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PubMed2006

Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review.

OBJECTIVE: To compare the methodological quality and conclusions in Cochrane reviews with those in industry supported meta-analyses and other meta-analyses of the same drugs. DESIGN: Systematic review comparing pairs of meta-analyses that studied the same two drugs in the same disease and were published within two years of each other. DATA SOURCES: Cochrane Database of Systematic Reviews (2003, issue 1), PubMed, and Embase. DATA EXTRACTION: Two observers independently extracted data and used a validated scale to judge the methodological quality of the reviews. RESULTS: 175 of 1596 Cochrane reviews had a meta-analysis that compared two drugs. Twenty four meta-analyses that matched the Cochrane reviews were found: eight were industry supported, nine had undeclared support, and seven had no support or were supported by non-industry sources. On a 0-7 scale, the median quality score was 7 for Cochrane reviews and 3 for other reviews (P < 0.01). Compared with industry supported reviews and reviews with undeclared support, Cochrane reviews had more often considered the potential for bias in the review--for example, by describing the method of concealment of allocation and describing excluded patients or studies. The seven industry supported reviews that had conclusions recommended the experimental drug without reservations, compared with none of the Cochrane reviews (P = 0.02), although the estimated treatment effect was similar on average (z = 0.46, P = 0.64). Reviews with undeclared support and reviews with not for profit support or no support had conclusions that were similar in cautiousness to the Cochrane reviews. CONCLUSIONS: Industry supported reviews of drugs should be read with caution as they were less transparent, had few reservations about methodological limitations of the included trials, and had more favourable conclusions than the corresponding Cochrane reviews.

Bias↗
PubMed2007

Why do peer reviewers decline to review? A survey.

BACKGROUND: Peer reviewers are usually unpaid and their efforts not formally acknowledged. Some journals have difficulty finding appropriate reviewers able to complete timely reviews, resulting in publication delay. OBJECTIVES AND METHODS: A survey of peer reviewers from five biomedical journals was conducted to determine why reviewers decline to review and their opinions on reviewer incentives. Items were scored on 5-point Likert scales, with low scores indicating low importance or low agreement. RESULTS: 551/890 (62%) reviewers responded. Factors rated most highly in importance for the decision to accept to review a paper included contribution of the paper to subject area (mean 3.67 (standard deviation (SD) 86)), relevance of topic to own work (mean 3.46 (SD 0.99)) and opportunity to learn something new (mean 3.41 (SD 0.96)). The most highly rated factor important in the decision to decline to review was conflict with other workload (mean 4.06 (SD 1.31)). Most respondents agreed that financial incentives would not be effective when time constraints are prohibitive (mean 3.59 (SD 1.01)). However, reviewers agreed that non-financial incentives might encourage reviewers to accept requests to review: free subscription to journal content (mean 3.72 (SD 1.04)), annual acknowledgement on the journal's website (mean 3.64 (SD 0.90)), more feedback about the outcome of the submission (mean 3.62 (SD 0.88)) and quality of the review (mean 3.60 (SD 0.89), and appointment of reviewers to the journal's editorial board (mean 3.57 (SD 0.99)). CONCLUSION: Reviewers are more likely to accept to review a manuscript when it is relevant to their area of interest. Lack of time is the principal factor in the decision to decline. Reviewing should be formally recognised by academic institutions and journals should acknowledge reviewers' work.

Attitude↗
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↗
PubMed2002

A randomized survey of the preference of gastroenterologists for a Cochrane review versus a traditional narrative review.

