Skip to main content
Download PDF
  • Research article
  • Open access
  • Published:

A transdisciplinary team approach to scoping reviews: the case of pediatric polypharmacy

BMC Medical Research Methodology volume 18, Article number: 102 (2018) Cite this article

Abstract

Background

Polypharmacy can be either beneficial or harmful to children. We conducted a scoping review to examine the concept of pediatric polypharmacy: its definition, prevalence, extent and gaps in research. In this manuscript, we report our transdisciplinary scoping review methodology.

Methods

After establishing a transdisciplinary team, we iteratively developed standard operating procedures for the study’s search strategy, inclusion/exclusion criteria, screening, and data extraction. We searched eight bibliographic databases, screened abstracts and full text articles, and extracted data from included studies using standardized forms. We held regular team meetings and performed ongoing internal validity measurements to maintain consistent and quality outputs.

Results

With the aid of EPPI Reviewer collaborative software, our transdisciplinary team of nine members performed dual reviews of 363 included studies after dual screening of 4398 abstracts and 1082 full text articles. We achieved overall agreement of 85% and a kappa coefficient of 0.71 (95% CI 0.68–0.74) while screening full text articles. The screening and review processes required about seven hours per extracted study. The two pharmacists, an epidemiologist, a neurologist, and a librarian on the review team provided internal consultation in these key disciplines. A stakeholder group of 10 members with expertise in evidence synthesis, research implementation, pediatrics, mental health, epilepsy, pharmacoepidemiology, and pharmaceutical outcomes were periodically consulted to further characterize pediatric polypharmacy.

Conclusions

A transdisciplinary approach to scoping reviews, including internal and external consultation, should be considered when addressing complex cross-disciplinary questions.

Peer Review reports

Background

Exposure to multiple medications is common among pediatric patients in both inpatient and outpatient settings [1,2,3,4]. Using multiple medications can have benefits such as augmentation, tolerability, and efficacy [5,6,7], or harms such as adverse drug reactions, drug-drug interactions, difficulty adhering to complex regimens, toxicity, overdose, and increased cost [8,9,10,11,12]. Balancing harms and benefits is challenging for prescribers, especially with limited evidence to guide treatment in pediatric patients, and varying definitions and methodologies for pediatric polypharmacy [7, 13, 14]. In the pediatric literature, the term polypharmacy is commonly used when more than one medication is prescribed for a single disease, despite the reality that it is more common to use multiple medications in patients with comorbid diagnoses [15,16,17,18]. In this context, we conducted a transdisciplinary scoping review to map the pediatric polypharmacy literature, identify gaps in literature, clarify the definition, and describe the prevalence of pediatric polypharmacy. Transdisciplinary team science is the most integrated form of collaborative research, after interdisciplinary and multidisciplinary approaches [19]. The three terms refer to the involvement of multiple disciplines interacting in different ways while examining aspects of the same larger question or problem. Multidisciplinary is the most basic level of involvement where each discipline independently applies knowledge and approaches, often in a sequential fashion. Interdisciplinary involves concurrent reciprocal interaction among disciplines, necessitating a degree of blurring of disciplinary boundaries. Transdisciplinary transcends disciplinary boundaries to consider the dynamics of systems in a holistic way [20]. To achieve the highest level of collaboration over the broad topic of pediatric polypharmacy, we selected the transdisciplinary team approach for our scoping review.

A scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field [21,22,23]. Like a systematic review, a scoping review uses transparent and reproducible processes to define a research question, search for studies, and synthesize findings. However, a systematic review typically focuses on a well-defined question and aims to provide answers to questions from a relatively narrow range of studies assessed for quality. A scoping study, in contrast, uses the literature to address a broader research question, typically without assessing quality of studies [21, 24, 25]. Scoping reviews seek to reveal patterns that emerge from the literature and are more likely to be hypothesis generating, whereas systematic reviews often are hypothesis testing [26].

We believe that applying a transdisciplinary approach to a scoping review is novel in pediatric literature synthesis. A transdisciplinary team approach is holistic in that team members from different disciplines exchange expertise, knowledge and skills around a complex problem, resulting in integrated insights not easily assigned to a particular discipline [19, 20]. Representatives of different disciplines transcend their separate conceptual, theoretical, and methodological orientations in order to develop a common conceptual framework, in ways that go beyond multidisciplinary and interdisciplinary approaches [27,28,29]. In multidisciplinary approaches, different disciplines work in parallel or sequentially with the research questions and methods staying within the boundaries of each discipline [20, 28]. Interdisciplinary approaches harmonize links between, typically two, disciplines while mostly maintaining disciplinary identities without a common framework [20]. Success of these collaborative initiatives depends on the extent to which cross disciplinary integrations are actually achieved by research teams [30].

