The potential foes in question are China and, to a lesser extent, Iran.Mr Gunzinger remarks that previous reviews have avoided radical change by simply adding missions rather than setting priorities.
John Hutton, a senior Labour Party figure who quit as defense minister this summer, sounded his own note of caution, saying that the submarine deterrent worked like an insurance policy, and that previous reviews had shown that four submarines were the minimum needed to keep one permanently at sea.
Furthermore a broad search of the literature has shown that previous reviews of STRICTA have been limited to English-language papers (and papers published in English) [ 1].
We realise that previous reviews were limited by the quality of evidence available, but a number of studies have been published since the last review and, therefore, an updated review is required.
Solberg [ 11] notes that previous reviews on this topic have neglected to address contextual factors that could affect implementation such as organizational support (leadership procedures and resources) for the change, and agency-level strategies needed to implement and maintain new systems.
However, it is important to note that previous reviews and recent studies reflect a wide range in quality of evidence with several studies limited by small sample sizes, weak study design and limited detail regarding the team-training curriculum or implementation strategy.
Furthermore, this review only searched two electronic databases (PubMed and National Health Service Economic Evaluation Database NHS EEDD)), and therefore the authors felt that the previous review's search may have missed relevant articles.
It is noteworthy that the previous review by Håkonsen and Toverud [ 2] on patients' perspectives included a similar number of articles.
Second, our meta-analyses were based on several additional studies that the previous reviews did not include.
