Objective: The aim of this scoping review is to describe how a public health approach to legal and illegal psychoactive substance use has been previously defined, and to identify its core values, concepts, activities, and goals. Introduction: Jurisdictions globally are increasingly endorsing a public health approach to addressing psychoactive substance use. However, there is currently no agreed definition of this approach, and this term has been applied inconsistently in the literature, policy, and practice. A critical first step toward advancing a public health approach to substance use is identifying and articulating its core components. Inclusion criteria: This review will consider all peer-reviewed and gray literature in English focused on conceptualizing, defining, or describing a public health approach to substance use. Our review does not place limitations on populations, psychoactive substance types, or other contextual factors. Methods: We will search PROSPERO, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and Scopus, as well as health and social science databases; websites of prominent nonprofit, civil society, and government agencies/ organizations in public health and substance use fields; and reference lists of included articles. Two independent reviewers will screen titles/abstracts of peer-reviewed literature, and 1 reviewer will screen titles/abstracts of gray literature. Two independent reviewers will conduct the full-text screening. A data extraction sheet will be pilot tested through double extraction. Findings will be presented as a narrative summary supported by tables and diagrams and, if feasible, a conceptual framework for understanding and applying a public health approach to substance use.

BACKGROUND:Internationally, many supervised consumption services (SCS) include drug inhalation (smoking). However, most research is focused on SCS for people who inject drugs. We aimed to: (1) synthesize the literature on including inhalation or other forms of non-injection drug use (e.g., oral, intranasal) within SCS; (2) describe the state of the science on the feasibility of this practice and its outcomes; and (3) outline an agenda for future evaluation research in this area.METHODS:We searched 9 academic and 13 grey literature databases and ultimately included 40 studies. Thirty-two studies (80%) reported findings from feasibility or needs assessments. From these studies, we extracted information on willingness to use these services, perspectives of people who use drugs and other stakeholders, and recommendations for implementation. Eight studies (20%) evaluated including inhalation in SCS, from which we extracted data on associated outcomes. Data were analysed using narrative synthesis and descriptive statistics.RESULTS:We found high willingness to use SCS including inhalation among people who use drugs, especially those experiencing structural vulnerability. Research emphasized a need for implementation to account for the social nature of drug inhalation, and to limit potential occupational hazards associated with passive inhalation. Positive outcomes associated with inhalation within SCS included improved health and safety of people who use drugs and decreased public drug use. However, this evidence was based primarily on a limited number of studies with designs of mixed quality.CONCLUSION:Our review demonstrates feasibility of, and need for, implementing SCS including inhalation, and some potential positive outcomes associated with this practice. However, more comprehensive and systematic evaluations of including inhalation as well as other forms of non-injection drug use (e.g., oral, intranasal, rectal) within SCS should be conducted.

Sammurtok, Nadia. The Owl and the Two Rabbits. Iqaluit, NU: Inhabit Media, 2019. Nadia Sammurtok, author of several children’s books including Caterpillar Woman and Siuluk: The Last Tuniq, has written stories of tundra animals. Like many Inuit children’s stories, this one is cautionary, teaching children not to play in dangerous places. In this story two small rabbits, who have been told to “remain hidden when they played outside,” get carried away jumping and attract the attention of an owl who wants to eat them. They escape by outwitting the owl and working together, two common survival themes in Inuit children’s stories. Marcus Cutler’s artwork is bright and fun. Often northern scenes are portrayed as muted or dark, but Cutler’s skies are orange, red or purple, and the grasses are vivid greens and yellows. Small children will be able to enjoy the pictures on their own, but the text will require an older reader. While this book is not meant to be realistic—the animals speak and small rabbits are able to push a huge rock—Sammurtok does include some real animal behaviour from which children can learn. For example, “the rabbits' brown coats blended in with the tundra” and they freeze when threatened. Overall this is an enjoyable volume which would be a good addition to public libraries and elementary school libraries. Highly recommended: 4 out of 4 starsReviewer: Sandy Campbell Sandy is a Health Sciences Librarian at the University of Alberta, who has written hundreds of book reviews across many disciplines. Sandy thinks that sharing books with children is one of the greatest gifts anyone can give.

