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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 109 records · Page 6Linked to original sources
PubMed2005

A systematic review of educational interventions for promoting sun protection knowledge, attitudes and behaviour following the QUESTS approach.

A literature review was performed to identify studies of educational interventions to promote sun protection behaviour. Fifty-nine clinical trials were identified. These studies were assessed using the QUESTS model. The studies showed that a wide range of educational interventions in different settings with a variety of target groups can be effective in promoting sun protection knowledge, attitudes, intended and actual behaviour. Relatively few studies made direct comparisons between different educational interventions. Therefore there was little evidence to suggest that any one form of intervention was more effective than any other. This review shows that the QUESTS criteria can be used to evaluate the effectiveness of patient education in the same way they are used to assess evidence in medical education. Performing systematic reviews on patient education topics should prove useful for health professionals developing educational interventions.

Health Behavior↗
PubMed2000

How to read a systematic review.

A systematic review is a carefully planned and conducted study designed to answer a specific focused clinical question. A systematic review differs from the frequently encountered narrative review article. Systematic review must be completed using a prespecified methodology. The reader must ask eight important questions when reading a systematic review: (i) did the review address a focused clinical question (ii) is it likely that important, relevant studies are missed (iii) were the inclusion criteria used to select appropriate articles (iv) was the validity of the included studies assessed (v) were the assessments of studies reproducible (vi) were the results similar from study to study (vii) what were the overall results and how precise are they and (viii) will the results help in caring for patients. The article also provides sources for systematic reviews.

Evidence-Based Medicine↗
PubMed2005

Can Cochrane Reviews in controversial areas be biased? A sensitivity analysis based on the protocol of a Systematic Cochrane Review on low-level laser therapy in osteoarthritis.

OBJECTIVE: The aim of this study was to test if a conclusion in a systematic review of low-level laser therapy (LLLT) for osteoarthritis from the Cochrane Library was valid and robust. BACKGROUND DATA: Health policy decisions often rely on conclusions from the Cochrane Database of Systematic Reviews for approval of new therapies, although their validity for controversial non-pharmacological treatment has been questioned. METHODS: Validity was tested against a nine-item checklist for systematic reviews. Review selections were analyzed for possible discrepancies between trial and review reports, and omissions of relevant trials and data. Alternative data from discrepancies and omissions were then imputed in a sensitivity analysis, to test if review conclusions were robust. RESULTS: Only clinicians who had performed LLLT trials with negative results were invited into the review group. Review quality was sound in areas of literature search and methodological assessments, and some of the limitations were mentioned. The statistical analysis held 18 questionable selections such as omissions of trials, data, and subgroup analyses. These selections systematically favored the negative review conclusion. Without altering the review protocol, the sensitivity analysis of combined results changed to significantly positive for continuous and categorical data when data from all included trials were combined. Further sensitivity analyses with inclusion of valid non-included trials, performance of missing follow-up, and subgroup analyses revealed consistent and highly significant results in favor of active LLLT. CONCLUSIONS: In this example, the Cochrane review conclusion was neither robust nor valid. Representation of experts and different views on efficacy in the review group and extensive use of sensitivity analyses could probably improve quality control of reviews in areas of controversy.

Bias↗
PubMed1995

The Cochrane Collaboration Stroke Review Group. Meeting the need for systematic reviews in stroke care.

BACKGROUND: There is a pressing need to identify which interventions are definitely effective in the prevention of stroke and in the treatment and rehabilitation of stroke patients, which interventions are definitely ineffective, and which interventions require further research. This information is most reliably obtained from reviewing all the available evidence from randomized controlled trials in a systematic way. SUMMARY OF COMMENT: There have been many (at least 8000) randomized controlled trials relevant to stroke. It would be difficult for any one individual to keep track of all these trials, and therefore most clinicians, therapists, and researchers are dependent, to some degree, on reviews of this literature. However, most current reviews are unsystematic and tend to be either incomplete or biased, so that their recommendations can be seriously flawed. Until now there has been no attempt to systematically identify all randomized controlled trials relevant to stroke (including subarachnoid hemorrhage), to review the data they contain, and to keep these reviews up-to-date in the light of new evidence. The Stroke Review Group has now been established within the Cochrane Collaboration to try to perform these tasks. There are presently 40 collaborators from 13 countries working on approximately 25 reviews. CONCLUSIONS: Identifying and reviewing all randomized controlled trials relevant to stroke should bring important benefits to patients and all those involved in purchasing or providing care for patients with stroke. The Cochrane Collaboration Stroke Review Group has started this process and would welcome help from anyone interested in collaborating in this enormous task.

Bias↗
PubMed2006

Systematic reviews of diagnostic tests in cancer: review of methods and reporting.

