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PubMed2003

Measurement of isometric wrist muscle strength--a systematic review of starting position and test protocol.

BACKGROUND: Isometric strength of the wrist musculature is frequently used in the clinical setting as a primary outcome measure following a wrist disorder. OBJECTIVE: A systematic search of the literature was undertaken to review published starting positions and test protocols used in assessing isometric strength of the wrist musculature. METHODS: AMED, CINAHL, Current Contents, EMBASE and MEDLINE computerized databases were searched for literature published between January 1980 and September 2002 that described the methodologies used to assess isometric wrist muscle strength. Papers were excluded if they explored motor unit recruitment, strength was assessed via manual muscle testing or no information regarding starting position or test protocol was included. RESULTS: A total of 15 papers met the inclusion criteria. Starting position varied between papers, with little justification for the positions assumed. Test protocols used also were variably described, with some not meeting accepted standards for the assessment of isometric strength. Many of the reports lacked information regarding starting position and test protocol used, which precluded replication of the methodology. CONCLUSIONS: Further research is required to determine the optimum starting position and test protocol for the assessment of isometric wrist muscle strength. These should subsequently be assessed for reliability, to ensure that consistent results are produced over different occasions of testing.

Humans↗
PubMed2005

Meta-review of high-quality systematic reviews of interventions in key areas of liaison psychiatry.

BACKGROUND: When planning and delivering a liaison psychiatry service it is important to have an understanding of the research evidence supporting the use of interventions likely to be delivered by the service. AIMS: To identify high-quality systematic reviews for all interventions in three defined areas of liaison psychiatry, to summarise their clinical implications and to highlight areas where more research is needed. The three areas were the psychological effects of physical illness or treatment, somatoform disorders and self-harming behaviour. METHOD: Computerised database searching, secondary reference searching, hand-searching and expert consultation were used to identify relevant systematic reviews. Studies were reliably selected, and quality-assessed, and data were extracted and interpreted by two reviewers. RESULTS: We found 64 high-quality systematic reviews. Only 14 reviews included meta-analyses. CONCLUSIONS: Many areas of liaison psychiatry practice are not based on high-quality evidence. More research in this area would help inform development and planning of liaison psychiatry services.

Disease↗
PubMed2001

Quality of life after obesity surgery, an evidence-based medicine literature review: how to improve systematic searches for enhanced decision-making and clinical outcomes.

BACKGROUND: Research attests to the exponential sweep of clinical obesity in America. Obesity has become one of the most profound public health concerns, closely linked to increased morbidity, mortality, and social, occupational, and psychological discrimination. It is incumbent for specialists to design treatment and outcome analysis based accurately upon systematic research. Regulators, payors, and most notably, patients, need reliable and effective treatment to determine practical standards, manage cost of care, and protocols. METHODS: A comprehensive evidence-based medicine (EBM) review was done of relevant research on quality-of-life (QoL) outcomes after obesity surgery. The Cochrane Collaboration was the EBM searching resource utilized for this project, accessed via the Internet. A systematic EBM search design was implemented. RESULTS: In the search, QoL reported 3,234 hits, "obesity surgery" reported 33 hits, QoL and obesity surgery" reported 6 hits, and QoL and hypertension reported 288 hits. CONCLUSION: We found that a thorough EBM search can be achieved using the Cochrane Collaboration, which provides an efficient, effective and ethical means to enhance evidence-based clinical decision-making in treating severely obese surgery patients.

Databases, Bibliographic↗
PubMed2001

Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder.