Background Most of the existing research on supervised consumption services (SCS) is focused on injection drug use. Less is known about the applicability of SCS for people who consume drugs orally, intranasally, or through inhalation. This is problematic because people who use drugs through modes other than injection are also at risk of overdose death and other harm, and experience barriers accessing health and social services. We aimed to describe existing SCS models that accommodate these alternate routes of drug consumption, and synthesize available information on characteristics of program participants. Methods We conducted a systematic scoping review of 9 peer-reviewed and 13 grey literature databases on SCS that incorporate non-injection routes of consumption. We screened 22,882 titles, and excluded 22,843 (99.8%) articles. We ultimately included 39 (0.2%) full-text articles; 28 (72%) of these articles explicitly identified SCS that permit alternate routes of consumption and 21 (54%) discussed characteristics of participants who consume drugs through non-injection routes. Data on study characteristics, terms and definitions, and site and program participant characteristics were extracted and double-coded. Extracted data were analyzed using descriptive statistics and narrative synthesis. Results Included articles describe 48 SCS that permit non-injection routes of consumption, most of which were located in Germany. The majority of these SCS were legally sanctioned and had models of care that were largely comparable to supervised injection services. Notable differences included physical infrastructure such as ventilated rooms or outdoor areas to accommodate inhalation, and shorter time limits on non-injection drug consumption episodes. Program participants engaging in non-injection forms of consumption were typically men over the age of 30 and structurally vulnerable (e.g., experiencing homelessness or unstable housing). Conclusions Extant academic and grey literature indicates that site characteristics and demographics of program participants of SCS that permit non-injection routes of consumption largely reflect those of supervised injection services. Further research on the range of existing SCS that incorporate non-injection routes of consumption is needed to ensure high quality service provision, and improved health outcomes for people who consume drugs via oral, intranasal, and inhalation routes.

Background Evidence from new health technologies is growing, along with demands for evidence to inform policy decisions, creating challenges in completing health technology assessments (HTAs)/systematic reviews (SRs) in a timely manner. Software can decrease the time and burden by automating the process, but evidence validating such software is limited. We tested the accuracy of RobotReviewer, a semi‐autonomous risk of bias (RoB) assessment tool, and its agreement with human reviewers. Methods Two reviewers independently conducted RoB assessments on a sample of randomized controlled trials (RCTs), and their consensus ratings were compared with those generated by RobotReviewer. Agreement with the human reviewers was assessed using percent agreement and weighted kappa ( κ ). The accuracy of RobotReviewer was also assessed by calculating the sensitivity, specificity, and area under the curve in comparison to the consensus agreement of the human reviewers. Results The study included 372 RCTs. Inter‐rater reliability ranged from κ = −0.06 (no agreement) for blinding of participants and personnel to κ = 0.62 (good agreement) for random sequence generation (excluding overall RoB). RobotReviewer was found to use a high percentage of “irrelevant supporting quotations” to complement RoB assessments for blinding of participants and personnel (72.6%), blinding of outcome assessment (70.4%), and allocation concealment (54.3%). Conclusion RobotReviewer can help with risk of bias assessment of RCTs but cannot replace human evaluations. Thus, reviewers should check and validate RoB assessments from RobotReviewer by consulting the original article when not relevant supporting quotations are provided by RobotReviewer. This consultation is in line with the recommendation provided by the developers.

