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PubMed2000

Multiple sclerosis, disease modifying treatments and depression: a critical methodological review.

BACKGROUND: Major depression affects one in two patients with multiple sclerosis (MS) during the course of their lifetime. This adds to the morbidity associated with the disorder and may contribute to an increased mortality rate because of suicide. Over the past few years, with the advent of disease modifying treatments for MS, a new concern with respect to mood has arisen, namely the possibility that some of these drugs may have depression as a clinically significant side effect. OBJECTIVE: To ascertain whether disease modifying treatments in MS are associated with the development of depression or the worsening of a depressive illness. METHODOLOGY: A MEDLINE and PSYCHLIT search focusing on depression and disease modifying treatments going back to 1993 (the publication date of the results of the first randomised, placebo controlled trial). The methodology pertaining to the assessment of depression is critically reviewed. Furthermore, a critical summary is provided of treatment modalities for the depressed MS patient. RESULTS: There are conflicting data that depression may occur with some disease modifying drugs, particularly interferon beta-1b. However, all studies reveal limitations with respect to the assessment of mood. Some reports, despite omitting details of how mentation was assessed, still comment on the presence or absence of depression. Others suffer from one or more of the following shortcomings: a failure to assess premorbid risk factors for mood disorder; a reliance on one question to assess depression; the utilisation of self report mood rating scales of questionable validity; neglecting to distinguish depression as a symptom from depression as a syndrome (i.e. major depression as defined by the DMS-1V). CONCLUSIONS: Given the many methodological pitfalls inherent in all studies to date, it is premature to conclude that disease modifying drugs are associated with depression. Evidence suggests that treatment of depression, irrespective of a putative association with a disease modifying agent, is frequently effective. This applies to pharmacotherapy or psychotherapy, although the former may be preferred should depression arise during a course of treatment with a disease modifying agent. Multiple Sclerosis (2000) 6 343 - 348

Major Depressive Disorder↗
PubMed1985

Association between indicators of perinatal asphyxia and adverse outcome in the term infant: a methodological review.

There are conflicting opinions about the significance of 5 perinatal findings felt to be indicators of asphyxia (meconium staining of the amniotic fluid, abnormal fetal heart rate patterns, acidotic fetal scalp blood gases, low Apgar scores, and acidotic cord blood gases). A review of the literature was undertaken to determine the strength of association of each of these findings with adverse outcomes. Although all studies contained methodological problems, these indicators were found to have strong associations with one or more adverse outcomes such as perinatal death, low Apgar scores or cerebral palsy. The strength of the association (relative risk) was found to vary inversely with the prevalence of the outcome.

Acidosis↗
PubMed2005

A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy.

