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PubMed2005

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

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

Bias↗
PubMed2004

A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression.

Controversy persists regarding the benefit of endoscopic carpal tunnel release compared with open carpal tunnel release for pain, numbness, strength, return to work and function, scar tenderness, and complications. For surgeons, a recommended first source of information on treatment effectiveness is a review of high-methodologic-quality articles. This review of reviews was undertaken to answer this clinical question regarding these outcomes. Cochrane, MEDLINE, EMBASE, CINAHL, and HealthSTAR databases were searched using the key words "endoscopic carpal tunnel," with limits "review or overview" and dates from 1989 to present. Five key journals were hand-searched. Any review with a reference to at least one randomized controlled trial that compared endoscopic carpal tunnel release to open carpal tunnel release was to be included. Two reviewers independently scanned titles and abstracts for potential relevance. Selection as relevant was confirmed through a review of full texts. Disagreements were resolved through discussion and consensus. The selected reviews were assessed for methodologic quality on the basis of the scale of Hoving et al. Of 48 articles initially identified, seven pertinent reviews were selected. Of these seven, three reviews of high methodologic quality concurred that there is no difference between the two techniques in symptom relief and that the evidence is conflicting for return to work and function. The risk of permanent median nerve injury does not differ between the techniques. The reviews indicated that the endoscopic carpal tunnel release technique is worse in terms of reversible nerve injury but superior in terms of grip strength and scar tenderness, at least in short-term follow-up. Several trials have not been incorporated in these reviews and statistical pooling has not been conducted. Further systematic review with meta-analysis may permit more definitive conclusions about the relative effectiveness of these two techniques, particularly with regard to return to work and function.

Carpal Tunnel Syndrome↗
PubMed2004

Peer review at the American Journal of Roentgenology: how reviewer and manuscript characteristics affected editorial decisions on 196 major papers.

OBJECTIVE: The objective of this study was to examine the relative influence of manuscript characteristics and peer-reviewer attributes in the assessment of manuscripts. MATERIALS AND METHODS: Over a 6-month period, all major papers submitted to the American Journal of Roentgenology (AJR) were entered into a database that recorded manuscript characteristics, demographic profiles of reviewers, and the disposition of the manuscript. Manuscript characteristics included reviewer ratings on five scales (rhetoric, structure, science, import, and overall recommendation); the subspecialty class of the paper; the primary imaging technique; and the country of origin. Demographic profiles of the reviewers included age, sex, subspecialty, years of reviewing, academic rank, and practice type. Statistical analysis included correlation analysis, ordinal logistic regression, and analysis of variance. RESULTS: A total of 445 reviews of 196 manuscripts were the work of 335 reviewers. Of the 196 submitted manuscripts, 20 (10.2%) were accepted, 106 (54.1%) were rejected, and 70 (35.7%) were rejected with the opportunity to resubmit. Regarding manuscript characteristics, we found that the country of origin, score on the science scale, and score on the import scale were statistically significant variables for predicting the final disposition of a manuscript. Of the reviewer attributes, we found a statistically significant association between greater reviewer age and also higher academic rank with lower scores on the import scale. Reviewer concordance was higher for structure, science, and overall scores than on the rhetoric and import scores. Greater variability in the overall scoring of papers could be attributed to the reviewer than the manuscript, but both factors combined explain only 23% of the total variability. CONCLUSION: At the AJR, manuscript acceptance was most strongly associated with reviewer scoring of the science and import of a major paper and also with the country of origin. Reviewers who were older and of higher academic rank tended to discount the importance of manuscripts.

Analysis of Variance↗
PubMed1990

Who are the peer reviewers and how much do they review?

To assess the nature and work load of reviewers for the American Journal of Public Health, I surveyed a sample of 276 reviewers in the latter half of 1988, with a 96% response rate. Respondents reported reviewing papers for 274 other journals in 1987, 81% of which were monitored by the Science Citation Index or the Social Science Citation Index. They reviewed most often for The Journal of the American Medical Association (27%), the American Journal of Epidemiology (26%), and the New England Journal of Medicine (23%). The median number of journals for which they reviewed was 3.6, the median of their estimated review time was 2.7 hours, and the weighted average review time (adjusted for number of reviews) was 2.4 hours. The range of review time was broad and inversely related to the number of papers reviewed. Respondents donated an estimated 3360 hours of uncompensated labor to the American Journal of Public Health in 1987, and a total of 6439 hours (26.8 hours per reviewer) to reviewing for all journals. Of the reviewers for the American Journal of Public Health, only 31% were not listed as an author of a source publication in the 1987 Science Citation Index and only 15% were not cited.

