application of basic principles and care models.The tools and strategies developed by MDM have been applied in clinical practice with good Results.Conclusion:MDM has a positive effect on reducing the burden of treatment for the multimorbidity and it is worthy of further research and promotion.

不同精度的土壤数据对水质和水量模拟的影响

【背景】模型模拟是研究面源污染的重要手段,建模过程中输入数据的质量是影响模型准确度的重要因素,其中土壤数据作为流域模型的重要输入数据之一,对模型的产流过程有重要的影响。然而,以往的研究多集中于土壤数据精度对水量和水文过程的影响,对水质的研究还比较欠缺。【目的】为丰富该领域建模的先验知识,为流域模型建立过程中的数据选择提供帮助。【方法】采用SWAT(soil&water assessment tool)模型,利用不同精度(1:5万、1:50万和1:100万)的土壤数据进行建模,对凤羽河流域的水量、泥沙、总氮和总磷含量进行了模拟。并采用SWAT-CUP软件进行参数的率定,得到基于3种不同土壤数据的最佳模拟结果。在此基础上,研究不同精度土壤数据对水文响应单元划分、模型参数、水质和水量模拟的影响。【结果】(1)土壤数据对水文响应单元(HRU,hydrologic response unit)的划分数量有明显影响,HRU划分数量的敏感性与划分阈值及土壤图详细程度有关;(2)进行参数率定后模型的表现效果有明显的提高,不同精度的土壤数据对于不同指标(流量、泥沙、总氮和总磷)的模拟效果存在差异,但并非土壤数据精度越高模拟效果越好;(3)随着子流域面积的增大,不同土壤数据提取的土壤属性的平均值趋于一致,且校准过程会对面积较小的子流域产生较大的影响。【结论】因此,在实际的模型模拟中应根据流域的大小和模拟的指标选择土壤数据的精度,同时在模型校准过程中要注意空间尺度的影响。

Combining CLUE-S and SWAT Models to Forecast Land Use Change and Non-point Source Pollution Impact at a Watershed Scale in Liaoning Province, China

Non-point source(NPS) pollution has become a major source of water pollution. A combination of models would provide the necessary direction and approaches designed to control NPS pollution through land use planning. In this study, NPS pollution load was simulated in urban planning, historic trends and ecological protection land use scenarios based on the Conversion of Land Use and its Effect at Small regional extent(CLUE-S) and Soil and Water Assessment Tool(SWAT) models applied to Hunhe-Taizi River Watershed, Liaoning Province, China. Total nitrogen(TN) and total phosphorus(TP) were chosen as NPS pollution indices. The results of models validation showed that CLUE-S and SWAT models were suitable in the study area. NPS pollution mainly came from dry farmland, paddy, rural and urban areas. The spatial distribution of TN and TP exhibited the same trend in 57 sub-catchments. The TN and TP had the highest NPS pollution load in the western and central plains, which concentrated the urban area and farm land. The NPS pollution load would increase in the urban planning and historic trends scenarios, and would be even higher in the urban planning scenario. However, the NPS pollution load decreased in the ecological protection scenario. The differences observed in the three scenarios indicated that land use had a degree of impact on NPS pollution, which showed that scientific and ecologically sound construction could effectively reduce the NPS pollution load in a watershed. This study provides a scientific method for conducting NPS pollution research at the watershed scale, a scientific basis for non-point source pollution control, and a reference for related policy making.

Simulation of hydrological processes of mountainous watersheds in inland river basins: taking the Heihe Mainstream River as an example

The hydrological processes of mountainous watersheds in inland river basins are complicated.It is absolutely significant to quantify mountainous runoff for social,economic and ecological purposes.This paper takes the mountainous watershed of the Heihe Mainstream River as a study area to simulate the hydrological processes of mountainous watersheds in inland river basins by using the soil and water assessment tool(SWAT)model.SWAT simulation results show that both the Nash–Sutcliffe efficiency and the determination coefficient values of the calibration period(January 1995 to December 2002)and validation period(January 2002 to December 2009)are higher than 0.90,and the percent bias is controlled within±5%,indicating that the simulation results are satisfactory.According to the SWAT performance,we discussed the yearly and monthly variation trends of the mountainous runoff and the runoff components.The results show that from 1996 to 2009,an indistinctive rising trend was observed for the yearly mountainous runoff,which is mainly recharged by lateral flow,and followed by shallow groundwater runoff and surface runoff.The monthly variation demonstrates that the mountainous runoff decreases slightly from May to July,contrary to other months.The mountainous runoff is mainly recharged by shallow groundwater runoff in January,February,and from October to December,by surface runoff in March and April,and by lateral flow from May to September.