OBJECTIVES: To assess the methods and reporting of systematic reviews of diagnostic tests. DATA SOURCES: Systematic searches of Medline, Embase, and five other databases identified reviews of tests used in patients with cancer. Of these, 89 satisfied our inclusion criteria of reporting accuracy of the test compared with a reference test, including an electronic search, and published since 1990. REVIEW METHODS: All reviews were assessed for methods and reporting of objectives, search strategy, participants, clinical setting, index and reference tests, study design, study results, graphs, meta-analysis, quality, bias, and procedures in the review. We assessed 25 randomly selected reviews in more detail. RESULTS: 75% (67) of the reviews stated inclusion criteria, 49% (44) tabulated characteristics of included studies, 40% (36) reported details of study design, 17% (15) reported on the clinical setting, 17% (15) reported on the severity of disease in participants, and 49% (44) reported on whether the tumours were primary, metastatic, or recurrent. Of the 25 reviews assessed in detail, 68% (17) stated the reference standard used in the review, 36% (9) reported the definition of a positive result for the index test, and 56% (14) reported sensitivity, specificity, and sample sizes for individual studies. Of the 89 reviews, 61% (54) attempted to formally synthesise results of the studies and 32% (29) reported formal assessments of study quality. CONCLUSIONS: Reliability and relevance of current systematic reviews of diagnostic tests is compromised by poor reporting and review methods.

Bias↗
PubMed1999

Down syndrome and craniovertebral instability. Topic review and treatment recommendations.

The diagnosis and management of occipital-atlantal and atlantoaxial instability in Down syndrome patients is a challenging problem in pediatric spine surgery. To date, no systematic review of this topic has been presented on this confusing and sometimes contentious issue. This topic review will focus on the biomechanical and radiographic foundations for which treatment recommendations in Down syndrome patients are made. In addition, otolaryngologic and anesthetic considerations in Down syndrome are also discussed, as well as advances in surgery that have made the operative fusion of these patients easier and safer.

Cervical Vertebrae↗
PubMed2000

Conducting a systematic review.

In response to the growing volume of health care literature and the variable quality of reported studies, systematic reviews have increasingly been used to guide health care decisions because of their rigorous summary of the research. Systematic reviews utilise planned methods of identifying, appraising, then summarising the results from individual studies. The steps in performing a systematic review include: preparing a detailed research protocol; selecting criteria for inclusion of articles in the review; systematically searching the published and unpublished literature; determining which articles meet the predefined inclusion criteria; critically appraising the quality of the research; extracting outcome data from the research report and statistically combining data, where appropriate, in order to summarise the best available evidence on the topic of interest. These processes are documented in the systematic review report, and can be subject to peer review and critique like other research.

Humans↗
PubMed2006

Recurrence of autoimmune liver disease after liver transplantation: a systematic review.

Recurrence of autoimmune liver disease in allografts has long been a topic of debate. We conducted a systematic review of the literature to examine the reported incidence of recurrence after liver transplantation of primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis (AIH). The MEDLINE, EMBASE, and Cochrane electronic databases were used to identify articles. The inclusion criteria used were articles on patients with at least 90 days of posttransplantation follow-up, histologic criteria for diagnosis of PBC and AIH recurrence, radiologic or histologic criteria or both for diagnosis of PSC recurrence, and exclusion of other causes of liver disease causing similar histologic findings. Incidence in individual studies was combined to calculate the overall recurrence. Risk factors were analyzed whenever crude data were available. Funnel plots were used to assess publication bias. Out of 90 articles identified, 43 met criteria for systematic review (PBC, 16; PSC, 14; AIH, 13). The calculated weighted recurrence rate was 18% for PBC, 11% for PSC, and 22% for AIH. No difference was found in PBC and AIH recurrence by type of primary immunosuppression. There were not enough data to assess this issue in PSC studies. There was evidence of publication bias among PSC and AIH studies but not among PBC studies. In conclusion, recurrence of autoimmune liver disease after liver transplantation appears to be a real concern. As these patients are followed long-term, recurrence of disease may become the primary cause of morbidity.

Autoimmune Diseases↗
PubMed2002

How to write an evidence-based clinical review article.

Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Non-quantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician. First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence, or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician, rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.

Evidence-Based Medicine↗
PubMed2006

Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: To define preoperative factors predicting clinical outcome after lumbar spinal stenosis (LSS) surgery. SUMMARY OF BACKGROUND DATA: LSS is the most common reason requiring lumbar spine surgery in adults older than 65 years. There are no published systematic reviews on this topic. METHODS: A literature search was done until April 30, 2005. Included were randomized controlled or controlled trials or prospective studies dealing with operated LSS. The preoperative predictors had to be presented. Included articles were assessed as high-quality (HQ) and low-quality studies. The predictors in HQ studies were considered as the main results. RESULTS: A total of 21 articles were included. Depression and walking capacity were predictors according to 2 HQ studies. Predictors reported in 1 HQ study were cardiovascular/overall comorbidity, disorder influencing walking ability, self-rated health, income, severity of central stenosis, and scoliosis. CONCLUSION: Depression, cardiovascular comorbidity, disorder influencing walking ability, and scoliosis predicted poorer subjective outcome. Better walking ability, self-rated health, higher income, less overall comorbidity, and pronounced central stenosis predicted better subjective outcome. Male gender and younger age predicted better postoperative walking ability. The predictive value may be outcome specific; thus, the use of all relevant outcome measures is recommended when studying predictors of LSS.