BACKGROUND: Clinicians often rely on review material rather than analysis of primary research to guide therapy. Systematic reviews use methods to insure thoroughness and to minimize bias, but many clinicians are not familiar with systematic reviews and continue to rely on narrative reviews. OBJECTIVES: To determine whether a traditional narrative review or a systematic review is perceived to be more useful. METHODS: A clinical scenario (patient with chronic Crohn's disease considered for azathioprine therapy) was circulated to gastroenterologists, along with a narrative review of therapy (including azathioprine) for inflammatory bowel disease written by an acknowledged expert, or with a systematic Cochrane review of the use of azathioprine for this disease. Whether knowledge of authorship and journal source influences the perception of usefulness of a narrative review was investigated. RESULTS: The Cochrane review was rated significantly more highly than the narrative review on a 100 mm visual analogue scale (21.3 mm; 95% CI 14.5 to 28 mm). The proportion of respondents who considered the review to be a useful guide was also higher in the group that received the Cochrane review (91%) than in the group that received the narrative review, with author and journal concealed (62%) or identified (70%) (P<0.001 for both comparisons). Ratings from the two groups that received the narrative review were not significantly different. CONCLUSIONS: The focused systematic review was perceived to be more useful than a traditional broad narrative review as a guide to making a decision concerning the use of specific therapy. The possible strengths of systematic reviews should be more fully investigated. If there is additional evidence supporting their greater value to clinicians, they should be made more widely available to clinicians and their strengths should be publicized.

Aged↗
PubMed2002

Comparison of review articles published in peer-reviewed and throwaway journals.

CONTEXT: To compare the quality, presentation, readability, and clinical relevance of review articles published in peer-reviewed and "throwaway" journals. METHODS: We reviewed articles that focused on the diagnosis or treatment of a medical condition published between January 1 and December 31, 1998, in the 5 leading peer-reviewed general medical journals and high-circulation throwaway journals. Reviewers independently assessed the methodologic and reporting quality, and evaluated each article's presentation and readability. Clinical relevance was evaluated independently by 6 physicians. RESULTS: Of the 394 articles in our sample, 16 (4.1%) were peer-reviewed systematic reviews, 135 (34.3%) were peer-reviewed nonsystematic reviews, and 243 (61.7%) were nonsystematic reviews published in throwaway journals. The mean (SD) quality scores were highest for peer-reviewed articles (0.94 [0.09] for systematic reviews and 0.30 [0.19] for nonsystematic reviews) compared with throwaway journal articles (0.23 [0.03], F(2,391) = 280.8, P<.001). Throwaway journal articles used more tables (P =.02), figures (P =.01), photographs (P<.001), color (P<.001), and larger font sizes (P<.001) compared with peer-reviewed articles. Readability scores were more often in the college or higher range for peer-reviewed journals compared with the throwaway journal articles (104 [77.0%] vs 156 [64.2%]; P =.01). Peer-reviewed article titles were judged less relevant to clinical practice than throwaway journal article titles (P<.001). CONCLUSIONS: Although lower in methodologic and reporting quality, review articles published in throwaway journals have characteristics that appeal to physician readers.

Consumer Behavior↗
PubMed1993

The characteristics of peer reviewers who produce good-quality reviews.

OBJECTIVE: To determine the characteristics of good peer reviewers. DESIGN: Cross-sectional analysis of data gathered during a randomized controlled trial. SETTING: The Journal of General Internal Medicine. PARTICIPANTS: 226 reviewers of 131 consecutively submitted manuscripts of original research. 201 (91%) completed the review and submitted a curriculum vitae. MEASUREMENTS AND MAIN RESULTS: The quality of each review was judged on a scale from 1 to 5 by an editor who was blinded to the identity of the reviewer. Reviewer characteristics were taken from the curricula vitae. 86 of the 201 reviewers (43%) produced good reviews (a grade of 4 or 5). Using logistic regression, the authors found that when a reviewer was less than 40 years old, from a top academic institution, well known to the editor choosing the reviewer, and blinded to the identity of the manuscript's authors, the probability that he or she would produce a good review was 87%, whereas a reviewer without any of these characteristics had a 7% probability of producing a good review. Other characteristics that were significant only on bivariate analysis included previous clinical research training, additional postgraduate degrees, and more time spent on the review. There was a negative but statistically nonsignificant association between academic rank and review quality: 37% of full professors, 39% of associate professors, and 51% of assistant professors or fellows produced good reviews (p = 0.11). CONCLUSIONS: Good peer reviewers for this journal tended to be young, from strong academic institutions, well known to the editors, and blinded to the identity of the manuscript's authors.

