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R Brian Haynes

Publications and source records attributed to R Brian Haynes.

At least 55 records · Page 3Linked to original sources
PubMed2004

Optimal search strategies for retrieving scientifically strong studies of diagnosis from Medline: analytical survey.

OBJECTIVE: To develop optimal search strategies in Medline for retrieving sound clinical studies on the diagnosis of health disorders. DESIGN: Analytical survey. SETTING: Medline, 2000. PARTICIPANTS: 170 journals for 2000 of which 161 were indexed in Medline. MAIN OUTCOME MEASURES: The sensitivity, specificity, precision ("positive predictive value"), and accuracy of 4862 unique terms in 17,287 combinations were determined by comparison with a hand search of all articles (the "gold standard") in 161 journals published during 2000 (49,028 articles). RESULTS: Only 147 (18.9%) of 778 articles about diagnostic tests met basic criteria for scientific merit. Combinations of search terms reached peak sensitivities of 98.6% at a specificity of 74.3%. Compared with best single terms, best multiple terms increased sensitivity for sound studies by 6.8% (absolute increase), while also increasing specificity (absolute increase 6.0%) when sensitivity was maximised. When terms were combined to maximise specificity, the single term, specificity.tw. (98.4%), outperformed combinations of terms. The strategies newly reported in this paper outperformed other validated search strategies except for one strategy that had slightly higher sensitivity (99.3% v 98.6%) but lower specificity (54.7% v 74.3%). CONCLUSION: New empirical search strategies in Medline can optimise retrieval of articles reporting high quality clinical studies of diagnosis.

Information Storage and Retrieval↗
PubMed2004

Doubling the impact: publication of systematic review articles in orthopaedic journals.

BACKGROUND: Investigators aim to publish their research papers in top journals to disseminate their findings to the widest possible audience. Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. We hypothesized that the number of citations (a measure of scholarly interest) for systematic reviews (or meta-analyses) published in leading orthopaedic journals would be greater than the number of citations for narrative reviews published in the same journals. METHODS: We identified fifteen journals that had high Science Citation Index impact factors for the orthopaedic subspecialty and were believed to have a higher yield of studies and reviews of scientific merit and clinical relevance. For the year 2000, six research associates applied methodological criteria to each article in each issue of the fifteen journals to determine whether the article was scientifically sound (rigorous versus nonrigorous). Of the 3916 articles identified, 2331 were original or review articles. We queried the ISI (Institute for Scientific Information) Web of Science database to ascertain, as of March 2003, the number of subsequent citations to each one of the reviews after its original publication in all journals that published both narrative and systematic reviews. RESULTS: Of the 2331 articles published across the fifteen journals in the year 2000, 110 were review articles. Only seventeen (15%) of the 110 reviews met our criteria for systematic reviews with rigor. Rigorous systematic reviews received more than twice the mean number of citations compared with other systematic or narrative reviews (13.8 compared with 6.0, p = 0.008). The rigor of a review was a significant predictor of the number of citations in other orthopaedic journals (p = 0.01). In addition, rigor was significantly associated with the number of citations in nonorthopaedic journals (p = 0.03). CONCLUSIONS: Our findings suggest that journal editors and authors can improve the relevance and scholarly interest in their reviews (as shown by the number of citations) by meeting standard guidelines for methodological rigor.

Humans↗
PubMed2004

Developing optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE.