OBJECTIVES: To review how heterogeneity has been examined in systematic reviews of diagnostic test accuracy studies. DATA SOURCES: Centre for Reviews and Dissemination's Database of Abstracts of Reviews of Effects (DARE). REVIEW METHODS: Systematic reviews that evaluated a diagnostic or screening test by including studies that compared a test with a reference test were identified from DARE. Reviews for which structured abstracts had been written up to December 2002 were screened for inclusion. Data extraction was undertaken using standardised data extraction forms. RESULTS: A total of 189 systematic reviews met the inclusion criteria. The median number of studies included was 18. Meta-analyses have a higher number with a median of 22 studies compared with 11 for narrative reviews. Graphical plots to demonstrate the spread in study results were provided in 56% of meta-analyses; in 79% these were plots of sensitivity and specificity in the receiver operating characteristic (ROC) space. Statistical tests to identify heterogeneity were used in 32% of reviews: 41% of meta-analyses and 9% of reviews using narrative syntheses. The chi-squared test and Fisher's exact test to assess heterogeneity in individual aspects of test performance were the most common. In contrast, only 16% of meta-analyses used correlation coefficients to test for a threshold effect. A narrative synthesis was used in 30% of reviews. Of the meta-analyses, 52% carried out statistical pooling alone, 18% conducted only summary receiver operator characteristic (SROC) analyses and 30% used both methods of statistical synthesis. For those undertaking SROC analyses, the main differences between the models used were the weights chosen for the regression models, although in 42% of cases the use of, or choice of, weight was not provided. The proportion of reviews using statistical pooling alone has declined from 67% in 1995 to 42% in 2001, with a corresponding increase in the use of SROC methods, from 33% to 58%. However, two-thirds of those using SROC methods also carried out statistical pooling rather than presenting only SROC models. Reviews using SROC analyses also tended to present their results as some combination of sensitivity and specificity rather than using alternative, perhaps less clinically meaningful, means of data presentation such as diagnostic odds ratios. Three-quarters of meta-analyses attempted to investigate statistically possible sources of variation, using subgroup analysis or regression analysis. The impact of clinical or socio-demographic variables was investigated in 74% of these reviews and test- or threshold-related variables in 79%. At least one quality-related variable was investigated in 63% of reviews. Within this subset, the most commonly considered variables were the use of blinding, sample size, the reference test used and the avoidance of verification bias. CONCLUSIONS: The emphasis on pooling individual aspects of diagnostic test performance and the under-use of statistical tests and graphical approaches to identify heterogeneity perhaps reflect the uncertainty in the most appropriate methods to use and also greater familiarity with more traditional indices of test accuracy. This indicates the difficulty and complexity of carrying out such reviews. In these cases it is strongly suggested that meta-analyses are carried out with the involvement of a statistician familiar with the field. Further methodological work on the statistical methods available for combining diagnostic test accuracy studies is needed, as are sufficiently large, prospectively designed primary studies of diagnostic test accuracy comparing two or more tests for the same target disorder. Use of individual patient data meta-analysis in diagnostic test accuracy reviews should be explored to allow heterogeneity to be considered in more detail.

Diagnostic Tests, Routine↗
PubMed1987

The value of trauma centres: a methodologic review.

This review examines the rationale for the development of trauma centres in North America. The value of local and regional trauma care systems is considered, emphasizing study methodology. Evidence is acquired from case-series reports, before-and-after studies and intersystem comparisons. It overwhelmingly suggests that the main determinants of survival, given the severity of the injury, are the adequacy of the initial resuscitation and the early recognition of serious injuries. Thus, doctors involved in front-line trauma care, whether in the centre-city teaching hospital or in the rural community setting, must be properly prepared.

Humans↗
PubMed2001

Ultrasonic myocardial tissue characterization: a methodological review.

Ultrasonic myocardial tissue characterization represents a relatively new diagnostic tool which allows integration of the conventional echocardiographic evaluation, in order to obtain specific textural parameters which reflect the myocardial ultrastructural texture. In particular, through this approach it is possible to obtain two different types of information: the first is static and consists of the absolute myocardial echo intensity that reflects the ultrastructural myocardial changes in different diseases; the second is dynamic and is related to the variations of echo intensity during the cardiac cycle which seem to be linked, even though not linearly, to the intrinsic myocardial contractility. Our research group has extensively applied this methodological approach to different pathophysiological models, in particular to essential hypertension. In the present review the technological evolution of the method and comparison with other research groups' experience with the specific pathophysiological models, are shown and discussed.

Echocardiography↗
PubMed1978

The treatment of primary and secondary orgasmic dysfunction: a methodological review of the literature since 1970.

This paper reviews the studies since 1970 which examined the treatment outcome of primary and secondary nonorgsmic women. The studies were evaluated within the following sections: subjects, therapists, time format, treatment, and outcome criteria. Many methodological deficiencies were found, most notably the lack of specificity regarding subject characteristics, a reliance on women's self-reports of outcome without obtaining partner validation, the failure to assess the influence of the woman's partner on her orgasmic responsivity, the failure to control for expectancy factors, and the use of different criteria for treatment success. The problems in the literature suggest that it is premature to place any confidence in the identification of the treatment format which is most successful for a defined population of women who experience a specific form of primary or secondary orgasmic dysfunction. The data tentatively suggest that (1) secondary nonorgasmic women would show greater gains than primary nonorgasmic women in treatments emphasizing sexual and nonsexual communication techniques, (2) primary nonorgasmic women would show greater gains than secondary nonorgasmic women in desensitization and sexual technique training procedures, (3) desensitization may be the appropriate treatment for women whose sexual anxiety contributes to secondary orgasmic dysfunction. These hypotheses should be examined in controlled research.