This clinical practice guideline provides evidence-based recommendations for the treatment of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). This guideline, the second in a set of policies on this condition, is intended for use by clinicians working in primary care settings. The initiation of treatment requires the accurate establishment of a diagnosis of ADHD; the American Academy of Pediatrics (AAP) clinical practice guideline on diagnosis of children with ADHD(1) provides direction in appropriately diagnosing this disorder. The AAP Committee on Quality Improvement selected a subcommittee composed of primary care and developmental-behavioral pediatricians and other experts in the fields of neurology, psychology, child psychiatry, education, family practice, and epidemiology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Evidence-based Practice Center at McMaster University, Ontario, Canada, to develop the evidence base of literature on this topic.(2) The resulting systematic review, along with other major studies in this area, was used to formulate recommendations for treatment of children with ADHD. The subcommittee also reviewed the multimodal treatment study of children with ADHD(3) and the Canadian Coordinating Office for Health Technology Assessment report (CCOHTA).(4) Subcommittee decisions were made by consensus where definitive evidence was not available. The subcommittee report underwent extensive review by sections and committees of the AAP as well as by numerous external organizations before approval from the AAP Board of Directors. The guideline contains the following recommendations for the treatment of a child diagnosed with ADHD:

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

[Systematic review: a resource that allows for the incorporation of evidence into nursing practice].

Systematic review is an important resource in evidence-based practice, which consists in a form of synthesizing the research results related to a specific problem. This article aimed to offer subsidies for reflections with a view to the construction and/or application of systematic reviews in the nursing environment. Based on the literature, authors presented the phases comprising a systematic review and the relevant aspects that must be considered for using this resource.

Evidence-Based Medicine↗
PubMed2026

Targeted Next-Generation Sequencing for Improved Clinical Outcomes in People Living With Rare Diseases in Global South: Protocol for a Systematic Review and Meta-Synthesis.

BACKGROUND: Rare diseases affect many individuals and pose major challenges in diagnosis and treatment, especially in Global South countries where health care resources are limited. Targeted next-generation sequencing (NGS) has significantly advanced diagnostic accuracy and clinical care for rare diseases globally; however, its implementation and impact within the Global South context remain insufficiently studied. OBJECTIVE: This study aims to evaluate the use, clinical benefits, challenges, and implementation outcomes of targeted NGS for diagnosing and managing rare diseases in Global South populations. Specifically, it seeks to quantify the diagnostic yield of NGS, examine its influence on subsequent clinical decision-making, and identify principal barriers to, and facilitators of, the implementation of targeted NGS approaches in these contexts. METHODS: This protocol follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will systematically search PubMed, Scopus, and Web of Science for studies published between 2005 and 2025 that report on the use of targeted NGS in Global South population with rare diseases. Two reviewers will independently perform study selection, data extraction, quality assessment, and evaluation of risk of bias by using QUADAS-2 for diagnostic accuracy studies and the risk of bias assessment tool for nonrandomized studies. Meta-analyses will be conducted to estimate pooled outcomes for diagnostic yield, with heterogeneity assessed using random effects models. Heterogeneity will be further examined through visual inspection of forest plots and by evaluating the chi-square test and I² statistic. RESULTS: The protocol has been registered with PROSPERO (CRD420251078455). Database search or screening, data extraction, and data synthesis are planned to commence in June 2026 and conclude by September 2026. Study findings will synthesize the diagnostic yield, clinical impact, and contextual determinants influencing the implementation of targeted NGS in Global South health care settings. CONCLUSIONS: This review will provide evidence on the application, advantages, limitations, and clinical outcomes of targeted NGS for individuals affected by rare diseases in countries of the Global South. The finding will identify priorities for capacity strengthening, policy development, and future genomic research. TRIAL REGISTRATION: PROSPERO CRD420251078455; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251078455. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/85150.

Rare Diseases↗
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↗
PubMed2001

Psychiatric research in South Africa: a systematic review of Medline publications.

BACKGROUND: There is debate about the future path that medical and psychiatric research in South Africa should take. In particular, there have been calls to make research more relevant to the needs of the population. There is, however, little systematically collected data on the nature, strengths, and flaws of past psychiatric research in this country. METHODS: We undertook a MEDLINE search to gather all manuscripts that fell under the umbrella of psychiatric research and published by South Africa-based authors during the years 1966-1997. Several kinds of data were collated from each of the articles, including information about the authors and the journal, as well as information on the focus and type of article. RESULTS: While publications from South Africa continue to grow in number, relatively few involve collaborative research groups and few authors write more than one paper. Many papers relevant to psychiatry were published in general medical journals and many were from general medical departments. While blacks and females have been included in research, a number of important areas have received little attention. CONCLUSIONS: Psychiatry research in South Africa requires additional fostering, including additional resources for research training and arguably additional development of subspecialty focuses. Given the limited resources, and the nature of modern research, increased emphasis on collaboration seems advisable. A number of areas in psychiatry deserve particular attention from future researchers.