Peer Review↗
PubMed2005

WHO non-Hodgkin's lymphoma classification by criterion-based report review followed by targeted pathology review: an effective strategy for epidemiology studies.

In a previous criterion-based pathology report review of 717 cases of non-Hodgkin's lymphoma in an Australian population-based epidemiologic study, a WHO category could be assigned in 91% of cases, but confidence in this classification was high in only 57.5%. Given this lack of confidence, a pathology review was done in a subset of 315 cases, with the aims of assigning a WHO classification category and the corresponding International Classification of Diseases for Oncology, Third Edition code in all cases previously unclassified or classified with low confidence and testing the accuracy of report review in assigning a confident WHO classification. After pathology review, 10 cases were ineligible (not non-Hodgkin's lymphoma, 3.2%) and 99% (301 of 305) of the remainder were assigned a WHO classification, with high confidence in 87% (261 of 301). There was 78% overall agreement between the WHO classification assigned by report review and pathology review, with 92% agreement when there was high confidence in the report review classification and 69% agreement when there was low confidence. Eighteen percent of follicular lymphomas and 23% of diffuse large B-cell lymphomas were reclassified. The pathology review increased the accuracy of WHO classification by an estimated 12.5% in the 694 cases who were still eligible in the study. Although a potential error rate of 7.5% remained, reviewing more cases, or not reviewing any cases classified with high confidence, would have produced only a small change in accuracy. Criterion-based pathology report review of all cases followed by selective pathology review in cases classified with low confidence is recommended as a cost-saving and accurate strategy for pathology review in large epidemiologic studies.

Adult↗
PubMed2006

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

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

Bias↗
PubMed1998

Effect on the quality of peer review of blinding reviewers and asking them to sign their reports: a randomized controlled trial.

CONTEXT: Anxiety about bias, lack of accountability, and poor quality of peer review has led to questions about the imbalance in anonymity between reviewers and authors. OBJECTIVE: To evaluate the effect on the quality of peer review of blinding reviewers to the authors' identities and requiring reviewers to sign their reports. DESIGN: Randomized controlled trial. SETTING: A general medical journal. PARTICIPANTS: A total of 420 reviewers from the journal's database. INTERVENTION: We modified a paper accepted for publication introducing 8 areas of weakness. Reviewers were randomly allocated to 5 groups. Groups 1 and 2 received manuscripts from which the authors' names and affiliations had been removed, while groups 3 and 4 were aware of the authors' identities. Groups 1 and 3 were asked to sign their reports, while groups 2 and 4 were asked to return their reports unsigned. The fifth group was sent the paper in the usual manner of the journal, with authors' identities revealed and a request to comment anonymously. Group 5 differed from group 4 only in that its members were unaware that they were taking part in a study. MAIN OUTCOME MEASURE: The number of weaknesses in the paper that were commented on by the reviewers. RESULTS: Reports were received from 221 reviewers (53%). The mean number of weaknesses commented on was 2 (1.7, 2.1, 1.8, and 1.9 for groups 1, 2, 3, and 4 and 5 combined, respectively). There were no statistically significant differences between groups in their performance. Reviewers who were blinded to authors' dentities were less likely to recommend rejection than those who were aware of the authors' identities (odds ratio, 0.5; 95% confidence interval, 0.3-1.0). CONCLUSIONS: Neither blinding reviewers to the authors and origin of the paper nor requiring them to sign their reports had any effect on rate of detection of errors. Such measures are unlikely to improve the quality of peer review reports.

Authorship↗
PubMed2006

Improving compliance in depression: a systematic review of narrative reviews.