A common feature of scoping studies has been the need to engage researchers from a wide range of academic disciplines [31]. Additionally, authors may find it appropriate to search multiple sources of literature— quantitative, qualitative, text, opinion pieces, or summaries [32,33,34].

Multidisciplinary approaches have been widely used in scoping studies [35, 36]. A multidisciplinary team provides the required specialist knowledge to map a subject that is not necessarily always found in one field [22, 31]. This approach can, however, create problems as researchers from very different theoretical perspectives often have difficulty in working together [31]. Because of its intentional integrational nature, the transdisciplinary approach may be better suited to handle the broad research questions and types of literature of scoping studies [37]. Similar to the transdisciplinary approach, an integrated knowledge translation approach [38] is a collaborative research process whereby researchers and knowledge users work together from developing the question through designing, completing the literature search, analyzing and interpreting the data and disseminating the results [26].

While multiple research teams have conducted narrative, scoping, and systematic reviews on polypharmacy among adults and the elderly [39,40,41,42], we were unable to find transdisciplinary teams that conducted systematic or scoping reviews of studies involving pediatric polypharmacy. In this manuscript, we report the methods of our transdisciplinary scoping review of pediatric polypharmacy. To facilitate potential replication by others, we also describe the key roles of our transdisciplinary team members.

Methods

Study design and methodology

We used the methodological framework for scoping reviews proposed by Arksey and O’Malley, and enhanced by others [21,22,23, 32, 43,44,45]. We specifically adopted Levac and colleagues’ modifications including the steps outlined below [44]. Our detailed protocol is available from the corresponding author upon request.

  1. 1)

    Articulate the research question in relation to the purpose and rationale of the study.

  2. 2)

    Identify relevant studies while considering human and financial resources, breadth, and comprehensiveness.

  3. 3)

    Select studies using an iteratively developed search strategy, and abstract and full text inclusion and exclusion criteria, applied independently by two reviewers.

  4. 4)

    Chart the data by two reviewers using a collectively and interactively developed extraction form.

  5. 5)

    Collate, summarize, and report the results in relation to study purpose, and implications for policy, practice, or research

  6. 6)

    Conduct ongoing engagement and consultation of experts to further understand the concept of pediatric polypharmacy

Transdisciplinary team approach

Our transdisciplinary team included core disciplines of pediatrics, pharmacy, evidence synthesis, epidemiology, and library and information science. We developed three sub-teams: the implementation team, the protocol team, and the project stakeholders or consultants. The implementation team was comprised of ten members who developed the protocol and standard operating procedures (SOPs), collected data and drafted the manuscripts. The protocol team - a group of three experts in internal medicine, research implementation, pharmaceutical outcomes research, pediatrics, health services research and policy - oversaw the development and implementation of the research by mentoring and advising the implementation team. Project stakeholders/consultants included experts in content areas critical to our research, including mental health, childhood complex chronic disease conditions, pediatrics, epilepsy, pharmacoepidemiology, and scoping research methodology. We consulted with members of this group during protocol development, data interpretation, and reporting.

We identified and recruited members to our team locally from three large hospital systems, a medical school, and a nursing school, and nationally, including authors of seminal manuscripts in the field. Graduate research assistants brought further relevant disciplinary expertise, including biostatistics and public health, into the team. We illustrate our transdisciplinary team in Fig. 1. The overlapping boxes and fading color depict the merging and fading of the individual disciplines into a new distinct transdisciplinary product. A team leader coordinated the activities of our transdisciplinary team.

Fig. 1
figure 1

The Pediatric Polypharmacy Transdiscipline Schema. Implementation Team: Alexis Horace (AH), Courtney Baker (CB), Hannah Johnson (HJ), Jennifer Staley (JS), Jennifer Waldron (JW), Negar Golchin (NG), Paul Bakaki (PB), Rujia Liu (RL), Shari Bolen (SB), Xuan Ma (XM). Protocol Team: Almut Winterstein (AW), Larry Kleinman (LK), Neal Dawson (ND). Stakeholders/Consultants: Cynthia Fontanella (CF), Elia Pestana (EP), Faye Gary (FG), James Feinstein (JF), Joseph Calabrese (JC), Mai Pham (MF), Sharon Meropol (SM)