BACKGROUND: The growing interest in qualitative research within the evidence based practice framework highlights the need for accurate search strategies to enhance the retrieval of qualitative studies. To date, little work has been done on developing optimal search filters for retrieving qualitative studies. The current study extends our earlier work, on developing optimal search strategies, to include qualitative studies. OBJECTIVE: To develop optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE in the publishing year 2000. DESIGN: Comparison of the retrieval performance of methodologic search strategies in MEDLINE with a manual review ("gold standard") of each article for each issue of 161 core health care journals for the year 2000. METHODS: 6 experienced research assistants who had been trained and intensively calibrated reviewed all issues of 161 journals for the publishing year 2000. Each article was systematically classified for "format" (whether it was an original study, review article, general article, or case report), "interest" (whether or not it was of interest to the health care of humans), and "purpose" (whether it pertained to therapy, diagnosis, prognosis, causation, economics, costs, or clinical prediction; was of a qualitative nature; or was about something else). Search strategies were developed for all purpose categories, including qualitative studies. MAIN OUTCOME MEASURES: The sensitivity (recall), specificity, precision, and accuracy of single and combinations of search terms. RESULTS: 49,028 articles were identified after matching the hand search records with the data downloaded from MEDLINE, of which 366 (0.75%) were classified as qualitative. Combinations of search terms reached peak sensitivities of 95%. Compared with the best single term, a three-term strategy increased sensitivity for qualitative studies by 23.6% (absolute increase), but with some loss of specificity when sensitivity was maximized. When search terms were combined to optimize sensitivity and specificity, both these values peaked above 90%. CONCLUSION: Several search strategies can achieve high performance in retrieving qualitative studies from MEDLINE.

Hepatitis, Viral, Human↗
PubMed2003

Systematic reviews: a cross-sectional study of location and citation counts.

BACKGROUND: Systematic reviews summarize all pertinent evidence on a defined health question. They help clinical scientists to direct their research and clinicians to keep updated. Our objective was to determine the extent to which systematic reviews are clustered in a large collection of clinical journals and whether review type (narrative or systematic) affects citation counts. METHODS: We used hand searches of 170 clinical journals in the fields of general internal medicine, primary medical care, nursing, and mental health to identify review articles (year 2000). We defined 'review' as any full text article that was bannered as a review, overview, or meta-analysis in the title or in a section heading, or that indicated in the text that the intention of the authors was to review or summarize the literature on a particular topic. We obtained citation counts for review articles in the five journals that published the most systematic reviews. RESULTS: 11% of the journals concentrated 80% of all systematic reviews. Impact factors were weakly correlated with the publication of systematic reviews (R2 = 0.075, P = 0.0035). There were more citations for systematic reviews (median 26.5, IQR 12 - 56.5) than for narrative reviews (8, 20, P <.0001 for the difference). Systematic reviews had twice as many citations as narrative reviews published in the same journal (95% confidence interval 1.5 - 2.7). CONCLUSIONS: A few clinical journals published most systematic reviews. Authors cited systematic reviews more often than narrative reviews, an indirect endorsement of the 'hierarchy of evidence'.

Bibliometrics↗
PubMed2003

Long-term renal prognosis of diarrhea-associated hemolytic uremic syndrome: a systematic review, meta-analysis, and meta-regression.

CONTEXT: The long-term renal prognosis of patients with diarrhea-associated hemolytic uremic syndrome (HUS) remains controversial. OBJECTIVES: To quantify the long-term renal prognosis of patients with diarrhea-associated HUS and to identify reasons for different estimates provided in the literature. DATA SOURCES: We searched MEDLINE and Experta Medica (EMBASE) bibliographic databases and conference proceedings, and we contacted experts until February 2003. We also searched the Institute for Scientific Information index and reference lists of all studies that fulfilled our eligibility criteria. The search strategy included the terms hemolytic-uremic syndrome, purpura, thrombotic thrombocytopenic, Escherichia coli O157, longitudinal studies, kidney diseases, hypertension, and proteinuria STUDY SELECTION: Any study that followed up 10 or more patients with primary diarrhea-associated HUS for at least 1 year for renal sequelae. DATA EXTRACTION: Two authors independently abstracted data on study and patient characteristics, renal measures, outcomes, and prognostic features. Disagreements were resolved by a third author or by consensus. DATA SYNTHESIS: Forty-nine studies of 3476 patients with a mean follow-up of 4.4 years (range, 1-22 years at last follow-up) from 18 countries, 1950 to 2001, were summarized. At the time of recruitment, patients were aged 1 month to 18 years. In the different studies, death or permanent end-stage renal disease (ESRD) ranged from 0% to 30%, with a pooled incidence of 12% (95% confidence interval [CI], 10%-15%). A glomerular filtration rate lower than 80 mL/min per 1.73 m2, hypertension, or proteinuria was extremely variable and ranged from 0% to 64%, with a pooled incidence of 25% (95% CI, 20%-30%). A higher severity of acute illness was strongly associated with worse long-term prognosis. Studies with a higher proportion of patients with central nervous system symptoms (coma, seizures, or stroke) had a higher proportion of patients who died or developed permanent ESRD at follow-up (explaining 44% of the between-study variability, P =.01). Studies with a greater proportion of patients lost to follow-up also described a worse prognosis (P =.001) because these patients were typically healthier than those followed up. One or more years after diarrhea-associated HUS, patients with a predicted creatinine clearance higher than 80 mL/min per 1.73 m2, no overt proteinuria, and no hypertension appeared to have an excellent prognosis. CONCLUSIONS: Death or ESRD occurs in about 12% of patients with diarrhea-associated HUS, and 25% of survivors demonstrate long-term renal sequelae. Patients lost to follow-up contribute to worse estimates in some studies. The severity of acute illness, particularly central nervous system symptoms and the need for initial dialysis, is strongly associated with a worse long-term prognosis.