Cross-Sectional Studies↗
PubMed2000

Self-management education and regular practitioner review for adults with asthma.

BACKGROUND: A key component of many asthma management guidelines is the recommendation for patient education and regular medical review. A number of controlled trials have been conducted to measure the effectiveness of asthma education programmes. These programmes improve patient knowledge, but their impact on health outcomes is less well established. This review was conducted to examine the strength of evidence supporting Step 6 of the Australian Asthma Management Plan: "Educate and Review Regularly"; to test whether health outcomes are influenced by education and self-management programmes. OBJECTIVES: The objective of this review was to assess the effects of asthma self-management programmes, when coupled with regular health practitioner review, on health outcomes in adults with asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and reference lists of articles. SELECTION CRITERIA: Randomised trials of self-management education in adults over 16 years of age with asthma. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. MAIN RESULTS: Twenty-five trials were included. Self-management education was compared with usual care in 22 studies. Self-management education reduced hospitalisations (odds ratio 0.57, 95% confidence interval 0.38 to 0.88); emergency room visits (odds ratio 0.71, 95% confidence interval (0.57 to 0.90); unscheduled visits to the doctor (odds ratio 0.57, 95% confidence interval 0.40 to 0.82); days off work or school (odds ratio 0.55, 95% confidence interval 0.38 to 0. 79); and nocturnal asthma (odds ratio 0.53, 95% confidence interval 0.39 to 0.72). Measures of lung function were little changed. Self-management programmes that involved a written action plan showed a greater reduction in hospitalisation than those that did not (odds ratio 0.35, 95% confidence interval 0.18 to 0.68). People who managed their asthma by self-adjustment of their medications using an individualised written plan had better lung function than those whose medications were adjusted by a doctor. REVIEWER'S CONCLUSIONS: Training in asthma self-management which involves self-monitoring by either peak expiratory flow or symptoms, coupled with regular medical review and a written action plan appears to improve health outcomes for adults with asthma. Training programmes which enable people to adjust their medication using a written action plan appear to be more effective than other forms of asthma self-management.

Adult↗
PubMed2001

A critical review of reviews on the treatment of chronic low back pain.

STUDY DESIGN: Systematic literature review. OBJECTIVE: To critically appraise the methodology of systematic reviews of conservative therapies for chronic nonspecific low back pain and to study the relation between the methodologic quality and other characteristics of these reviews. SUMMARY OF BACKGROUND DATA: Systematic reviews offer a concise summary of the evidence on treatment effectiveness, but flaws in their methodology can lead to invalid conclusions with serious implications for quality of patient care. METHODS: Searches of MEDLINE, EMBASE, Psychinfo, and the Cochrane Library were conducted. Titles, abstracts, and articles were reviewed by two blinded authors using three inclusion criteria: 1) chronic nonspecific low back pain, 2) systematic review, and 3) conservative treatment intervention. Data were extracted from each review by three authors. RESULTS: The search strategy retrieved 1102 titles and abstracts; 109 met inclusion criteria. A review of the full text of these articles excluded an additional 73 articles. Data abstraction and methodologic assessment were conducted on 36 articles reviewing 19 discrete interventions. The average quality score was 4.1, ranging from 1 (low) to 7 (high). There was a trend for recent reviews to be of higher quality. Fifty-six percent of the reviews had positive conclusions, but they had lower quality scores compared with those that had negative or uncertain conclusions. There were 27 (73%) qualitative and 10 (27%) quantitative summaries of results. CONCLUSIONS: Although the overall quality of systematic reviews was satisfactory, the quality of the individual papers included in the reviews varied considerably. The reviews often provided contradictory evidence on the effectiveness of a wide range of commonly used conservative interventions for chronic nonspecific low back pain. These findings illustrate the pitfalls of systematic reviews where there are a number of low-quality trials and underscore the need for high-quality primary trials that will allow for more conclusive reviews.