Full size image

The implementation team met weekly, in person and via teleconference, while the broader team communication was primarily electronic. Table 1 summarizes the activities of our transdisciplinary implementation team, designed to foster communication and cooperation, and to ensure quality research outputs. We conducted training sessions for the implementation team at critical stages of the study, including when the team was newly created, when new members joined the team, and before the beginning of the pilot and implementation phases. We used weekly meetings to discuss challenging studies and share information about progress, interrater agreement, weekly targets, and quality improvement. The epidemiologist, librarian, pharmacists, pediatric neurologist, and evidence synthesis expert on the implementation team provided disciplinary perspectives during training, SOP development, and review of studies. For example, the epidemiologist helped to incorporate principles of study design; pharmacists guided the classification of medications; clinicians clarified clinical meaning; and the librarian guided the team towards best practices in literature search. Each played an integral role in teaching the team respective disciplines to help in the execution of the project. These experts on our implementation team also screened studies and extracted data (Additional file 1), requiring them to learn and apply skills from other disciplines. For example, the librarian participated in conceptualizing the project, screening and extracting data from studies, and drafting abstracts and manuscripts in addition to searching for studies.

Table 1 Activities and Procedures of the Pediatric Polypharmacy Transdisciplinary Team
Full size table

The incorporation of internal content experts was efficient and informative when faced with the many technical, pharmacological, and clinical data challenges in the literature. Even so, medication classification remained challenging because of the existence of multiple classification systems and the presence of apparent misclassifications in the literature. The ready availability of pharmacists on the team made it possible to complete the work despite this lack of clarity.

The team made use of a shared Google Drive account to create and/or store research documents including the protocol, responses to an appreciative inquiry questionnaire [46], “letters to Mum” (described in Table 1), seminal methodological manuscripts, meeting minutes, SOPs, draft abstracts, and manuscripts. We used the tool “letter to Mum” to convey the need to communicate our research to lay people, referring to one of our team member’s mum who is unschooled.

Protocol

The team leader (PB) conceptualized the research questions and drafted the research protocol in consultation with the evidence synthesis expert (SB) and librarian (JS). The rest of the team, including our stakeholders, reviewed, edited, and approved the protocol before implementation. This iterative process ensured that the experts generated transdisciplinary research questions and approaches. We made a few modifications to the protocol during implementation to refine our inclusion and exclusion criteria in keeping with scoping review methodology. For example, while our search strategy specified children, we decided to retain any resulting studies that included a few young adults up to age 25 when they predominantly studied children below age 19 and were conducted in pediatric facilities. The team leader drafted the initial screening and data extraction forms which, with input from the implementation team, underwent considerable changes during the pilot and implementation phases of the study. This process aligns with the iterative nature of scoping reviews [21]. These modifications were valuable as they were informed by new insights, discoveries, prior omissions, and the need for clarification discovered during study screening and data extraction. As a function of EPPI Reviewer-4 software [47], our screening and data extraction forms were able to accommodate reference information explaining the meaning of each field and how it should be completed. These SOPs were developed iteratively [21] by our core implementation team. They were also available to team members as stand-alone electronic copies in our shared Google Drive account for reference. The SOPs, screening, and data extraction forms were piloted on 100 studies. Twenty-one of these studies were included in the final data.

Eligibility

We sought to review original observational studies written in English that assessed polypharmacy in children 18 years of age or younger. Studies must have assessed polypharmacy as an aim, outcome measure, main predictor of outcome, or a covariate. We did not impose any geographical or publication year limits. Neither did we consider study quality, as is common in scoping reviews. We excluded case reports; non-English or non-original studies (reviews, opinion pieces, letters, or abstracts); studies exclusively conducted in adult subjects; those not about polypharmacy; or those that assessed polypharmacy experimentally, prenatally, or during breastfeeding. We excluded experimental research because our study aims involved gaining understanding regarding the practice patterns, definition, and prevalence of pediatric polypharmacy, which cannot be addressed by experimental studies.

Search strategy

Our librarian developed a search strategy in consultation with the team leader and evidence synthesis expert. The final MEDLINE search strategy is shown in Fig. 2. First, we searched the following databases from inception to October 2016 using controlled vocabulary and free text terms for the concepts of polypharmacy and children: Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, ProQuest Dissertations & Theses A&I, and the Web of Science Core Collection. We then updated the database search in July 2017. Finally, we hand searched a random sample of 30 studies (10% of included studies from the original search), as well as six relevant review articles to find any studies our database search might have missed. The six review articles were purposively selected by two reviewers, out of 15 identified by the whole review team, prioritizing medications studied (all medications, antipsychotics, antiepileptic), age groups (neonates, older children), and outcomes (e.g. adverse drug reactions).