Diarrhea↗
PubMed2003

A quantitative analysis of research publications in physical therapy journals.

BACKGROUND AND PURPOSE: Many physical therapists depend on their professional journals for high-quality evidence. The purpose of this study was to evaluate the rigor of research and review articles in 4 national physical therapy journals. SUBJECTS AND METHODS: All articles in 6 consecutive issues of the Australian Journal of Physiotherapy, Physical Therapy, Physiotherapy, and Physiotherapy Canada, published between January 2000 and June 2001 (N=179), were reviewed. One trained reviewer identified the type and purpose of each article and assessed the rigor of treatment and review articles according to explicit criteria. RESULTS: The majority of articles reviewed were original studies (56%). The majority of the research articles that dealt with human health care (66%) addressed topics that were not directly applicable to the provision of patient care such as measurement topics and studies on subjects without identified pathologies or impairments. Of the 179 journal articles, 19 met the standards for rigor (11%). The majority of these articles dealt with treatment. The pass rate per journal was as follows: Australian Journal of Physiotherapy, 10% (4/42); Physical Therapy, 15% (7/47); Physiotherapy, 12% (4/34); and Physiotherapy Canada, 7% (4/56). DISCUSSION AND CONCLUSION: Because such a small percentage of articles in these professional journals were identified as having direct application to patient care, physical therapists should attempt to access other sources of information to find additional high-quality evidence. A larger sample with a greater number of issues per journal may have yielded different results and indicated different trends, and further research appears to be warranted.

Australia↗
PubMed2003

Developing optimal search strategies for detecting clinically sound causation studies in MEDLINE.

BACKGROUND: Clinical end users of MEDLINE must be able to retrieve articles that are both scientifically sound and directly relevant to clinical practice. The use of methodologic search filters has been advocated to improve the accuracy of searching for such studies. These filters are available for the literature on therapy and diagnosis, but strategies for the literature on causation have been less well studied. OBJECTIVE: To determine the retrieval characteristics of methodologic terms in MEDLINE for identifying methodologically sound studies on causation. DESIGN: Comparison of methodologic search terms and phrases for the retrieval of citations in MEDLINE with a manual hand search of the literature (the gold standard) for 162 core health care journals. METHODS: 6 trained, experienced research assistants read all issues of 162 journals for the publishing year 2000. Each article was rated using purpose and quality indicators and categorized into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized as 'pass' or 'fail' for methodologic rigor in the areas of therapy/quality improvement, diagnosis, prognosis, causation, economics, clinical prediction, and review articles. Search strategies were developed for all categories including causation. MAIN OUTCOME MEASURES: Sensitivity, specificity, precision, and accuracy of the search strategies. RESULTS: 12% of studies classified as causation met basic criteria for scientific merit for testing clinical applications. Combinations of terms reached peak sensitivities of 93%. Compared with the best single term, multiple terms increased sensitivity for sound studies by 15.5% (absolute increase), but with some loss of specificity when sensitivity was maximized. Combining terms to optimize sensitivity and specificity achieved sensitivities and specificities both above 80%. CONCLUSION: The retrieval of causation studies cited in MEDLINE can be substantially enhanced by selected combinations of indexing terms and textwords.