Adolescent↗
PubMed2004

The effectiveness of public health nursing: the problems and solutions in carrying out a review of systematic reviews.

BACKGROUND: In 1999 the Scottish Office, United Kingdom, intimated that the Chief Nursing Officer would undertake a policy review of nurses' contribution to improving the public's health. The importance of reviewing the scientific literature on the effectiveness of public health nursing was recognized as a crucial part of the policy review. A final report was expected within a 6-month period. The reason for the short time period was to fit the policy-making schedule. This paper discusses our literature review for this work. AIMS: The aim was to conduct a review of the international scientific literature that gave the greatest coverage of the role and potential role of nurses in improving the public's health in relation to 14 major health topics. This paper describes the methods used, outlines the rationale underpinning the methods, discusses the problems encountered and offers solutions to some of these problems. METHODS: The initial search for relevant scientific literature revealed 709 suitable primary papers. Reviewing this number was beyond the time limit set by the funding organization. Therefore, a decision was made to concentrate on the evidence contained in systematic reviews. Reviewing systematic reviews raises a number of methodological problems to which there are often no predetermined solutions, such as ensuring that important interventions are included, assessing the relevance and quality of the reviews, and grading the strength of the evidence. DISCUSSION: Reviewing systematic reviews provides the scope to increase the number of topics that might be covered. However, it is possible that a number of interventions may be missed, particularly those that are not subject to review or those assessed using qualitative techniques. The definition of public health nursing used in the present study was also restrictive, and could be widened to include community interventions. Finally, assessing the quality of reviews and grading the evidence proved difficult and there is lack of consensus on how these tasks should be achieved. Nevertheless, the review presented policy makers with accessible information on a large number of relevant international studies.

Delivery of Health Care↗
PubMed2006

A review of methodological quality of systematic reviews on multiple pregnancies.

We set out to determine the quality of existing systematic reviews on multiple pregnancies. We conducted an electronic search in MEDLINE (1951 - 2005), EMBASE (1974 - 2005) and the Cochrane Database for Systematic reviews (2005:2) and a hand-search of reference lists without any language restrictions to identify relevant reviews. Two reviewers independently selected review articles in which a publicly available database was searched for studies concerning multiple pregnancies, and assessed them for quality of methods of review. Information was extracted on framing of question, literature search and data synthesis. Of 342 citations 14 (4%) eligible reviews were identified. Only 8/14 reviews specified the review question. Adequate literature search without language restriction and the use of a reference list was found in 7/14 reviews, but the risk of missing studies was assessed in only 1/14 reviews. Quality assessment of included studies was reported in 7/14 and tabulation of their findings was reported in 8/14 reviews, but heterogeneity of results was evaluated in only 4/14 reviews. Meta-analysis was employed in 3/14 reviews. Systematic reviews of existing studies on multiple pregnancies are infrequent and it is difficult to generate robust inferences from them as they lack good methodology.

Bibliometrics↗
PubMed2002

Author perception of peer review: impact of review quality and acceptance on satisfaction.