Fig. 2
figure 2

Medline Search Strategy

Full size image

Study selection

Once we acquired relevant titles and abstracts, two independent reviewers screened titles and abstracts together using a standardized abstract screening form. Likewise, pairs of independent reviewers screened full text articles using an article screening form. Reviewer pairs met in-person or by telephone to reconcile differences after independently reviewing their studies. Conflicts were resolved by the larger implementation team.

Data extraction

We iteratively designed a comprehensive data extraction form to collect information pertaining to study and population characteristics, study measures, definition of polypharmacy, diseases and medications evaluated. Sections of the extraction form were initially drafted by members of the relevant disciplines (e.g. medications by pharmacists, disease conditions by pediatricians, and study measures by epidemiologists) then they were discussed and revised by the transdisciplinary team. Data extraction was conducted through two sequential reviews. Our detailed data extraction form is provided in Additional file 2.

We timed both screening and data extraction in order to distribute studies according to each reviewer’s availability and review speed. In addition to computing individual average duration, we computed group average duration of screening and data extraction in order to establish an objective timeline of study activities. This tracking did not take into account the immense amount of time spent on project administration, database searches, article retrieval, data cleaning, and processing.

Data synthesis

We conducted both qualitative and quantitative synthesis of the data. We performed a qualitative synthesis on the definitions of polypharmacy that assessed text definitions for the presence of components such as number of medications, overlap period of medications, class or drug level, medication or class name, and limitation to one or two medications. Additionally, we conducted descriptive statistics of individual variables and cross-tabulated variables to examine relationships. A pharmacist, an epidemiologist, and a library and information scientist conducted the qualitative synthesis in pairs and among all of them in case of disagreements. The quantitative health scientists (epidemiologist and statisticians) performed the descriptive statistics and shared preliminary results with both the review team and consultants for input before generating the final results.

Software

We used Clarivate Analytics EndNote (X7) to find studies and remove duplicates. We then imported the titles and abstracts into EPPI-Reviewer 4 (EPPI) [47]. We used EPPI for data management and collaborative review. It aided us in randomly assigning studies to groups, creating screening and data extraction forms, screening studies and reconciling differences, data cleaning, data synthesis, and report generation. We used SAS and Microsoft Excel to compute Kappa statistics, process, and analyze data downloaded from EPPI.

Quality control

Implementing quality control measures such as training, independent paired reviews and the use of standardized data collection forms reinforced the reliability of our study procedures. We screened titles and abstracts in batches of 120 randomly assigned studies and extracted data from 20 randomly assigned full text studies per pair of reviewers. The team leader purposively assigned these groups to varying review pairs to maximize interactions between team members based on availability, experience, and academic discipline. We measured inter-rater reliability using percent agreement and Kappa statistic (k) [48]. Percent agreement for each group of studies was immediately available to the reviewer pair. The team leader also generated cumulative percent agreement on a weekly basis to provide insight on screening uniformity. We discussed strategies for improving agreement during our weekly team meetings. Kappa statistic was computed for a 30% sample of all titles and abstracts screened as well as for all full text studies screened.

Results

Studies reviewed

Of 8651 citations, we screened 4398 studies. A total of 363 studies remained for data extraction and synthesis. A full list of the 363 included studies is provided in Additional file 3.

Time investment

The pilot phase lasted 3 months, implementation lasted 8 months, data cleaning and processing lasted 2 months. Individual time commitment varied among team members (Additional file 1). On average, it took 7 min to screen a study on title and abstract, 13 min to screen on full text, 76 min to conduct a primary data extraction, 52 min to verify the extraction, and 30 min to address queries raised through the verification and data cleaning process. Dividing the total time spent on the reviews by the 363 included studies revealed that it took 7.3 h to produce a record in our analytic database. We required reviewers to time only their uninterrupted reviews which were 61% (220/363) of included studies.

Inter-rater concordance

The Kappa coefficients (k) ranged from fair to excellent (0.41–0.8) [48] for all screening on title and abstract or full text, with/without reason for exclusion (Additional file 4). Inter-reviewer agreement was highest when reviewers were similar to one another, for example, between pharmacists or between graduate assistants. The agreement was lowest between dissimilar reviewers, especially during the early phase of the implementation period. Pharmacists tended to go “deeper” when extracting information related to medicines and physicians went “deeper” when extracting information about disease conditions while non clinicians were uniform while extracting information. Inter-reviewer agreement increased as the study progressed, irrespective of reviewer similarity, mainly because we tasked specialists to simplify professional language while training others and writing SOPs.