Desensitization, Immunologic↗
PubMed1983

Cognition and suicide: a methodological review.

This article reviews the literature related to studies measuring various cognitive properties in suicidal patients. It provides a structural framework with which to classify the studies, and employs the categories of suicidal logic, cognitive style, social cognition, and cognitive control. The methodological issues discussed include: sample characteristics, operational definitions of suicidal behaviors, use of appropriate control groups, and the temporal nature of assessment. Improvements in experimental design are suggested for use in future research.

Attitude↗
PubMed1996

F-waves in clinical neurophysiology: a review, methodological issues and overall value in peripheral neuropathies.

This report comments on methodological issues related to the use of F-wave in clinical neurophysiology. An F-wave study aims to describe with relative accuracy the properties of the compound F-wave population which is the population of F-waves consecutively recorded from a muscle. This can only be achieved if an adequate number of F-waves is sampled. In order to avoid inaccuracies, correction of F-wave latency measurements for height or limb length and age is also required. Differences in the recording procedure could account for the variability in F-wave measurements. The usefulness of F-wave parameters other than latency is discussed. F-chronodispersion and F-tacheodispersion are more sensitive than conventional neurophysiological methods in detecting mild nerve lesions. F-persistence provides valuable information only if the findings are interpreted in correlation with the particular clinical setting. The suitability of the F-wave technique for routine studies is examined and a current view on the clinical applications is briefly recounted. There is an urgent need for the standardization of F-wave methodology.

Electromyography↗
PubMed2003

Classification and regression tree analysis in public health: methodological review and comparison with logistic regression.

BACKGROUND: Audience segmentation strategies are of increasing interest to public health professionals who wish to identify easily defined, mutually exclusive population subgroups whose members share similar characteristics that help determine participation in a health-related behavior as a basis for targeted interventions. Classification and regression tree (C&RT) analysis is a nonparametric decision tree methodology that has the ability to efficiently segment populations into meaningful subgroups. However, it is not commonly used in public health. PURPOSE: This study provides a methodological overview of C&RT analysis for persons unfamiliar with the procedure. METHODS AND RESULTS: An example of a C&RT analysis is provided and interpretation of results is discussed. Results are validated with those obtained from a logistic regression model that was created to replicate the C&RT findings. Results obtained from the example C&RT analysis are also compared to those obtained from a common approach to logistic regression, the stepwise selection procedure. Issues to consider when deciding whether to use C&RT are discussed, and situations in which C&RT may and may not be beneficial are described. CONCLUSIONS: C&RT is a promising research tool for the identification of at-risk populations in public health research and outreach.

Decision Trees↗
PubMed2005

Working memory span tasks: A methodological review and user's guide.

Working memory (WM) span tasks-and in particular, counting span, operation span, and reading span tasks-are widely used measures of WM capacity. Despite their popularity, however, there has never been a comprehensive analysis of the merits of WM span tasks as measurement tools. Here, we review the genesis of these tasks and discuss how and why they came to be so influential. In so doing, we address the reliability and validity of the tasks, and we consider more technical aspects of the tasks, such as optimal administration and scoring procedures. Finally, we discuss statistical and methodological techniques that have commonly been used in conjunction with WM span tasks, such as latent variable analysis and extreme-groups designs.

Group Processes↗
PubMed2002

Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review.

Disturbances in affect recognition may be one of the most pervasive and serious aspects of the schizophrenic patient's interpersonal problems. Interest in the decoding of emotional information in schizophrenia has focused on facial affect recognition with 29 experimental papers on that topic published since 1987. A smaller literature exists on the topic of recognition of affect in speech and there are at least seven studies, which have examined both face and voice perception in the same individuals with schizophrenia. This paper includes a comprehensive analysis of the schizophrenia facial affect recognition research over the past decade and the schizophrenia literature on affective prosody, and provides the first review of the schizophrenia literature on multichannel emotion recognition research. The weight of evidence would suggest that individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Emotion recognition research in schizophrenia should be informed by the general literature on emotion recognition with serious attention paid to methodological issues.