CONTEXT: To determine author perception of peer review and association between quality of review and author satisfaction. METHODS: Survey between May 1999 and October 2000 of 897 corresponding authors of manuscripts under consideration by the Annals of Emergency Medicine and had received final editorial decisions during the study period. A total of 576 authors (64%) returned the survey. Using a 5-point Likert scale, the survey assessed differences in satisfaction between authors whose manuscripts were accepted, reviewed and rejected, and rejected without full review. The association of author satisfaction with editor's assessment of review quality, publication decision, author sex, specialty, and publication experience were also assessed. RESULTS: Overall mean (SD) satisfaction score, indicated by agreement with "My experience with the review process will make me more likely to submit to Annals in the future," was 3.1 (1.0) and was significantly higher among authors of accepted papers (3.7 [0.9]) than among either group of rejected papers (rejected/reviewed, 2.8 [1.0]; rejected/no review, 3.0 [0.9]; P.05). Authors whose manuscripts were reviewed and rejected were the least satisfied with the time to decision (rejected/reviewed, 3.0 [1.2] vs accepted, 3.7 [1.0] and rejected/no review, 3.9 [0.9]; P<.05). Those whose papers were rejected without review were the least satisfied with the letter explaining the editorial decision (rejected/no review, 2.8 [1.2] vs accepted, 4.2 [0.7] and rejected/reviewed, 3.1 [1.2]; P<.05). Among respondents whose manuscripts underwent full review (accepted and rejected/reviewed), overall satisfaction was highly associated with acceptance of the manuscript for publication (odds ratio [OR], 6.12; 95% confidence interval [CI], 3.43-10.91) but not with quality rating of reviews (OR, 1.26; 95% CI, 0.84-1.90). CONCLUSION: Contributor satisfaction with peer review was modest. Authors of rejected manuscripts were dissatisfied with the time to decision and communication from the editor. Author satisfaction is associated with acceptance but not with review quality.

Authorship↗
PubMed1998

Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals.

CONTEXT: Review articles are important sources of information to help guide decisions by clinicians, patients, and other decision makers. Ideally, reviews should include strategies to minimize bias and to maximize precision and be reported so explicitly that any interested reader would be able to replicate them. OBJECTIVE: To compare the methodological and reporting aspects of systematic reviews and meta-analyses published by the Cochrane Collaboration with those published in paper-based journals indexed in MEDLINE. DATA SOURCES: The Cochrane Library, issue 2 of 1995, and a search of MEDLINE restricted to 1995. STUDY SELECTION: All 36 completed reviews published in the Cochrane Database of Systematic Reviews and a randomly selected sample of 39 meta-analyses or systematic reviews published in journals indexed by MEDLINE in 1995. DATA EXTRACTION: Number of authors, trials, and patients; trial sources; inclusion and exclusion criteria; language restrictions; primary outcome; trial quality assessment; heterogeneity testing; and effect estimates. Updating by 1997 was evaluated. RESULTS: Reviews found in MEDLINE included more authors (median, 3 vs 2; P<.001), more trials (median, 13.5 vs 5; P<.001), and more patients (median, 1280 vs 528; P<.001) than Cochrane reviews. More Cochrane reviews, however, included a description of the inclusion and exclusion criteria (35/36 vs 18/39; P<.001) and assessed trial quality (36/36 vs 12/39; P<.001). No Cochrane reviews had language restrictions (0/36 vs 7/39; P<.01). There were no differences in sources of trials, heterogeneity testing, or description of effect estimates. By June 1997, 18 of 36 Cochrane reviews had been updated vs 1 of 39 reviews listed in MEDLINE. CONCLUSIONS: Cochrane reviews appear to have greater methodological rigor and are more frequently updated than systematic reviews or meta-analyses published in paper-based journals.

Meta-Analysis as Topic↗
PubMedDate not supplied

Systematic review of 10 years of systematic reviews in prosthodontics.

