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Locating and appraising systematic reviews.

Several methods can be used to identify systematic reviews. These include bibliographic databases, such as MEDLINE, Best Evidence, and the Cochrane Library. In the future, the Cochrane Library could become the source of choice for systematic reviews because it provides the full text for Cochrane reviews and citations to many other systematic reviews. Moreover, the Library is growing rapidly and becoming more readily available, and its searching capabilities are being improved with each update. Although Best Evidence contains fewer systematic reviews than the Cochrane Library, it is specifically designed for practicing internists and primary care physicians and includes systematic reviews on diagnosis, cause, prognosis, and quality improvement. At present, however, MEDLINE and other bibliographic databases are probably the most up-to-date and readily available sources of systematic reviews. Systematic reviews are a powerful and useful way to assemble evidence; however, just because a review has been done using systematic review methods does not guarantee that its results are credible. Regardless of the source, all systematic reviews (like all types of research evidence) require critical appraisal to determine their validity and to establish whether and how they will be useful in practice.

Anti-Inflammatory Agents, Non-Steroidal↗

Challenges in using nonrandomized studies in systematic reviews of treatment interventions.

Randomized, controlled trials (RCTs) are firmly established as the standard for determining which medical treatments are effective. In some areas of health care, however, among them surgery, public health, and the organization of health care delivery, most evidence addressing the effectiveness of clinical or policy interventions rests on nonrandomized studies. We examine the use of study designs other than RCTs in Evidence-based Practice Center reports addressing questions of the effectiveness of treatment interventions. These reports offer the opportunity to examine the approaches used and the challenges faced by reviewers when nonrandomized studies are included and their quality assessed. We then offer recommendations for using these studies in systematic reviews of treatment interventions.

Clinical Trials as Topic↗

Medical usage and abusage: "prevalence" and "incidence".

In view of the frequent misuse of the term "incidence," the concepts of incidence, prevalence, and period prevalence are defined and illustrated. The importance of restricting "incidence" to the rate of development of new events in a population or a group of patients, per unit of time, is stressed. Clearly distinguishing incidence from prevalence or simple proportion can help both in the understanding and the communication of findings in patient groups.

Epidemiology↗

Guidelines for producing patient information literature.

This article provides practical information on developing patient information literature. The step-by-step approach provided by the authors should be of use to nurses who are currently involved in producing such literature or who are looking at ways of effectively disseminating information to patients on specific topics.

Guidelines as Topic↗

Roundtable discussion: Incorporating bone marrow transplantation into NCCN guidelines.

A newly formed National Comprehensive Cancer Network (NCCN) panel on bone marrow transplantation has the task of ensuring the incorporation of allogeneic and autologous transplantation into all disease guidelines where significant evidence exists to warrant their inclusion. The panel is further charged with ensuring that there is consistency among guidelines regarding the use of marrow transplantation. A preliminary review of existing NCCN guidelines found that marrow transplantation was appropriately included for the treatment of the common hematologic malignancies of adults, including acute myeloid leukemia, chronic myeloid leukemia, myelodysplasia, multiple myeloma, Hodgkin's disease, and the malignant lymphomas. Frequent refinements regarding lymphomas will be necessary, particularly in rapidly evolving areas, such as multiple myeloma and myelodysplasia, and conditions with changing definitions, such as malignant disease. The increasing volume of data supporting the use of autologous bone marrow transplantation in advanced primary and responding metastatic breast cancers needs to be reflected in the breast cancer guideline if it is to remain credible. Well-designed and well-conducted clinical trials are the most appropriate setting for all bone marrow transplantations and patient referral to these trials remains the standard of care in all settings.

Adult↗

Look-alike and sound-alike drug names: the problem and the solution.

This list of 645 pairs of look-alike and sound-alike drug names (1,290 names are shown; they are listed both ways), has been complied to graphically emphasize the importance for the pharmaceutical industry, the United States Adopted Name (USAN) Council, and Food and Drug Administration (FDA) to select new names with great care. It also stresses to health professionals the necessity of writing legibly, writing complete orders, speaking slowly and clearly when giving verbal orders, carefully reading prescription orders, knowing what is wrong with patients, maintaining records of previous drugs patients have received, and learning about new drug products. It also indicates that patients must be educated about the medications they are taking. Your cooperation in alerting the authors of names they may have overlooked or of new problems would be greatly appreciated. When a sufficient number of additions are received, an updated list will be published.

Drug Information Services↗