Affect↗
PubMed2002

Somatization in survivors of catastrophic trauma: a methodological review.

The literature on mental health effects of catastrophic trauma such as community disasters focuses on posttraumatic stress disorder. Somatization disorder is not listed among the classic responses to disaster, nor have other somatoform disorders been described in this literature. Nondiagnostic "somatization," "somatization symptoms," and "somatic symptoms" form the basis of most information about somatization in the literature. However, these concepts have not been validated, and therefore this work suffers from multiple methodological problems of ascertainment and interpretation. Future research is encouraged to consider many methodological issues in obtaining adequate data to address questions about the association of somatization with traumatic events, including a) appropriate comparison groups, b) satisfactory definition and measurement of somatization, c) exclusion of medical explanations for the symptoms, d) recognition of somatizers' spurious attribution of symptoms to medical causes, e) collection of data from additional sources beyond single-subject interviews, f) validation of diagnosis-unrelated symptom reporting or reconsideration of symptoms within diagnostic frameworks, g) separation of somatization after an event into new (incident) and preexisting categories, h) development of research models that include sufficient variables to examine the broader scope of potential relationships, and i) novel consideration of alternative causal directionalities.

Data Collection↗
PubMed2006

Does experimental pain response vary across the menstrual cycle? A methodological review.

The findings on sex differences in human experimental pain research are inconsistent. One possible factor contributing to the inconsistent findings is the female hormonal cycle, as hormone levels may affect pain sensitivity. A number of studies suggest that women's responses to experimentally evoked pain vary across the menstrual cycle. However, at least an equal number of studies suggest a lack of variability. The purpose of this article is to review the literature with emphasis on what we believe could be the reasons for the inconsistent findings, namely, differences in populations sampled, timing of experimental sessions across the menstrual cycle, and nomenclature used to identify the time (phases) in the cycle when measurements were done, nature of the pain stimuli chosen, and outcomes measured. These inconsistencies and other methodological problems associated with most experimental pain studies make it difficult to draw inferences from this literature. For the science to improve, replication of significant findings using standardized timing of sessions, pain stimulus procedures, outcomes, and hormonal assessment is necessary.

Female↗
PubMed1996

Evaluating intensive family preservation programs: a methodological review.

OBJECTIVES: To determine the adequacy of evaluations of family preservation services (FPS), which are designed to support families and prevent out-of-home placements of children at risk of abuse or neglect, and to assess the effectiveness of FPS at reducing out-of-home placements of children. DATA SOURCES: References published from 1977 to 1993 were identified from a computerized search of databases for English-language publications using the key phrases "family preservation," "child abuse," and "family-based services." Unpublished references were identified by mail or phone from a listing of more than 200 programs in a national directory. SELECTION OF STUDIES: Of 802 references initially identified, 46 program evaluations were reviewed. Ten studies met the following inclusion criteria: (1) evaluated an intensive family preservation program, (2) included outcome data in the report, and (3) used a comparison group. Five were randomized trials, and 5 were quasi-experimental studies (nonrandomized). DATA EXTRACTION: Descriptive information about the programs and evaluations was collected. To determine methodological quality, two independent raters used a 15-item questionnaire to examine the assignment of families to treatment groups, the interventions provided, and the outcomes assessed. A composite score of 11 or greater represented an acceptable study, 6 to 10 represented an adequate study, and 5 or less represented an unacceptable study. RESULTS: Only two studies were rated acceptable, four were adequate, and four were unacceptable. Methodological shortcomings included poorly defined assessment of risk, inadequate descriptions of the interventions provided, and nonblinded determination of the outcomes. Rates of out-of-home placements were 21% to 59% among families who received FPS and 20% to 50% among comparison families. The relative risk of placement was significantly reduced by FPS in only two studies (one randomized trial and one quasi-experimental study). CONCLUSIONS: Despite current widespread use of FPS to prevent out-of-home placements of children, evaluations of FPS are methodologically difficult and show no benefit in reducing rates of out-of-home placements of children at risk of abuse or neglect in 8 of 10 studies. Consistent, methodologically rigorous evaluations are needed to determine the effectiveness of FPS and to guide social policy for high-risk children and their families.

Adolescent↗