Cluster randomized trial design, where groups of participants are randomized instead of individual participants, is increasingly being used in long-term care research. The purpose of this review was to determine the characteristics of cluster randomized trials in long-term care facilities. A medical librarian conducted the literature search. Two independent reviewers reviewed each paper. Studies were included if the design was cluster randomized and participants were from long-term care facilities. For each included study, two independent data extractors captured data on study attributes, including: journal, location, year published, author discipline, funding, methodology, number of participants, and intervention target. The literature search yielded 7,679 unique studies, with 195 studies meeting the selection criteria and being included for data extraction. The included studies were published between 1976 and 2017, with 53% of studies published after 2009. The term cluster randomized was in the title of only 45% of the studies. The studies were conducted worldwide; the United States had the largest number of studies (23%), followed by the United Kingdom (18%). Ten percent of studies were published in journals with an impact factor >10. The most frequent discipline of the first and last authors was medicine (34%), followed by nursing (17%). Forty-nine percent of the studies had government funding, while only 20% had medical industry funding. In studies with <1000 residents, 85% of the studies obtained consent from the resident and/or their proxy, while in studies with ≥ 1000 residents, it was 31%. The most frequent intervention targets were infection (13%), falls/fracture (13%), and behavior/physical restraint (13%). Cluster randomized controlled trials in long-term care have a unique set of characteristics. Results of this review will provide guidance to researchers conducting studies in long-term care facilities.

Objective: The objective of this systematic review was to explore the effectiveness of various systemic corticosteroid (SCS) regimens to mitigate relapse in children with asthma discharged from an acute care setting. Data Sources: Medline, EMBASE, Global Health, International Pharmaceutical Abstracts, EMB ALL, CINAHL, SCOPUS, Proquest Dissertations and Theses Global, and LILACS were searched using controlled vocabulary and key words. Additional citations were searched via clinical trial registries, Google Scholar, bibliographies, a SCOPUS forward search of a sentinel paper, and hand searching conference abstracts. Study Selection: No limitations based on language, publication status, or year of publication were applied. Two independent reviewers searched to identify randomized controlled trials comparing the effectiveness of SCS regimens to prevent relapse in children following treatment for acute asthma. Results: Fifteen studies were included. In 3 studies comparing SCS to placebo, asthma relapse was significantly reduced (RR = 0.10; 95% CI: 0.01, 0.77; I2 = 0%). A network analysis identified a significant reduction in relapse in children treated with intramuscular corticosteroids (OR = 0.038; 95% CrI: 0.001, 0.397), short-course oral prednisone (OR = 0.054; 95% CrI: 0.002, 0.451), and oral dexamethasone (OR = 0.071; 95% CrI: 0.002, 0.733) compared to placebo. Conclusion: This review found evidence that SCS reduces relapse in children following treatment for acute asthma, albeit based on a limited number of studies. Additional studies are required to assess the differential effect of SCS doses and treatment duration to prevent relapse in children following discharge for acute asthma.

Weiner, Andrew. Down by the River: A Family Fly Fishing Story. Harry N. Abrams, 2018. This is a beautifully illustrated book that tells a simple story about a boy, Art, who goes on a fly-fishing trip with his mother and grandfather. The story recalls a time when Art’s grandfather taught his mother to fish. April Chu has used a subdued palette for her two-page riverine landscapes, with lots of green and rich autumn colours in the environment. The book has a calm and peaceful feel about it that mirrors the contemplative nature of fly-fishing. The text is simple and descriptive of a day spent on the river. The reading level is too difficult for the intended Kindergarten to Grade 2 audience, so an adult will need to read the book aloud, especially those sentences that could confuse young readers with difficult concepts or complicated jargon: “The line arced forward and the fly landed softly a few feet above the rock. It drifted with the current past the rock. There was a splash and the line went tight.” The last three pages contain information about fly fishing, the clothing worn by fly fishers and where to get more information about the sport. The end pages are decorated with images of intricate flys with such fun and mysterious names as: “Ian’s Crunch Caddis,” “Black Fur Ant,” and “Purple Parachute Adams.” This book is a good introduction to fly fishing for younger children that also tells a charming story. Highly recommended for school and public libraries. Highly Recommended: 4 stars out of 4 Reviewer: Sandy Campbell Sandy is a Health Sciences Librarian at the University of Alberta, who has written hundreds of book reviews across many disciplines. Sandy thinks that sharing books with children is one of the greatest gifts anyone can give.