Discussion

In this project, we established a transdisciplinary team of experts that conducted a large scoping review in order to map the pediatric polypharmacy literature, identify research gaps, clarify the definition of pediatric polypharmacy, and describe the prevalence of pediatric polypharmacy. In addition to reviewing studies, the team also provided internal consultation to one another throughout the project cycle.

Study strengths

In the past, some scoping reviews have been conducted by multidisciplinary [35] and inter-professional [23] teams while other large scoping reviews have depended on a few individuals to conduct the review [29, 49]. What distinguishes our project from many others is integration of the transdisciplinary approach at every stage of the scoping review [29]. Five out of ten members of our implementation team participated in acquiring studies, nine reviewed studies, and eight were involved in drafting abstracts and manuscripts. Achieving this level of participation required learning about other disciplines and teaching one’s own discipline to each other. We illustrate this integrated effort through the description of activities of our health science librarian, a discipline that has been found lacking among authors of scoping reviews [50]. The librarian was engaged during the whole scoping review cycle: conceptualizing the research question; developing database search strategies; retrieving studies, screening studies; extracting data; training team members; reviewing SOPs; and writing abstracts, posters, and manuscripts. Similar experiences were mirrored among members of the other core disciplines including pharmacists, clinicians, and research methodologists.

With a librarian, epidemiologist, two pharmacists, and a clinician reviewing studies, we had internal consultation in our core disciplines. Moreover, we had a knowledge synthesis expert attend our weekly meetings to address pressing issues in real time. The transdisciplinary approach where we constantly worked on establishing a common strategy enabled us to perform internal consultation at least as rigorously as the inter-professional approach used by Daudt and colleagues [23]. The episodic engagement of the project stakeholders provided a second layer of consultation.

Time requirement

As other authors of scoping reviews have argued previously, a scoping review is not a rapid review [23, 50] as it was initially defined [21]. In our situation, it took thirteen months to complete the project. Lack of published guidance on detailed time frames made it difficult for us to project how much time each stage would take. The detailed extraction form partially explains why it took our group more than 2 h for each study. However, it is not likely that a shorter extraction form would have significantly reduced the amount of time needed to extract a study. Additionally, a shorter form would not have adequately met the needs of our broad research questions. One potential option for time saving could have included utilizing the machine learning capability available in EPPI Reviewer-4 (EPPI) software for screening on title and abstract. By our estimates, automated screening would have reduced our review time by about 800 h or 30% of the total time. This approach, however, would still require manually screening about 1000 random titles and abstracts from which EPPI would learn in order to screen the rest of the studies. In any case, we hope that future researchers planning scoping reviews similar to ours can use the 7 h estimate for an extracted study to plan their own projects.

Limitations

Our scoping review project had some limitations. As expected in a large team like ours, member involvement varied with time due to competing engagements and the unpredictable time requirements of our study. The team leader ensured that each person was assigned work proportional to their availability during each phase of the study. Setting short-term targets, typically of one to 2 weeks, helped to ensure continuity. Converging our team’s diverse training, experiences, and backgrounds around the concept of pediatric polypharmacy required more time, discussions, and meetings among team members.

Whereas we achieved kappa coefficients in the moderate to substantial range of 0.41–0.80 [48], the coefficients for screening on title and abstract were lower than those for screening on full text. This may be explained by the difference in inclusion proportions at title and abstract screening of 25% and at full text screening of 30%. The opportunity for chance agreement to increase (and for kappa coefficients to decrease) is enhanced with the deviation of inclusion proportion away from 50% [51]. Overall, both percent agreement and kappa coefficients increased as the study progressed, implying mastery of screening guidelines with time and practice. The high agreement we observed between reviewers of the same discipline seems to imply similarity of background knowledge rather than protocol-based decisions. Minimizing the paring of reviewers with similar disciplinary backgrounds and changing reviewer pairs of study batches between the screening phases addressed this problem.

Excluding experimental and non-primary observational studies such as review studies may have led to exclusion of some definitions of pediatric polypharmacy, affecting one of the primary aims of this study.

Conclusions

In conclusion, we completed a scoping review as a transdisciplinary team. Our team efforts have enabled us to implement a project of considerable magnitude, as well as benefit from all team members’ skills and efforts. Our transdisciplinary review team provided inbuilt expert consultation which complemented that from external stakeholders. We found holding regular meetings, producing SOPs, and continually assessing internal validity to be helpful.