PURPOSE: The objective was to make an inventory of systematic reviews in the field of prosthodontics and to assess the strength of evidence yielded by these studies. MATERIALS AND METHODS: The literature was searched using MEDLINE (keywords "dental" in subset combined with "meta-analysis" in publication type, and "dental" in subset combined with "systematic review"). Reviews related to prosthodontics were selected by hand. Analogies between the reviewing processes were assessed, and the quality was described. RESULTS: There were 138 articles qualifying as either systematic reviews or meta-analyses. Of these, 13 reported pooled data on prosthodontic subjects. Two pairs of reviews were identified as dealing with comparable items; the others described all different subjects. In one pair, the studies reviewed the survival of conventional fixed partial dentures (FPD); the other pair was on single-tooth implants. The pooled results within each pair were almost equal. For the FPD reviews, 65% of the unity of studies was included in both reviews. For the single-tooth implants, 29% of the potentially useful studies were included in both reviews. The data pooling processes showed the same pattern. One large study included in both reviews explained a large part of the similarity of the combined survivals of FPDs. For the single-tooth implant reviews, the largest common study explained 20% of the similarity. CONCLUSION: Although there were methodologic differences between the paired reviews, they produced similar results. The outcomes of the evaluated reviews may be used as prognostic data; however, they cannot be used for direct comparison of treatments.

Dental Implants, Single-Tooth↗
PubMed2000

Discussion between reviewers does not improve reliability of peer review of hospital quality.

OBJECTIVES: Peer review is used to make final judgments about quality of care in many quality assurance activities. To overcome the low reliability of peer review, discussion between several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability. The authors assessed the impact of discussion between 2 reviewers on the reliability of peer review. METHODS: A group of 13 board-certified physicians completed a total of 741 structured implicit record reviews of 95 records for patients who experienced severe adverse events related to laboratory abnormalities while in the hospital (hypokalemia, hyperkalemia, renal failure, hyponatremia, and digoxin toxicity). They independently assessed the degree to which each adverse event was caused by medical care and the quality of the care leading up to the adverse event. Working in pairs, they then discussed differences of opinion, clarified factual discrepancies, and rerated the record. The authors compared the reliability of each measure before and after discussion, and between and within pairs of reviewers, using the intraclass correlation coefficient for continuous ratings and the kappa statistic for a dichotomized rating. RESULTS: The assessment of whether the laboratory abnormality was iatrogenic had a reliability of 0.46 before discussion and 0.71 after discussion between paired reviewers, indicating considerably improved agreement between the members of a pair. However, across reviewer pairs, the reviewer reliability was 0.36 before discussion and 0.40 after discussion. Similarly, for the rating of overall quality of care, reliability of physician review went from 0.35 before discussion to 0.58 after discussion as assessed by pair. However, across pairs the reliability increased only from 0.14 to 0.17. Even for prediscussion ratings, reliability was substantially higher between 2 members of a pair than across pairs, suggesting that reviewers who work in pairs learn to be more consistent with each other even before discussion, but this consistency also did not improve overall reliability across pairs. CONCLUSIONS: When 2 physicians discuss a record that they are reviewing, it substantially improves the agreement between those 2 physicians. However, this improvement is illusory, as discussion does not improve the overall reliability as assessed by examining the reliability between physicians who were part of different discussions. This finding may also have implications with regard to how disagreements are resolved on consensus panels, guideline committees, and reviews of literature quality for meta-analyses.

Causality↗
PubMed2003

An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: resolving the discrepancy between systematic reviews.