Traumatic brain injury (TBI) management based on Brain Trauma Foundation (BTF) guidelines is widely accepted and thought to improve outcome. The objectives of this study are to provide an overview of adherence to BTF guidelines and to explore which factors influence adherence. We conducted a search of relevant electronic bibliographic databases. Twenty articles met inclusion/exclusion criteria out of 666 articles screened. All were cohort studies. Wide variation in adherence to BTF guidelines was observed with a median of 66.2% (range 0-100%). The lowest median adherence was observed with surgical management (14%), whereas the highest was observed with oxygenation (100%), steroid (97.8%), and blood pressure recommendation (92.3%). Variability was primarily explained by the variation in the strength of evidence of each recommendation. Treating patients with higher severity of injury as well as treatment in a Level I trauma center positively influenced adherence. Overall, adherence to BTF guidelines varies. Further research is required to strengthen the current evidence and to identify factors related to adherence to guidelines from a professional prospective.

In a collaborative research process, the participation of interdisciplinary researchers and multi-sectoral stakeholders supports the co-creation, translation, and exchange of new knowledge. Following a scoping review methodology, we explored the collaborative research processes in the specific context of environment and human health research. Initially, our literature search strategy identified 1,328 publications. After several phases of reviewing and applying screening criteria to titles, abstracts, and full text, 45 publications were selected for final review. Data were charted by different topics and then collated, summarized, and analyzed thematically. From the different experiences and research approaches analyzed, we identified comprehensive details of the key components, facilitators, challenges, and best practices that impact the collaborative research process. Specifically, we identified the following seven emerging themes: (a) allocating time and resources, (b) addressing disciplinary and sectoral issues, (c) building relationships, (d) ensuring representation, (e) embedding participation in the research, (f) supporting ongoing collaboration, and (g) developing knowledge translation and exchange.

This paper reports a usability evaluation study of the Digital Library North prototype that wasconducted in May 2016. It proposes a culturally-aware and community-informed approach to theusability of digital libraries for Northern communities in Canada along with the emerging themesand the changes that were implemented as a result of the evaluation.

Background Endometrial cancer is strongly associated with obesity, and weight reduction has been demonstrated to decrease risk and overall mortality. Bariatric surgery results in the most dramatic weight loss among morbidly obese individuals, and the impact of bariatric surgery on endometrial cancer requires further investigation. Objective To conduct a scoping review of the published literature of the effects of bariatric surgery on endometrial cancer, as risk reduction and potential adjunct to treatment. Setting University Hospital, Canada. Methods A comprehensive search of peer-reviewed literature was conducted by an expert searcher and librarian to retrieve relevant articles discussing aspects of endometrial cancer or endometrial hyperplasia and bariatric surgery. Results After screening, 23 articles met inclusion for review. They were categorized into evidence for risk reduction of bariatric surgery on endometrial cancer, the impact of bariatric surgery on endometrial pathology, immunohistochemistry, metabolic profiles, and bariatric surgery as a potential adjunct to treatment in endometrial cancer. Conclusion There is ample evidence demonstrating a risk reduction in women with obesity (body mass index >30 kg/m2) undergoing bariatric surgery for subsequent development of endometrial cancer. However, there is a paucity of data investigating its role as an adjunct for therapy. There is sufficient evidence to argue for the inclusion of endometrial hyperplasia and endometrial cancer as obesity-related conditions and the access to bariatric surgery should be broadened for affected individuals to reflect this.

Simpson, Kate. Finding Granny: We Never Really Lose the People We Love. EK Books, 2018. This is an uplifting picture book about a child, Edie, whose beloved grandmother has a stroke and spends a long time recovering in hospital. At first, Edie does not accept that the woman in the bed, whose words do not make sense, is her grandmother. Through art therapy classes that Edie shares with her grandmother, she slowly rebuilds and reaffirms their close relationship. Edie comes to understand that while the colours in Granny’s painting are “all running into each other”, the painting is still beautiful. Gwyenneth Jones’ artwork is bright, exuberant and makes a sad and frightening subject engaging and entertaining. When the doctor, who has bright red glasses and a giant nose, explains that Granny’s “brain isn’t working the way it used to,” she points to a huge picture of a brain that has tiny eyes, a downturned mouth and huge adhesive bandages in an X across it. This book celebrates intergenerational love and the effectiveness of art therapy in healing both relationships and illness. It also offers a lesson of patience and hope for those whose loved ones are recovering from stroke. Finding Granny would be a good addition to public, school, and hospital libraries. Highly Recommended: 4 out of 4 starsReviewer: Sandy Campbell Sandy is a Health Sciences Librarian at the University of Alberta, who has written hundreds of book reviews across many disciplines. Sandy thinks that sharing books with children is one of the greatest gifts anyone can give.