We recommend that researchers conducting large scoping reviews consider using a transdisciplinary approach to elevate the breadth and focus of the questions; enhance the scoping review decisions and iterations; and enrich review conclusions. We hope the detailed description provided in this paper will help others conducting future scoping reviews when designing their studies and planning for necessary resource requirements.

Abbreviations

EPPI:

EPPI-Reviewer 4

SAS:

Statistical analysis system

SOP:

Standard operating procedures

References

  1. Feudtner C. Prevalence of polypharmacy exposure among hospitalized children in the United States. Arch Pediatr Adolesc Med. 2012;166(1):9.

    Article  Google Scholar 

  2. JAFeinstein CF, Valuck RJ, Kempe A. The depth, duration, and degree of outpatient pediatric polypharmacy in Colorado fee-for-service Medicaid patients. Pharmacoepidemiol Drug Saf. 2015;24(5):1049–57.

    Article  Google Scholar 

  3. Clavenna A, Bonati M. Drug prescriptions to outpatient children: a review of the literature. Eur J Clin Pharmacol. 2009;65(8):749–55.

    Article  Google Scholar 

  4. Horace A, Ahmed F. Polypharmacy in pediatric patients and opportunities for pharmacists’ involvement. Integr Pharm Res Pract. 2015;4:113.

    Article  Google Scholar 

  5. Correll CU, Gallego JA, Nielsen J, De Hert M, Kane JM. Safety and tolerability of antipsychotic polypharmacy. Expert Opin Drug Saf. 2013;11(4):527–42.

    Google Scholar 

  6. Lochmann van Bennekom MW, Gijsman HJ, Zitman FG. Antipsychotic polypharmacy in psychotic disorders: a critical review of neurobiology, efficacy, tolerability and cost effectiveness. J Psychopharmacol. 2013;27(4):327–36.

    Article  Google Scholar 

  7. Constantine RJ, Boaz T, Tandon R. Antipsychotic polypharmacy in the treatment of children and adolescents in the fee-for-service component of a large state medicaid program. Clin Ther. 2010;32(5):949–59.

    Article  Google Scholar 

  8. Feinstein J, Dai D, Zhong W, Freedman J, Feudtner C. Potential drug-drug interactions in infant, child, and adolescent patients in Children’s hospitals. Pediatrics. 2015;135(1):e99–e108.

    Article  Google Scholar 

  9. Rashed AN, Wong ICK, Cranswick N, Tomlin S, Rascher W, Neubert A. Risk factors associated with adverse drug reactions in hospitalised children: international multicentre study. Eur J Clin Pharmacol. 2012;68(5):801–10.

    Article  CAS  Google Scholar 

  10. Schall C. A Consumer’s guide to monitoring psychotropic medication for individuals with autism Spectrum disorders. Focus Autism Other Dev Disabl. 2002;17(4):229–35.

    Article  Google Scholar 

  11. Saldaña SN, Keeshin BR, Wehry AM, et al. Antipsychotic polypharmacy in children and adolescents at discharge from psychiatric hospitalization. Pharmacotherapy. 2014;34(8):836–44.

    Article  Google Scholar 

  12. Sammons H, Choonara I. Learning lessons from adverse drug reactions in children. Child Aust. 2016;3(1):1.

    Article  Google Scholar 

  13. Freudenreich O, Goff DC. Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations. Acta Psychiatr Scand. 2002;106(5):323–30.

    Article  CAS  Google Scholar 

  14. Boots I, Sukhai RN, Klein RH, et al. Stimulation programs for pediatric drug research - do children really benefit? Eur J Pediatr. 2007;166(8):849–55.

    Article  Google Scholar 

  15. Ballardini N, Bergström A, Wahlgren CF, et al. IgE antibodies in relation to prevalence and multimorbidity of eczema, asthma, and rhinitis from birth to adolescence. Allergy Eur J Allergy Clin Immunol. 2016;71(3):342–9.

    Article  CAS  Google Scholar 

  16. Bassili A, Omar T, Zaki A, Abdel-Fattah M, Tognoni G. Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt. Int J Qual Heal Care. 2002;14(4):277–84.

    Article  Google Scholar 

  17. O’Leary S, Burns T, Borden K. Performance of children with epilepsy and normal age-matched controls on the WISC-III. Child Neuropsychol. 2006;12(3):173–80.

    Article  Google Scholar 

  18. Thomé-Souza S, Freitas A, Fiore LA, Valente KD. Lamotrigine and valproate: efficacy of co-administration in a pediatric population. Pediatr Neurol. 2003;28(5):360–4.