Case-Control Studies↗
PubMed2003

Developing optimal search strategies for detecting sound clinical prediction studies in MEDLINE.

BACKGROUND: The gaining interest in the use of clinical prediction guides as an aid for helping clinicians make effective front-line decisions, together with the increasing emphasis on evidence-based practice, underscores the need for accurate identification of sound clinical prediction studies. Despite the growing use of clinical prediction guides, little work has been done on identifying optimal literature search filters for retrieving these types of studies. The current study extends our earlier work, on developing optimal search strategies, to include clinical prediction guides. OBJECTIVE: To develop optimal search strategies for detecting methodologically sound clinical prediction studies in MEDLINE in the publishing year 2000. DESIGN: Comparison of the retrieval performance of methodologic search strategies in MEDLINE with a manual review ("gold standard") of each article for each issue of 162 core health care journals for the year 2000. METHODS: 6 experienced research assistants who had been trained and intensively calibrated reviewed all issues of 162 journals for the publishing year 2000. Each article was classified for format, interest, purpose, and methodologic rigor. Search strategies were developed for all purpose categories, including studies of clinical prediction guides. MAIN OUTCOME MEASURES: The sensitivity (recall), specificity, precision, and accuracy of single and combinations of search terms. RESULTS: 39% of original studies classified as a clinical prediction guide were methodologically sound. Combinations of terms reached peak sensitivities of 95%. Compared with the best single term, a three-term strategy increased sensitivity for sound studies by 17% (absolute increase), but with some loss of specificity when sensitivity was maximized. When search terms were combined to optimize sensitivity and specificity, these values reached or were close to 90%. CONCLUSION: Several search strategies can enhance the retrieval of sound clinical prediction studies.

Causality↗
PubMed2002

Interventions to enhance patient adherence to medication prescriptions: scientific review.

CONTEXT: Low adherence with prescribed treatments is ubiquitous and undermines treatment benefits. OBJECTIVE: To systematically review published randomized controlled trials (RCTs) of interventions to assist patients' adherence to prescribed medications. DATA SOURCES: A search of MEDLINE, CINAHL, PSYCHLIT, SOCIOFILE, IPA, EMBASE, The Cochrane Library databases, and bibliographies was performed for records from 1967 through August 2001 to identify relevant articles of all RCTs of interventions intended to improve adherence to self-administered medications. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications for a medical or psychiatric disorder; both adherence and treatment outcome were measured; follow-up of at least 80% of each study group was reported; and the duration of follow-up for studies with positive initial findings was at least 6 months. Information on study design features, interventions, controls, and findings (adherence rates and patient outcomes) were extracted for each article. DATA SYNTHESIS: Studies were too disparate to warrant meta-analysis. Forty-nine percent of the interventions tested (19 of 39 in 33 studies) were associated with statistically significant increases in medication adherence and only 17 reported statistically significant improvements in treatment outcomes. Almost all the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective interventions had modest effects. CONCLUSIONS: Current methods of improving medication adherence for chronic health problems are mostly complex, labor-intensive, and not predictably effective. The full benefits of medications cannot be realized at currently achievable levels of adherence; therefore, more studies of innovative approaches to assist patients to follow prescriptions for medications are needed.

Acute Disease↗
PubMed2002

Helping patients follow prescribed treatment: clinical applications.