Databases, Factual↗
PubMed1994

Systematic reviews--theory and practice.

The consumer of health care services experts that medical practice is based on scientific evidence with regard to efficacy and effectiveness. Randomized controlled trials provide the most valid basis for comparison of interventions in health care and offer the most reliable information to guide clinical practice. The need for well-designed and performed systematic reviews of the available information to address a specific clinical question should be obvious both to the practicing clinician and the consumer. A systematic review is defined as "the application of scientific strategies that limits bias to the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic". "Meta-analysis (quantitative overview) is a systematic review that employs statistical methods to combine and summarize the results of several trials". In a meta-analysis the individual studies are weighted according to the inverse of the variance; that is more weight is given to studies with more events. The pooling of data allows for an increase in power and thus a more precise estimate of the effect size. Systematic reviews that meet explicit criteria for validity offer the reader information that as a rule is less biased than the unstructured overview which has traditionally been performed by one or several experts in a specific content area. Recently statistical methods have been developed to summarize data from studies of diagnostic tests. Cumulative meta-analyses offer the caregiver and the health-care consumer with answers regarding the effectiveness of a certain intervention at the earliest possible date in time.

Humans↗
PubMed2001

Topical negative pressure for treating chronic wounds: a systematic review.

Some wounds take a long time to heal, fail to heal or recur, causing significant pain and discomfort to the patient and cost to the National Health Service. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Trials Register was searched for randomised controlled trials (RCTs) that evaluated the effectiveness of TNP on chronic-wound healing. Eligibility for inclusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials, with different outcome measures, fulfilled the selection criteria. Trial 1 considered any type of chronic wound, trial 2 considered diabetic foot ulcers. Both trials compared TNP with saline-gauze dressings. Trial 1 reported a statistically significant difference in the percentage change in wound volume after 6 weeks, in favour of TNP. Trial 2 reported a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. These two small trials provide weak evidence to suggest that TNP may be superior to saline-gauze dressings in terms of wound healing. However, due to the small sample sizes and the methodological limitations of the studies, these findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not possible to determine the optimum TNP regimen. Further high-quality RCTs that address these issues are required.

Chronic Disease↗
PubMed2005

[Usefulness of Cochrane Collaboration for pediatric cardiology].

The Cochrane Collaboration provides growing and readily accessible resources to help ensure that medical decision-making is based on detailed, methodical, and up-to-date reviews of the best available evidence. We analyzed systematic reviews in the field of pediatric cardiology published by the Cochrane Collaboration's 50 Collaborative Review Groups. We found a total of 20 systematic reviews: 13 published by the Cochrane Neonatal Group, 6 by the Cochrane Heart Group, and 1 by the Cochrane Peripheral Vascular Disease Group. Systematic reviews in pediatric cardiology appear infrequently. They only concern evidence-based decision-making in the therapeutic management of patent ductus arteriosus and arterial hypotension in preterm infants, and in the management of children with Kawasaki disease. The quality of the clinical trials contained in the systematic reviews of acute rheumatic fever or obesity in children is limited. Consequently, the reviewers' conclusions provide an inadequate basis for inferring probable effects in clinical practice. In pediatric cardiology, many therapies continue to be used without supportive evidence. We found no systematic reviews of important cardiologic topics in childhood such as heart failure, shock, hypertension, congenital cardiopathy, and arrhythmia. Clinical practice guidelines complement systematic reviews, which can recommend only strategies that are supported by strong evidence or suggest further research when scientific evidence is inadequate.

Adult↗
PubMed1999

Fruit and vegetables and ischaemic heart disease: systematic review or misleading meta-analysis?

In a recent meta-analysis published in this journal Law and Morris (1998) sought to quantify the association between fruit and vegetable intake and ischaemic heart disease. They estimated that for six dietary markers of fruit and vegetables the risk of ischaemic heart disease was on average reduced by 15% at the 90th centile of consumption when compared to the 10th centile. In this commentary we will argue that this figure is misleading; and that a more cautious and considered approach should be adopted when reviewing the body of evidence that is available on this issue.

Humans↗
PubMed1999

Prevalence of complementary/alternative medicine for children: a systematic review.

UNLABELLED: Complementary/alternative medicine (CAM) has become an important topic, not least because of its popularity with patients. This systematic review is aimed at summarising the data known about CAM use in paediatric populations. A thorough search strategy was designed to identify all surveys on the prevalence of CAM utilisation in children. Data from those investigations that met the pre-defined criteria for inclusion were extracted and reported in a standardised fashion. Ten studies were found. Their results suggest that the prevalence of CAM use is variable but generally high. CAM is often perceived as helpful. Insufficient data exist about safety and cost. CONCLUSION: The generally high and possibly growing prevalence of complementary/alternative medicine use by children renders this topic an important candidate for rigorous investigation. In particular, we should determine the efficacy, safety and expense of these treatments through rigorous, unbiased investigations.

Child↗