    Article  Google Scholar 

  19. Stevenson DK, Shaw GM, Wise PH, et al. Transdisciplinary translational science and the case of preterm birth. J Perinatol. 2013;33(4):251–8.

    Article  CAS  Google Scholar 

  20. Choi BCK, AWP P. Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Investig Med. 2006;29(6):351–64.

    Google Scholar 

  21. Arksey H, Malley LO. Scoping Studies : towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

    Article  Google Scholar 

  22. Colquhoun HL, Levac D, O’Brien KK, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291–4.

    Article  Google Scholar 

  23. Daudt HML, Van MC, Scott SJ. Enhancing the scoping study methodology : a large , inter-professional team ’ s experience with Arksey and O ’ Malley ’ s framework. BMC Med Res Methodol. 2013;12(48):1–9.

    Google Scholar 

  24. Armstrong R, Hall BJ, Doyle J, Waters E. “Scoping the scope” of a cochrane review. J Public Health (Bangkok). 2011;33(1):147–50.

    Article  Google Scholar 

  25. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Inf Libr J. 2009;26(2):91–108.

    Article  Google Scholar 

  26. Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16:15.

    Article  Google Scholar 

  27. Rosenfield PL. The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Soc Sci Med. 1992;35(11):1343–57.

    Article  CAS  Google Scholar 

  28. Fawcett J. Thoughts about multidisciplinary, interdisciplinary, and transdisciplinary research. Nurs Sci Q. 2013;26(4):376–9.

    Article  Google Scholar 

  29. Min B, Allen-Scott LK, Buntain B. Transdisciplinary research for complex one health issues: a scoping review of key concepts. Prev Vet Med. 2013;112(3–4):222–9.

    Article  CAS  Google Scholar 

  30. Stokols D, Hall KL, Taylor BK, Moser RP. The science of team science. Overview of the field and introduction to the supplement. Am J Prev Med. 2008;35(2 SUPPL):s77–89.

    Article  Google Scholar 

  31. Anderson S, Allen P, Peckham S, Goodwin N. Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. Heal Res Policy Syst. 2008;6:7.

    Article  Google Scholar 

  32. Khalil H, Peters M, Godfrey CM, Mcinerney P, Soares CB, Parker D. An evidence-based approach to scoping reviews. Worldviews Evidence-Based Nurs. 2016;13(2):118–23.

    Article  Google Scholar 

  33. Kim HD, Park DH, Vydiswaran VGV, Zhai C. Opinion summarization using entity features and probabilistic sentence coherence pptimization: UIUC at TAC 2008 opinion summarization pilot. 2008. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.232.1185&rep=rep1&type=pdf. Accessed 23 Aug 2018.

  34. Pearson A, Wiechula R, Court A, Lockwood C. The JBI model of evidence-based healthcare. Int J Evid Based Healthc. 2005;3(8):207–15.

    PubMed  Google Scholar 

  35. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.

    Article  Google Scholar 

  36. Schultz A, Goertzen L, Rothney J, et al. A scoping approach to systematically review published reviews: adaptations and recommendations. Res Synth Methods. 2018;9:116–23.

    Article  Google Scholar 

  37. Allen-Scott LK, Hatfield JM, McIntyre L. A scoping review of unintended harm associated with public health interventions: towards a typology and an understanding of underlying factors. Int J Public Health. 2014;59:3–14.

    Article  CAS  Google Scholar 

  38. Straus SE, Tetroe JM, Graham ID. Knowledge translation is the use of knowledge in health care decision making. J Clin Epidemiol. 2011;64(1):6–10.

    Article  Google Scholar 

  39. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(230):1–10.

    Google Scholar 

  40. Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11:82–99.

    Article  Google Scholar 

  41. Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: a systematic review and meta-analysis. J Am Pharm Assoc. 2017;57(6):729–738.e10.

    Article  Google Scholar 

  42. Tani H, Uchida H, Suzuki T, Fujii Y, Mimura M. Interventions to reduce antipsychotic polypharmacy: a systematic review. Schizophr Res. 2013;143(1):215–20.

    Article  Google Scholar 

  43. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141–6.

    Article  Google Scholar 

  44. Levac D, Colquhoun H, Brien KKO. Scoping studies : advancing the methodology. Implement Sci. 2010;5(69):1–9.

    Google Scholar 

  45. Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, Mcewen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5(4):371–85.

    Article  Google Scholar 

  46. Cooperrider DL, Srivastva S. Appreciative inquiry in organizational life. Resarch Organ Chang Develoment. 1987;1:129–69.