Low adherence to prescribed medical regimens is a ubiquitous problem. Typical adherence rates are about 50% for medications and are much lower for lifestyle prescriptions and other more behaviorally demanding regimens. In addition, many patients with medical problems do not seek care or drop out of care prematurely. Although accurate measures of low adherence are lacking for many regimens, simple measures, such as directly asking patients and watching for appointment nonattendance and treatment nonresponse, will detect most problems. For short-term regimens (< or =2 weeks), adherence to medications is readily achieved by giving clear instructions. On the other hand, improving adherence to long-term regimens requires combinations of information about the regimen, counseling about the importance of adherence and how to organize medication taking, reminders about appointments and adherence, rewards and recognition for the patient's efforts to follow the regimen, and enlisting social support from family and friends. Successful interventions for long-term regimens are all labor-intensive but ultimately can be cost-effective.

Diabetes Mellitus, Type 2↗
PubMed2002

Comparison of deferral rates using a computerized versus written blood donor questionnaire: a randomized, cross-over study [ISRCTN84429599].

BACKGROUND: Self-administered computer-assisted blood donor screening strategies may elicit more accurate responses and improve the screening process. METHODS: Randomized crossover trial comparing responses to questions on a computerized hand-held tool (HealthQuiz, or HQ), to responses on the standard written instrument (Donor Health Assessment Questionnaire, or DHAQ). Randomly selected donors at 133 blood donation clinics in the area of Hamilton, Canada participated from 1995 to 1996. Donors were randomized to complete either the HQ or the DHAQ first, followed by the other instrument. In addition to responses of 'yes' and 'no' on both questionnaires, the HQ provided a response option of 'not sure'. The primary outcome was the number of additional donors deferred by the HQ. RESULTS: A total of 1239 donors participated. Seventy-one potential donors were deferred as a result of responses to the questionnaires; 56.3% (40/71) were deferred by the DHAQ, and an additional 43.7% (31/71) were deferred due to risks identified by the HQ but not by the DHAQ. Fourteen donors self-deferred; 11 indicated on the HQ that they should not donate blood on that day but did not use the confidential self-exclusion option on the DHAQ, and three used the self-exclusion option on the DHAQ but did not indicate that they should not donate blood on the HQ. The HQ identified a blood contact or risk factor for HIV/AIDS or sexually transmitted infection that was not identified by the DHAQ in 0.1% to 2.7% of donors. CONCLUSION: A self-administered computerized questionnaire may increase risk reporting by blood donors.

Anonymous Testing↗
PubMed2002

What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?

BACKGROUND: In 1992, Evidence-Based Medicine advocates proclaimed a "new paradigm", in which evidence from health care research is the best basis for decisions for individual patients and health systems. Hailed in New York Times Magazine in 2001 as one of the most influential ideas of the year, this approach was initially and provocatively pitted against the traditional teaching of medicine, in which the key elements of knowing for clinical purposes are understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience. This paper reviews the origins, aspirations, philosophical limitations, and practical challenges of evidence-based medicine. DISCUSSION: EBM has long since evolved beyond its initial (mis)conception, that EBM might replace traditional medicine. EBM is now attempting to augment rather than replace individual clinical experience and understanding of basic disease mechanisms. EBM must continue to evolve, however, to address a number of issues including scientific underpinnings, moral stance and consequences, and practical matters of dissemination and application. For example, accelerating the transfer of research findings into clinical practice is often based on incomplete evidence from selected groups of people, who experience a marginal benefit from an expensive technology, raising issues of the generalizability of the findings, and increasing problems with how many and who can afford the new innovations in care. SUMMARY: Advocates of evidence-based medicine want clinicians and consumers to pay attention to the best findings from health care research that are both valid and ready for clinical application. Much remains to be done to reach this goal.

Decision Making↗
PubMed2002

The effectiveness of hydroxychloroquine in patients with type 2 diabetes mellitus who are refractory to sulfonylureas--a randomized trial.