BACKGROUND AND OBJECTIVE: Narrative reviews represent a popular source of information for clinicians, especially where the evidence on a given subject is sparse and analogies from other fields of medicine may help in filling the information gap. Unfortunately, narrative reviews often follow less stringent criteria for information selection and appraisal than systematic reviews, potentially leading to incomplete or biased recommendations. The objective of the present study was to examine the quality of the recommendations provided by narrative reviews on how to improve patient adherence to pharmacological treatment of unipolar depressive disorders. METHOD: We sought to locate all narrative review papers addressing adherence to treatment in unipolar depressive disorders. In order to do so, we searched Medline and PsychInfo from 1980 to December 2003, using the following keywords: review, depressive disorders, treatment, dropout, patient compliance and adherence. We inspected the title and the abstract, whenever available to identify the relevant reviews and obtained a full copy of the publications in this subset, and read the articles to identify further relevant reviews. These were in turn copied and reviewed, until no further references were found. RESULTS AND DISCUSSION: We identified 23 reviews, providing a total of 87 recommendations. The most common recommendation was for patient education (19 times), patient-physician empathy/alliance (14 times), and education of family (nine times). Reviewers' recommendations were based on the literature on depression 54 times, and on other medical conditions 17 times. A critical appraisal of the evidence base of the recommendations showed that randomized controlled trials or meta-analyses were quoted to support the recommendations only 23% of the times, while important interventions of proven efficacy in the field of depression or in other chronic conditions (e.g. medication clinics, training of nurses, psychological treatment, and telephone follow-up) were not mentioned. CONCLUSIONS: Narrative reviews on adherence to pharmacological treatment of depressive disorders suffer not only from the limited availability of good quality evidence, but also from an incomplete critical appraisal of available evidence on interventions both for depression and for other chronic disorders.

Antidepressive Agents↗
PubMed2006

Methodological quality of systematic reviews of animal studies: a survey of reviews of basic research.

BACKGROUND: Systematic reviews can serve as a tool in translation of basic life sciences research from laboratory to human research and healthcare. The extent to which reviews of animal research are systematic and unbiased is not known. METHODS: We searched, without language restrictions, Medline, Embase, bibliographies of known reviews (1996-2004) and contacted experts to identify citations of reviews of basic science literature which, as a minimum, performed search of a publicly available resource. From these we identified reviews of animal studies where laboratory variables were measured or where treatments were administered to live animals to examine their effects, and compared them with reviews of bench studies in which human or animal tissues, cell systems or organ preparations were examined in laboratories to better understand mechanisms of diseases. RESULTS: Systematic reviews of animal studies often lacked methodological features such as specification of a testable hypothesis (9/30, 30%); literature search without language restriction (8/30, 26.6%); assessment of publication bias (5/30, 16.6%), study validity (15/30, 50%) and heterogeneity (10/30, 33.3%); and meta-analysis for quantitative synthesis (12/30, 40%). Compared to reviews of bench studies, they were less prone to bias as they specified the question (96.6% vs. 80%, p = 0.04), searched multiple databases (60% vs. 26.6%, p = 0.01), assessed study quality (50% vs. 20%, p = 0.01), and explored heterogeneity (33.3% vs. 2.2%, p = 0.001) more often. CONCLUSION: There seems to be a gradient of frequency of methodological weaknesses among reviews: Attempted systematic reviews of whole animal research tend to be better than those of bench studies, though compared to systematic reviews of human clinical trials they are apparently poorer. There is a need for rigour when reviewing animal research.

Animal Experimentation↗
PubMed1995

The role of the manuscript reviewer in the peer review process.

Peer review of submitted manuscripts is recognized as a critical component of the publication process in all major medical journals. It lends respectability and scientific credibility to those journals that have adopted the process [1]. This function is delegated to a group of persons who perform the task selflessly and without compensation. Of the many facets of the peer review process, the selection of manuscript reviewers and their subsequent interaction with both editors and authors may be so poorly understood by aspiring authors that certain misconceptions ensue. Authors of rejected manuscripts may fear that reviewers have acted in an arbitrary and possibly censorial fashion [2, 3]. Conversely, authors of accepted manuscripts who face a mountain of revisions may wonder if such an effort is likely to improve their manuscript [4, 5]. The following questions come to mind: Where do the reviewers come from? What do they do, and what constitutes a good reviewer? What power do they have? How is reviewer performance measured? Can the editor recognize publicly the good reviewer? Are reviewers really blinded? How does one become a good reviewer? Who will be the reviewers of the future? While looking at these questions, we should consider objective approaches of assessing reviewer quality and wonder whether they would improve the quality of the published manuscript.

Peer Review, Research↗
PubMed2002

Effects of editorial peer review: a systematic review.