Humans↗
PubMed2000

Applying the results of a systematic review in general practice.

OBJECTIVE: To assess how general practitioners might interpret and apply the results of a systematic review relevant to general practice. DESIGN: Cross-sectional postal survey of general practitioners in August 1997. PARTICIPANTS: 51 general practitioners in the Southern Division of General Practice in Adelaide and 11 professors or heads of departments of general practice. MAIN OUTCOME MEASURES: Extent to which comments on the implications for practice and implications for research coincided with the evidence presented in a systematic review of antibiotics for the treatment of acute otitis media in children; and reported probability that respondents would prescribe antibiotics in three brief case scenarios. RESULTS: There was considerable variation in the comments made by general practitioners on the implications of the review for clinical practice. After reading the review, respondents with training in critical appraisal were more likely to state that children with acute otitis media would usually recover spontaneously and reported a lower probability of prescribing antibiotics in two of the three case scenarios. CONCLUSIONS: Providing systematic reviews is not sufficient for the results of such evidence to be translated into clinical practice. There is an association between critical appraisal skills and the application of evidence-based practice.

Adult↗
PubMed1997

Selecting and appraising studies for a systematic review.

After thoroughly searching the potentially relevant literature for a systematic review, reviewers face the sequential tasks of selecting studies for inclusion and appraising these studies. Methodical, impartial, and reliable strategies are necessary for these two tasks because systematic reviews are retrospective exercises and are therefore prone to both bias and random error. To plan for study selection, reviewers begin with a focused clinical question and choose selection criteria that reflect this question. A detailed selection protocol that specifies the study designs and publication status of articles to be included is often helpful. Selection criteria are itemized on customized forms and are used to examine each potentially relevant primary study, usually by two different reviewers. In planning the critical appraisal of included studies, reviewers decide which clinical and methodologic study features require documentation. After choosing methods for evaluating study quality, reviewers construct customized appraisal forms and an explicit protocol for the actual evaluation. Some of the techniques commonly used to minimize the potential for error in study appraisal include duplicate, independent examination; blinding to study results and other identifying features of each article; and correspondence with study authors to clarify issues. Ultimately, primary studies should be selected, appraised, and reported in sufficient detail to allow readers to judge the applicability of the review to clinical practice and to clarify the strength of the inferences that can be drawn from the review.

Research Design↗
PubMed2001

Mapping a method for systematically reviewing the medical literature: a helpful checklist postmortem protocol of human immunodeficiency virus (HIV)-related pathology in childhood.

INTRODUCTION: Since the first description of two children affected with human immunodeficiency virus (HIV), various diagnostic procedures have been established. However, the morphologic study of biopsy and autopsy material from children with acquired immunodeficiency syndrome (AIDS) is still of fundamental importance. The morphology has contributed remarkably to the progress in understanding the pathogenesis of the primary tissue lesions and of the sequelae directly or indirectly associated with HIV infection. The aim of this study was to evaluate the HIV pathology in pediatric AIDS (PAIDS) through a systematic review of the English-language literature and to draw up a practical checklist protocol for the postmortem. MATERIALS AND METHODS: Information on HIV pathology in childhood was retrieved from a MEDLINE search (January 1994-January 2001) of the original reports and bibliographic article reviews published in English. Citations from papers retrieved were screened and retrieved papers were evaluated. RESULTS: Based on the screened data, we propose a practical, organ-oriented checklist protocol for the postmortem according to the HIV pathogenesis. CONCLUSIONS: Evidence-based medicine is a paradigm now exerting increasing influence in related fields such as surgery, general practice, psychiatry, and pathology. This article is a summary of the literature on PAIDS pathology. The protocol that we propose is particularly useful for pediatric pathology programs and for electronic data processing.