AIM: To assess the glucose-lowering efficacy, responsiveness, duration of action and impact on quality-of-life of hydroxychloroquine (HXCHL), when added as an antihyperglycemic agent to patients with sulfonylurea-refractory type 2 diabetes. METHODS: One hundred and thirty-five obese patients with type 2 diabetes (mean age 57.5 years) and a glycated hemoglobin (GHb) > or = 11% despite maximum sulfonylureas were randomly allocated to the addition of HXCHL (up to 300 mg bid) or placebo and followed for up to 18 months. Randomization was stratified by baseline GHb (<13.5% versus > or = 13.5%). The primary outcome was 'blinded' withdrawal of study drug due to unacceptable glycemic control; GHb, glucose tolerance, lipids, and quality of life were also assessed. RESULTS: Those on placebo were more likely to be withdrawn from study drug because of unacceptable glycemic control than patients randomized to HXCHL (95.5 and 69.6% given placebo and HXCHL, respectively; P=0.0001). During the first 6 months, HXCHL decreased GHb by an absolute amount of 1.02% more than placebo (95% CI 0.24, 1.81). Glucose tolerance and LDL cholesterol improved during the first 3 months of therapy. No significant adverse effects were noted. Factors that predicted responsiveness included an initial GHb <13.5%, early responsiveness to study drug, and no prior metformin use. Lower GHb levels at baseline predicted a better response; the hazard of withdrawal increased 36% (95% CI 11%, 66%) for every 1% increase in GHb even in patients whose baseline GHb was <13.5%. CONCLUSIONS: HXCHL improves glycemic control in sulfonylurea-refractory patients with poorly controlled type 2 diabetes.

Body Mass Index↗
PubMed2002

Evidence-based endocrinology. Finding the current best research evidence for practice in endocrinology.

New medical information is accumulating at an astonishing rate. It is available in many forms and flavors, and information seekers benefit from being discriminating in searches for answers to clinical problems. Few problems can be addressed satisfactorily simply by entering some relevant content terms into Medline. Such a search, unless the problem is rare, usually results in a flood of citations with no arrangement according to quality, and the user must determine painstakingly which citations are relevant and clinically useful. Fortunately, evidence-based information services are catching up with the growth of the medical literature. Such services organize and provide access to the current best evidence at the point of need. We have described a "4 S" hierarchy of evidence-based resources to help focus a practitioner's information seeking strategies, with systems at the highest level of organization, followed by synopses, syntheses, and studies. Practitioners should become familiar with the best access routes for regularly updated services of relevance to their interests and direct their inquiries initially to the highest level of organization of information that exists for their interests. Evidence-based resources continue to be created and evolve, so keeping an eye out for new resources and examining their pedigrees according to the "4 S" approach permit practitioners to assemble and organize an ever-improving personal evidence-based library for endocrinology.

Endocrine System Diseases↗
PubMed2002

Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I.

BACKGROUND: Conflicting evidence exists concerning whether renal insufficiency is an independent risk factor for cardiovascular disease in the general population. The objective of this study was to determine whether moderate renal insufficiency was associated with total and cardiovascular mortality, independent of traditional cardiovascular risk factors, in a community sample representative of the U.S. general non-institutionalized population. METHODS: Participants in the U.S. First National Health and Nutrition Examination Survey (NHANES I, 1974-1975) and NHANES I Epidemiologic Follow-up Study (NHEFS, 1992, 18 year follow-up) were evaluated. The primary analysis was limited to 2352 adults with complete data, and no baseline cardiovascular disease. A creatinine of 104 to 146 micromol/L in women, and 122 to 177 micromol/L in men (approximate glomerular filtration rate of 30 to 60 mL/min/1.73 m2) was defined as moderate renal insufficiency. Supplementary analyses included participants with marked renal impairment and baseline cardiovascular disease. RESULTS: The unadjusted hazard ratio for moderate renal insufficiency compared to preserved renal function was significant for total mortality (hazard ratio 1.7; 95% confidence interval 1.3 to 2.2), and for cardiovascular mortality (2.2; 1.5 to 3.1). After adjustment for traditional cardiovascular risk factors, there was no independent association between moderate renal insufficiency and total mortality (1.0; 0.8 to 1.4), or cardiovascular mortality (1.2; 0.8 to 1.8). These results were consistent in supplementary analyses. CONCLUSIONS: These results do not support moderate renal insufficiency as an independent risk factor for cardiovascular disease in the general population. The association between moderate renal insufficiency and cardiovascular disease, demonstrated in other epidemiologic studies, appears to be due to co-occurrence of renal insufficiency with traditional cardiovascular risk factors.