A Modified Groundwater Module in SWAT for Improved Streamflow Simulation in a Large, Arid Endorheic River Watershed in Northwest China

Interactions between surface water and groundwater are dynamic and complex in large endorheic river watersheds in Northwest China due to the influence of both irrigation practices and the local terrain. These interactions interchange numerous times throughout the middle reaches, making streamflow simulation a challenge in endorheic river watersheds. In this study, we modified the linear-reservoir groundwater module in SWAT(Soil and Water Assessment Tools, a widely used hydrological model) with a new nonlinear relationship to better represent groundwater processes; we then applied the original SWAT and modified SWAT to the Heihe River Watershed, the second largest endorheic river watershed in Northwest China, to simulate streamflow. After calibrating both the original SWAT model and the modified SWAT model, we analyzed model performance during two periods: an irrigation period and a non-irrigation period. Our results show that the modified SWAT model with the nonlinear groundwater module performed significantly better during both the irrigation and non-irrigation periods. Moreover, after comparing different runoff components simulated by the two models, the results show that, after the implementation of the new nonlinear groundwater module in SWAT, proportions of runoff components changed-and the groundwater flow had significantly increased, dominating the discharge season. Therefore, SWAT coupled with the non-linear groundwater module represents the complex hydrological process in the study area more realistically. Moreover, the results for various runoff components simulated by the modified SWAT models can be used to describe the hydrological characteristics of lowland areas. This indicates that the modified SWAT model is applicable to simulate complex hydrological process of arid endorheic rivers.

Effect of Land Use Change on Runoff and Sediment Yield in Da River Basin of Hoa Binh province, Northwest Vietnam

The objective of this study was to assess runoff discharge and sediment yield from Da River Basin in the Northwest of Vietnam using Soil and Water Assessment Tools(SWAT) model.The SWAT model was calibrated and validated using the observed monthly stream flows and sediment yield at selected gauging stations.The results indicated that SWAT generally performs well in simulating runoff and sediment yield according to Nash-Sutcliffe efficiency(NSE), Observation's standard deviation ratio(RSR), and percent bias(PBIAS) values.For runoff, the values of NSE, RSR, and PBIAS were 0.98,0.02, and 3.69 during calibration period and 0.99,0.01, and 1.56 during validation period, respectively.For sediment yield, the efficiency was lower than the value of NSE, RSR, and PBIAS during calibration period were 0.81, 0.19, and-4.14 and 0.84, 0.16, and-2.56 during validation period, respectively.The results of the study indicated that the vegetation status has a significant impact on runoff and sediment yield.Changes in land use type between 1995 and2005 from forest to field crop and urban strongly contributed to increasing the average annual runoff from 182.5 to 342.7 mm and sediment yield from101.3 to 148.1 ton-1 ha.Between 2005 and 2010, adecrease of both runoff(from 342.7 to 167.6 mm) and sediment yield(from 148.1 to 74.0 ton-1 ha) was due to the expansion of forested area and application of soil conservation practices.The results of this study are important for developing soil and water conservation programs, extending future SWAT modelling studies and disseminating these results to other regions in Vietnam.

Managing osteoporosis in ulcerative colitis: Something new?

The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX® tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.