CONTEXT: Editorial peer review is widely used to select submissions to journals for publication and is presumed to improve their usefulness. Sufficient research on peer review has been published to consider a synthesis of its effects. METHODS: To examine the evidence of the effects of editorial peer-review processes in biomedical journals, we conducted electronic and full-text searches of private and public databases to June 2000 and corresponded with the World Association of Medical Editors, European Association of Science Editors, Council of Science Editors, and researchers in the field to locate comparative studies assessing the effects of any stage of the peer-review process that made some attempt to control for confounding. Nineteen of 135 identified studies fulfilled our criteria. Because of the diversity of study questions, methods, and outcomes, we did not pool results. RESULTS: Nine studies considered the effects of concealing reviewer/author identity. Four studies suggested that concealing reviewer or author identity affected review quality (mostly positively); however, methodological limitations make their findings ambiguous, and other studies' results were either negative or inconclusive. One study suggested that a statistical checklist can improve report quality, but another failed to find an effect of publishing another checklist. One study found no evidence that training referees improves performance and another showed increased interrater reliability; both used open designs, making interpretation difficult. Two studies of how journals communicate with reviewers did not demonstrate any effect on review quality. One study failed to show reviewer bias, but the findings may not be generalizable. One nonrandomized study compared the quality of articles published in peer-reviewed vs other journals. Two studies showed that editorial processes make articles more readable and improve the quality of reporting, but the findings may have limited generalizability to other journals. CONCLUSIONS: Editorial peer review, although widely used, is largely untested and its effects are uncertain.

Peer Review, Research↗
PubMed2004

Annual review of patients with sleep apnea/hypopnea syndrome--a pragmatic randomised trial of nurse home visit versus consultant clinic review.

BACKGROUND: This pragmatic randomised, controlled trial investigated annual review of patients with sleep apnea/hypopnea syndrome (SAHS). Clinical outcomes and costs were compared for consultant clinic review versus specialist nurse home visit. METHOD: One hundred and seventy-four patients were randomised to annual review by consultant clinic appointment or by specialist nurse home visit. SAHS symptoms, Epworth score, hospital anxiety and depression scale (HADS), Short Form-36 (SF-36) and hours of use of constant positive airway pressure (CPAP) were measured before and 3 months after review. The costs and patient preference for review were determined. RESULTS: After review, both groups significantly increased CPAP use (mean (SD) increase: nurse, 0.66 (1.71) h; consultant, 0.45 (1.69) h) and reduced symptom scores (nurse, -2 (7); consultant, -3 (9)), compared to baseline. There were no differences between groups in these improvements, or in HADS or SF-36 scores. Average duration of a nurse home visit, excluding travel time, was 26 (6) min. Total NHS cost per visit was 52.26 UK pounds (49.85) ($83.62 (79.76)), of which 6.57 UK pounds (1.43) ($10.51 (2.29)) reflected time spent with the patient and the remainder was travel cost. Average duration of consultant review was 10 (6) min, total NHS cost 6.21 UK pounds (3.99) ($9.94 (6.38)). However, the cost to the patient of attending the clinic was 23.63 UK pounds (23.21) ($37.81 (37.13)). Patient preference for review was nurse 16%, consultant 19%, and no preference 65%. CONCLUSION: Following annual review, use of CPAP increased and symptoms improved. Outcomes were similar for consultant and nurse led review. Home visits were expensive for the healthcare provider, whereas clinic attendance incurred substantial costs to the patient. The majority of patients would accept nurse review for their sleep apnea management.

Annual Reports as Topic↗
PubMed2005

Who benefits from peer review? An analysis of the outcome of 100 requests for review by Plastic and Reconstructive Surgery.