Adult↗
PubMed2002

Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III.

BACKGROUND: A number of screening criteria, applied either at a single point in time or serially, can be used for the purpose of identifying individuals at risk of end-stage renal disease (ESRD). This study focused on two such criteria measured on a single occasion, proteinuria and renal insufficiency, and examined their prevalence in a sample representative of the adult U.S. non-institutionalized population. Such knowledge guides the utility of population screening to prevent ESRD. METHODS: The prevalence of albuminuria (microalbuminuria and macroalbuminuria from a random urine albumin-to-creatinine ratio) and renal insufficiency [glomerular filtration rate (GFR) estimated from serum creatinine] was determined in different age categories in various adult screening groups in the cross-sectional Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: A total of 14,622 adult participants were included in the analysis. In the general population, 8.3% and 1.0% of participants demonstrated microalbuminuria and macroalbuminuria, respectively. To identify one case of albuminuria, one would need to screen three persons with diabetes mellitus, seven non-diabetic hypertensive persons, or six persons over the age of 60. When albuminuria and renal insufficiency were considered together, it was clear that these tests were identifying different segments of the population; 37% of participants with a GFR less than 30 mL/min/1.73 m2 demonstrated no albuminuria. Non-albuminuric renal insufficiency was most evident in the ages of 60 to 79; 34% of diabetics, and 63% of non-diabetic hypertensives with a GFR less than 30 mL/min/1.73 m2 demonstrated no albuminuria. CONCLUSIONS: Albuminuria is prevalent, and when considered together, screening tests of albuminuria and renal insufficiency measured on a single occasion identify different segments of the population. The prevalence of albuminuria and renal insufficiency in populations of interest should be considered, as this knowledge has implications for the effectiveness of screening.

Adult↗
PubMed2002

Robustness of empirical search strategies for clinical content in MEDLINE.

BACKGROUND: It is important for clinical end users of MEDLINE to be able to retrieve articles that are both scientifically sound and directly relevant to clinical practice. The use of methodologic search filters (such as "random allocation" for sound studies of medical interventions) has been advocated to improve the accuracy of searching for such studies. Methodologic search filters have been tested in previous MEDLINE files but indexing continues to evolve and the operating characteristics of these search filters in current MEDLINE files are unknown. OBJECTIVE: To determine the robustness of empirical search strategies developed in 1991 for detecting clinical content in MEDLINE in the year 2000. DESIGN: A survey based on a hand search of 171 core health care journals using predetermined quality indicators for scientific merit and clinical relevance. METHODS: 6 trained, experienced research assistants read all issues of 171 journals for the publishing year 2000. Each article was rated using purpose and quality indicators and categorized into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized as 'pass' or 'fail' for methodologic rigor in the areas of therapy/quality improvement, diagnosis, prognosis, causation, economics, clinical prediction, and qualitative and review articles. Search strategies developed in 1991 were tested in the 2000 database. MAIN OUTCOME MEASURES: Sensitivity, specificity, precision, and accuracy of the search strategies. RESULTS: Search strategies developed in 1991 generally performed at least as well in 2000 for both best single terms and combinations of terms for high-sensitivity MEDLINE searches for studies of treatment, prognosis, etiology and diagnosis. For example, the accuracy of "clinical trial (pt)" rose from 91.6% to 94.4% (P<0.05) for retrieving high-quality studies of treatments. CONCLUSION: Most MEDLINE search strategies developed in 1991 are robust when searching in the publishing year 2000.

Information Storage and Retrieval↗