    Google Scholar 

  47. Thomas J, Brunton J, Graziosi S. EPPI-Reviewer 4: software for research synthesis. EPPI-Centre Software. London: Social Science Research Unit, UCL Institute of Education. 2010. https://eppi.ioe.ac.uk/cms/er4/Features/tabid/3396/Default.aspx. Accessed 23 Aug 2018.

  48. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37–46.

    Article  Google Scholar 

  49. Anderson S, Allen P, Peckham S, Goodwin N. Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. pdf. Heal Res Policy Syst. 2008;6:7.

    Article  Google Scholar 

  50. Morris M, Boruff JT, Gore GC. Scoping reviews: establishing the role of the librarian. J Med Libr Assoc. 2016;104(4):346–53.

    Article  Google Scholar 

  51. Sim J, Wright CC. The kappa statistic in reliability Studies : use , interpretation , and sample size requirements. Phys Ther. 2005;85(3):257–68.

    PubMed  Google Scholar 

Download references

Acknowledgements

We thank our expert stakeholders whose contribution at different stages of the project improved our research protocol, data quality, interpretation, and reporting: Dr. Joseph Calabrese, Dr. Faye Gary, Dr. Jamie Feinstein, Dr. Cynthia Fontanella, Dr. Sharon Meropol, Dr. Elia Pestana-Knight, and Dr. Mai Pham. We are also grateful to Ms. Xuan Ma and Ms. Courtney Baker who conducted a great amount of study screening, data extraction, data cleaning, quality checks, processing, and analysis. Lastly, we thank Prof. Shirly Moor for providing the appreciative inquiry questionnaire we adapted for our team.

Funding

This publication was made possible by the Clinical and Translational Science Collaborative of Cleveland, KL2TR000440 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The funding body was not involved in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Availability of data and materials

Not applicable.

Author information

Authors and Affiliations

  1. Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA

    Paul M Bakaki, Rujia Liu, Neal Dawson, Hannah Johnson & Shari D Bolen

  2. Rainbow Babies and Children’s Hospital, University Hospitals, Cleveland, OH, USA

    Jennifer Staley, Jennifer Waldron & Lawrence C Kleinman

  3. Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA

    Neal Dawson & Shari D Bolen

  4. School of Pharmacy, University of Washington, Seattle, WA, USA

    Negar Golchin

  5. Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA, USA

    Alexis Horace

  6. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Jennifer Waldron & Lawrence C Kleinman

  7. College of Pharmacy, University of Florida, Gainesville, FL, USA

    Almut Winterstein

  8. The Center for Child Health and Policy at Rainbow, University Hospitals, Cleveland, OH, USA

    Lawrence C Kleinman

  9. Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA

    Shari D Bolen

Authors
  1. Paul M Bakaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer Staley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rujia Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neal Dawson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Negar Golchin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexis Horace
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hannah Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jennifer Waldron
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Almut Winterstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lawrence C Kleinman
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shari D Bolen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PMB, JS, and SDB conceptualized and designed the study; collected, synthesized, and interpreted data; drafted the initial manuscript; and revised the manuscript for intellectual content. NG and AH, conceptualized and designed the study; collected, synthesized, and interpreted data; and revised the manuscript for intellectual content.

ND, LCK, and WA conceptualized and designed the study; synthesized and interpreted data; and revised the manuscript for intellectual content. RL collected, synthesized, and interpreted data; drafted the initial manuscript; and revised the manuscript for intellectual content. HJ and JW collected, synthesized, and interpreted data; and revised the manuscript for intellectual content. All authors approved the final version of the manuscript as submitted for publication, and they agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Paul M Bakaki.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional files

Additional file 1:

Distribution of Studies Reviewed and Time Spent by the Pediatric Polypharmacy Scoping Review Implementation Team. Reviewer work load and amount of time spent on abstract screening, full text screening, and data extraction. (DOCX 17 kb)

Additional file 2:

Data Extraction Form. All the questions used for extracting data. (DOCX 24 kb)

Additional file 3:

Included Studies. List of first author, year of publication, and title of all included studies. (DOCX 54 kb)

Additional file 4:

Inter-rater Concordance Measures for Screening on Title & Abstract, and Full Text. Details of percent agreement and kappa statistics for screening title & abstracts as well as full texts. (DOCX 19 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bakaki, P.M., Staley, J., Liu, R. et al. A transdisciplinary team approach to scoping reviews: the case of pediatric polypharmacy. BMC Med Res Methodol 18, 102 (2018). https://doi.org/10.1186/s12874-018-0560-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12874-018-0560-4

Keywords

BMC Medical Research Methodology

ISSN: 1471-2288

Contact us