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 onDR, 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 3500patients. 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 within-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.

Introduction: The CHLA/ABSC Special Committee on Research undertook this project to identify potential ways in which the Association could support its members in undertaking research. The goal was to inform future CHLA/ABSC research-related service and program offerings. A literature review revealed limited publication related to health librarians' research needs. Method: The Committee developed and distributed an online survey to CHLA/ABSC's membership. The questions related to demographics, previous research engagement or experience, current research support, work-related research requirements and expectations, barriers and enablers for conducting research, desired research support (topic and format) from CHLA/ABSC, and types of programs that would benefit members the most. Both qualitative and quantitative data were collated and analysed. Data from open ended questions were examined to identify relevant themes. Results: Survey participants (45) were nearly equally divided between academic health libraries and hospital libraries. Forty-three members responded to the English survey, while two responded to the French version. Results showed that the barriers to research, and the research supports needed are similar for both academic health librarians and hospital librarians. Results showed a strong desire for methodological and statistical training. Conclusion: Through this study CHLA/ABSC members identified several kinds of preferred research support. CHLA/ABSC can use these findings to guide the selection and delivery of further continuing education products, as well as the development of specific research support services such as a peer-review program, a research question and answer blog and research mentorship; and also improve communications around CHLA/ABSC's research services.

OBJECTIVES:Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes. METHODS:An a priori protocol was published in PROSPERO. Two independent reviewers screened, selected, rated quality, and extracted data. Third-party adjudication resolved disagreements. Rate ratios of post- versus pre-intervention ED visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users' ED visits and patient-oriented outcomes. RESULTS:A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before-after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (n = 18), care plans (n = 8), diversion strategies (n = 3), printout case notes (n = 1), and social work visits (n = 1). Post- versus pre-intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range = 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease ED visits post-intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6- or 12-month follow-up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high. CONCLUSIONS:Interventions targeting frequent ED users appear to decrease ED visits and may improve stable housing. Future research should examine cost-effectiveness and adopt standardized definitions.

OBJECTIVE:Cognitive support technologies that support clinical decisions and practices in the emergency department (ED) have the potential to optimize patient care. However, limited uptake by clinicians can prevent successful implementation. A better understanding of acceptance of these technologies from the clinician perspective is needed. We conducted a scoping review to synthesize diverse, emerging evidence on clinicians' acceptance of point-of-care (POC) cognitive support technology in the ED. METHOD:We systematically searched 10 electronic databases and gray literature published from January 2006 to December 2016. Studies of any design assessing an ED-based POC cognitive support technology were considered eligible for inclusion. Studies were required to report outcome data for technology acceptance. Two reviewers independently screened studies for relevance and quality. Study quality was assessed using the Mixed-Methods Appraisal Tool. A descriptive analysis of the features of POC cognitive support technology for each study is presented, illustrating trends in technology development and evaluation. A thematic analysis of clinician, technical, patient, and organizational factors associated with technology acceptance is also presented. RESULTS:Of the 1,563 references screened for eligibility, 24 met the inclusion criteria and were included in the review. Most studies were published from 2011 onward (88%), scored high for methodologic quality (79%), and examined POC technologies that were novel and newly introduced into the study setting (63%). Physician use of POC technology was the most commonly studied (67%). Technology acceptance was frequently conceptualized and measured by factors related to clinician attitudes and beliefs. Experience with the technology, intention to use, and actual use were also more common outcome measures of technology acceptance. Across studies, perceived usefulness was the most noteworthy factor impacting technology acceptance, and clinicians generally had positive perceptions of the use of POC cognitive support technology in the ED. However, the actual use of POC cognitive support technology reported by clinicians was low-use, by proportion of patient cases, ranged from 30% to 59%. Of the 24 studies, only two studies investigated acceptance of POC cognitive support technology currently implemented in the ED, offering "real-world" clinical practice data. All other studies focused on acceptance of novel technologies. Technical aspects such as an unfriendly user interface, presentation of redundant or ambiguous information, and required user effort had a negative impact on acceptance. Patient expectations were also found to have a negative impact, while patient safety implications had a positive impact. Institutional support was also reported to impact technology acceptance. CONCLUSIONS:Findings from this scoping review suggest that while ED clinicians acknowledge the utility and value of using POC cognitive support technology, actual use of such technology can be low. Further, few studies have evaluated the acceptance and use of POC technologies in routine care. Prospective studies that evaluate how ED clinicians appraise and consider POC technology use in clinical practice are now needed with diverse clinician samples. While this review identified multiple factors contributing to technology acceptance, determining how clinician, technical, patient, and organizational factors mediate or moderate acceptance should also be a priority.