OBJECTIVES: A Cochrane systematic review on the efficacy of Helicobacter pylori (H. pylori) eradication therapy in nonulcer dyspepsia concluded that this intervention had a small but statistically significant effect in curing symptoms. A systematic review in the Annals of Internal Medicine suggested that there was no statistically significant effect of H. pylori eradication therapy on nonulcer dyspepsia symptoms. We updated the Cochrane review and explored reasons for these discrepant results. METHODS: In our update of the Cochrane review we included randomized controlled trials evaluating H. pylori eradication in nonulcer dyspepsia published up to September, 2002. A statistician and the lead author of two negative randomized controlled trials explored reasons for the differences between the Cochrane and Annals systematic reviews according to the review methodology, data analyzed, and statistical methods. Sensitivity analyses were undertaken to evaluate which differences had an impact on the review conclusions. RESULTS: The updated review identified 12 trials evaluating H. pylori eradication versus placebo antibiotics in 2903 patients. H. pylori eradication reduced nonulcer dyspepsia (nonulcer dyspepsia relative risk = 0.91; 95% CI = 0.86-0.95). We identified five differences in methodology between the Cochrane and Annals reviews. The Annals review included all dual, triple, and quadruple H. pylori eradication therapies searched until December, 1999; did not contact authors for further information; included abstracts; and assumed that dropouts were treatment failures. The Cochrane review included only those therapies proved to be successful in eradicating H. pylori; searched until May, 2000; contacted authors for further information; included abstracts only if further information was available; and excluded dropouts from the analysis. Not including trials published in 2000 reduced the number of trials in the review and the number of patients evaluated, changing the conclusions from evidence of benefit to benefit not being proved. The method of statistical analysis did not alter conclusions when all studies were included. CONCLUSIONS: The results of systematic reviews in a rapidly developing field depend on inclusion of all relevant studies. There is evidence for a small benefit of eradicating H. pylori in nonulcer dyspepsia, and this is confirmed by updating the Cochrane systematic review.

Anti-Bacterial Agents↗
PubMed1998

Genetic protocols review by Institutional Review Boards at National Cancer Institute-designated cancer centers.

Absent a clear and enforceable national policy on cancer genetic testing and genetic research, the responsibility may currently be on institutional review boards to regulate those activities at their institutions through protocol approval or disapproval. The survey reported here was carried out to gain information on National Cancer Institute-designated cancer center policies governing institutional review board review of genetic protocols and the preparedness of institutional review boards to review genetic protocols. Thirty-five responses (63% response rate) were received, of which 30 were evaluable. Twenty-four responders reported that they believed that there is a need for research that may lead to improved review of genetic research and genetic testing protocols. Only 14 responders felt adequately informed of current and developing issues and legislation relative to genetic testing and research. Seven responders reported that their cancer centers require an institutional review board-approved protocol for genetic testing activities. Five responders reported that their cancer centers have a formal written policy that guides institutional review board review of genetic testing protocols. About half of the responders reported that their cancer centers have no formal written policy that guides institutional review board review of genetic research protocols. Only three responders reported that institutional review board members receive formal training to prepare them to evaluate all of the issues associated with genetic protocols. We conclude that greater effort needs to be made to establish uniform policy governing cancer genetic testing and genetic research and greater effort should be made to prepare institutional review boards formally for the review of genetic-related protocols.

Cancer Care Facilities↗
PubMed2000

Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.

Computer Communication Networks↗
PubMed1996

Improving peer review: alternatives to unstructured judgments by a single reviewer.

BACKGROUND: Peer review, usually involving unstructured judgments by a single peer reviewing medical records, was the backbone of quality management in health care organizations until recent years. Although other approaches to quality management, such as continuous quality improvement, are now being widely adopted, peer review can still play a role in identifying dysfunctional organizational processes and individuals delivering poor care. Given the questionable reliability and validity of peer review as usually practiced, however, a more rigorous and thoughtful approach is needed-with consideration of issues such as the number of peers involved, the nature of their interaction while forming judgments, and the type of assessment instruments they use. MULTIPLE-REVIEWER PROCEDURES: Such procedures include the use of two or more reviewers making their assessments independently, discussion to consensus among reviewers, and committee review. STRUCTURED ASSESSMENT INSTRUMENTS: A number of studies suggest that instruments that carefully guide the reviewer have higher interrater reliability than less structured instruments. IDENTIFICATION OF SYSTEM ISSUES: The focus of peer review can be expanded beyond individual practitioner performance to include assessment of the operational environment in which the clinician functions. For example, one might ask whether any changes in hospital policies or procedures or in administrative or computerized support for clinicians might have improved the care received by a patient. CONCLUSION: The available data and the known limitations of unstructured judgments by a single reviewer justify serious consideration of multiple reviewer procedures and structured assessment instruments, particularly for reviews that have major consequences for patients and practitioners.

Humans↗