Acquired Immunodeficiency Syndrome↗
PubMed2003

[What is the systematic review?].

Systematic reviewing provides a major backbone for evidence-based laboratory medicine(EBLM). Compared with a usual review paper, a systematic review is characterized by pursuing both the most comprehensive search for available evidence and the highest level of scientific quality. The word of 'scientific' does not mean a scientific truth but means a reliable result proven by a scientific method. According to the best effort policy of EBM, a result including some statistical bias may be adopted as the current best evidence if better ones are not available. In addition, EBLM requires specialized approaches because of the following reasons. (1) Many factors, such as analytical errors or lack of standardization may cause various statistical biases in the laboratory data. (2) Unlike the effectiveness of therapeutic measures that can be evaluated by comparing only two groups, there are almost infinite combinations of diagnostic tests and phases of clinical courses, and it is hardly possible to statistically match the patient group with the control group at any of those combinations. (3) Unlike medication, which has direct effects on a patient's outcome, many steps must be taken to analyze the effects of laboratory tests. From now, more effort should be dedicated to promoting systematic reviewing in laboratory medicine.

Evidence-Based Medicine↗
PubMed2003

[Critical appraisal of the literature in systematic review].

Critical appraisal of a literature is an important part of Systematic Review(SR) of laboratory tests. In this process, the quality of the clinical study is evaluated by using knowledge of clinical epidemiology and biostatistics. In the critical appraisal of articles of diagnostic tests, estimation of the design related bias, such as selection bias, spectrum bias, work-up bias, and referral bias, is extremely important. This article introduces the checklist for a diagnostic test proposed by the EBD collaboration in Japan. The proposed checklist consists of 23 items which effect on quality and external validity of the clinical studies. It will become a useful tool for systematic review in laboratory medicine.

Clinical Laboratory Techniques↗
PubMed2005

The librarian's roles in the systematic review process: a case study.

UNLABELLED: QUESTION/SETTING: Although the systematic review has become a research standard, little information addresses the actions of the librarian on a systematic review team. METHOD: This article is an observational case study that chronicles a librarian's required involvement, skills, and responsibilities in each stage of a real-life systematic review. MAIN RESULTS: Examining the review process reveals that the librarian's multiple roles as an expert searcher, organizer, and analyzer form an integral part of the Cochrane Collaboration's criteria for conducting systematic reviews. Moreover, the responsibilities of the expert searcher directly reflect the key skills and knowledge depicted in the "Definition of Expert Searching" section of the Medical Library Association's policy statement, "Role of Expert Searching in Health Sciences Libraries." CONCLUSION: Although the librarian's multiple roles are important in all forms of medical research, they are crucial in a systematic review. As an expert searcher, the librarian must interact with the investigators to develop the terms required for a comprehensive search strategy in multiple appropriate sources. As an organizer and analyzer, the librarian must effectively manage the articles and document the search, retrieval, and archival processes.

Humans↗
PubMed1980

[Rapid determination of MB fraction of serum creatine kinase in the diagnosis of acute myocardial infarction (author's transl)].

The behaviour of the myocardial fraction of creatine kinase has been studied in a group of 80 patients diagnosed as having an acute myocardial infarction. The method of selective activation with dithiothreitol was employed. This technique enables the isoenzyme quantification in less than 15 minutes, which represents a great advantage in comparison to other complex methods used in the past. According to the time of evolution of the infarction the patients were classified into four groups and comparative statistical studies were carried out between these groups and the group of 20 normal controls. The early increase of the myocardial fraction is stressed, even when creatine kinase is still within normal limits. Literature on this topic is reviewed and a systematic determination of the myocardial fraction of serum creatine kinase in the intensive Coronary Units is recommended in order to certainly diagnose myocardial infarction as soon as possible.

Creatine Kinase↗