Rooney, Christina. Saila & Betty, illustrated by Ali Hinch. Inhabit Education, 2016.Inhabit Education has launched a series of text levelled readers, called the Nunavummi Reading Series. Saila and Betty has been levelled using the Fountas & Pinnell Text Level Gradient Level: I, which makes it appropriate for upper level Grade 1. It is a picture book with two to three sentences per page including simple dialog. The sentences get progressively more difficult through the book. Ali Hinch’s comic-like artwork is black-line with bright colours for infill. The animals all show animation and emotions. While this is primarily a reading text, it contains a wellness message, as well. The story is a simple one about birds, who fly very well and seals, who swim very well discovering that while their strengths are different, and they are not very good at each other’s strengths at all, they can still be friends and have fun together. It is great to see curriculum materials being developed with Arctic themes. These will be very valuable learning tools in Arctic classrooms and as supplementary reading materials in southern classrooms. Highly recommended for elementary school libraries and public libraries. Highly Recommended: 4 stars out of 4Reviewer: Sandy CampbellSandy is a Health Sciences Librarian at the University of Alberta, who has written hundreds of book reviews across many disciplines. Sandy thinks that sharing books with children is one of the greatest gifts anyone can give.

OBJECTIVES While systemic corticosteroids (SCS) are widely used to prevent relapse in adults with acute asthma discharged from the emergency department, the most effective route of administration is unclear. The objective of this review was to examine the effectiveness of SCS in adults and to identify the most effective route of SCS to preventing relapse. METHODS A search was conducted to identify randomized controlled trials comparing the effectiveness of intramuscular (IM) or oral (PO) short-course or long-course corticosteroids to prevent relapse in adults with acute asthma. Two independent reviewers judged study relevance, inclusion, and risk of bias. Pooled statistics were calculated as risk ratios (RR) and odds ratios (OR) with 95% confidence intervals (CI) and credibility intervals (CrI) using a random-effects model. A Bayesian network meta-analysis was performed for indirect comparisons of SCS to placebo. Probability of best (PB) analysis was reported for comparisons between the routes of administration. RESULTS Thirteen studies of moderate quality were included. Four studies compared SCS to placebo, in which SCS significantly reduced relapse (RR = 0.43; 95% CI = 0.25 to 0.74). In the network meta-analysis, a significant reduction in relapse within 10 days of discharge was found in adults receiving IM (OR = 0.21; 95% CrI = 0.05 to 0.73) and PO long-course (OR = 0.31; 95% CrI = 0.09 to 0.95) corticosteroids. Relapse rates between PO short-course corticosteroids and placebo were not statistically significantly different (OR = 0.37; 95% CrI = 0.04 to 3.38). PB analysis favored IM corticosteroids (62%) followed by PO short-course (20.3%) and PO long-course (14.1%) corticosteroids. CONCLUSIONS The network analysis identified IM corticosteroids and PO long-course corticosteroids as the most effective strategies to prevent relapse among adults with acute asthma, compared to PO short-course corticosteroids. The lack of significant findings with PO short-course corticosteroids is likely due to the paucity of research. Further comparative studies are required to determine the safety and effectiveness of briefer PO SCS treatment options in adults.