Quantification of Effects of Natural Geographical Factors and Land-scape Patterns on Non-point Source Pollution in Watershed Based on Geodetector:Burhatong River Basin,Northeast China as An Example

Changes in natural geographic features and landscape patterns directly influence the hydrology and non-point source pollution processes in the watershed;however,to slow down non-point source pollution,it is necessary to distinguish their effects.But the non-point source pollution process is interactional as a result of multiple factors,and the collinearity between multiple independent variables limits our ability of reason diagnosis.Thus,taking the Burhatong River Basin,Northeast China as an example,the methods of hydrological simulation,geographic detectors,and redundancy analysis have been combined to determine the impact of natural geographic features and landscape patterns on non-point source pollution in the watershed.The Soil&Water Assessment Tool(SWAT)has been adopted to simulate the spatial and temporal distribution characteristics of total nitrogen and total phosphorus in the watershed.The results show that the proportions of agricultural land and forest area and the location-weighted landscape contrast index(LWLI)are the main indicators influencing the rivers total nitrogen and total phosphorus.The interaction of these indicators with natural geographic features and landscape configuration indicators also significantly influences the changes in total nitrogen(TN)and total phosphorus(TP).Natural geographical features and landscape patterns have different comprehensive effects on non-point source pollution in the dry and wet seasons.TN and TP loads are affected mainly by the change in landscape pattern,especially in the wet season.Although the ecological restoration program has improved forest coverage,the purification effect of increased forest coverage on the water quality in the watershed may be offset by the negative impact of increased forest fragmentation.The high concentration and complexity of farmland patches increase the risk of non-point source pollution spread to a certain extent.

Hydrological Impacts of Climate Change on Streamflow of Dongliao River Watershed in Jilin Province,China

The impacts of future climate change on streamflow of the Dongliao River Watershed located in Jilin Prov-ince, China have been evaluated quantitatively by using a general circulation model （HadCM3） coupled with the Soil and Water Assessment Tool （SWAT） hydrological model. The model was calibrated and validated against the historical monitored data from 2005 to 2009. The streamflow was estimated by downscaling HadCM3 outputs to the daily mean temperature and precipitation series, derived for three 30-year time slices, 2020s, 2050s and 2080s. Results suggest that daily mean temperature increases with a changing rate of 0.435~C per decade, and precipitation decreases with a changing rate of 0.761 mm per decade. Compared with other seasons, the precipitation in summer shows significant downward trend, while a significant upward trend in autumn. The annual streamflow demonstrates a general down-ward trend with a decreasing rate of 0.405 m^3/s per decade. The streamflow shows significant downward and upward trends in summer and in autumn, respectively. The decreasing rate of streamflow in summer reaches 1.97 m^3/s per decade, which contributes primarily to the decrease of streamflow. The results of this work would be of great benifit to the design of economic and social development planning in the study area.

Development of the Documentation and Appraisal Review Tool for systematic reviews

AIM:To develop a tool to more explicitly assess and document the quality of systematic reviews.METHODS:We developed the Documentation and Appraisal Review Tool(DART)using epidemiologic principles of study design and the following resources:the modified Overview Quality Assessment Questionnaire(modified OQAQ),Assessment of Multiple Systematic Reviews(AMSTAR),the Cochrane Handbook,and the standards promoted by the Agency for Healthcare Research and Quality,and the Institutes of Medicine(IOM).We designed the DART tool to include the following:more detail to provide guidance and improve standardization of use,an approach to assess quality of systematic reviews addressing a variety of research designs,and additional space for recording notes to facilitate recall.DART underwent multiple rounds of testing with methodologists of varying levels of training and experience.Based on the results of six phases of pilot testing,we revised DART to improve performance,clarity and consistency.Pilot testing also included comparisons between DART,and the two most commonly used tools to evaluate the quality of systematic reviews,the modified OQAQ and AMSTAR.RESULTS:Compared to AMSTAR and modified OQAQ,DART includes two unique questions and several questions covered by modified OQAQ or AMSTAR but not both.Modified OQAQ and DART had the highest reporting consistency.Four AMSTAR questions were unclear and elicited inconsistent responses.Identifying reviewer rationale was most difficult using the modified OQAQ tool,and easiest using DART.DART allowsfor documentation of reviewer rationale,facilitating reconciliation between reviewers and documentation for future updates.DART also provides a comprehensive,systematic approach for reviewers with limited experience with systematic review methodology,to critically analyze systematic reviews.In addition,DART is the only one of the three tools to explicitly include quality review for biases specific to observational studies.This is now more widely recognized as important for assessing risk in order to generate recommendations that balance benefit to harm.The tool also includes the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.CONCLUSION:This comprehensive tool improves upon existing tools for assessing the quality of systematic reviews and guides reviewers through critically analyzing a systematic review.