BACKGROUND: Little is known of what is done with the comments on submitted manuscripts provided by peer reviewers or to what extent these comments benefit the editor in deciding to accept or reject the manuscript, the author(s) in revising their manuscript, or the readership at large. Furthermore, nothing is known of any possible benefits of the process to the peer reviewer. Finally, the peer-review process may even be maleficent because of its implicit delay of publication and a possible bias against manuscripts originating from non-Anglo-American countries. METHODS: The authors evaluated the benefits of the peer-review process to authors, editor, readers, and reviewers by a bibliometric analysis of the outcome of 100 requests for review made by the editor of Plastic and Reconstructive Surgery from 1992 through 2003. The publication delay and potential geographical bias were evaluated as potential disadvantages. RESULTS: The authors' reviewer advised acceptance of 56 percent of the manuscripts, and the editor mostly agreed with his advice. This suggests that the editor benefited from the review. The authors addressed 48 to 81 percent of the reviewer's constructive suggestions, and this suggests that they and the readers benefited also. Readers of Plastic and Reconstructive Surgery may further benefit because manuscripts rejected by Plastic and Reconstructive Surgery end up in less prestigious journals. The implicit delay of publication is limited, and the authors found no bias against non-Anglo-American submissions. The cost-effectiveness of the process for the peer reviewer remains unclear. CONCLUSIONS: The peer-review system of Plastic and Reconstructive Surgery, in general, is beneficial.

Bibliometrics↗
PubMed1997

Adherence to prescribed explicit criteria during utilization review. An analysis of communications between attending and reviewing physicians.

CONTEXT: Utilization review (UR) seeks to improve quality and cost-efficiency of health care. However, how well the process works in practice has not been assessed. OBJECTIVE: To describe the outcomes of a sample of physician reviews in terms of the explicit criteria that the UR was designed to implement. DESIGN: Retrospective analysis of transcripts of precertification reviews. PARTICIPANTS AND SETTING: California physicians employed by a UR firm conducted 96 interviews from April 1990 to July 1991 with attending physicians who had proposed to insert tympanostomy tubes on a patient younger than 16 years and whose proposals had been found to be inappropriate on an initial screen. MAIN OUTCOME MEASURES: The appropriateness rating assigned to each case by the physician-reviewer and by the investigators using explicit criteria. Logistic regression identified factors associated with the reviewers' recommendations to perform surgery and with recommendations at variance from the criteria. RESULTS: The reviewers recommended 78% of cases for surgery, of which only 29% were supported by the criteria or had extenuating circumstances. The criteria concurred with all 30 of the reviewers' recommendations against surgery. Two factors, female sex (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.2-53.8) and previous tympanostomy tube insertion (OR, 30.9; 95% CI, 2.4-394.8) were associated with reviewer recommendations in favor of surgery that were at variance from the criteria, despite the lack of evidence for either as a mitigating circumstance. CONCLUSION: Physician reviewers were more lenient than the explicit criteria that the reviews were designed to implement. In no cases did the reviewers depart from the criteria's recommendations in favor of surgery.

California↗
PubMed2026

Effectiveness of exercise-based prehabilitation on pre and postoperative outcomes of patients undergoing cardiac surgery-An umbrella review of systematic reviews.

AIMS: Individuals undergoing cardiac surgery are becoming older, frailer, and less mobile. Prehabilitation has shown to improve postoperative outcomes by optimizing preoperative physical function. This umbrella review aims to pool the systematic reviews assessing the effectiveness of exercise-based prehabilitation in cardiac surgery. METHODS AND RESULTS: The review followed the PRIOR checklist. PubMed, Embase, CINAHL, Cochrane library, Scopus, Web of science, ProQuest NAHD, ProQuest HMC, Open Grey and MedNar were searched using relevant keywords from inception to 16th December, 2024. Two reviewers screened and extracted data from the included reviews and assessed primary study overlap with the corrected covered area. Methodological quality of the reviews was evaluated with the A MeaSurement Tool to Assess systematic Reviews-2 scale. Certainty of evidence was assessed using a previously developed criteria for overview of reviews. Six systematic reviews with 30 unique trials and 6705 participants were included. The interventions assessed included breathing exercises, inspiratory muscle training, and exercise training. Prehabilitation reduced length of hospital stay, postoperative pulmonary complications, and clinically improved functional capacity with a very low to moderate certainty of evidence. However, there was uncertainty regarding the effects pertaining to adverse events and quality of life. The methodological quality of all reviews was critically low. The primary trials scored poorly in the domains of selection and detection bias. CONCLUSION: Exercise-based prehabilitation might reduce length of hospital stay and postoperative complications, and improve functional capacity. However, the quality of evidence is poor, and individual discretion is required before implementing them into practice. REGISTRATION: PROSPERO: CRD42023480100.

Humans↗
PubMed2003

Updated method guidelines for systematic reviews in the cochrane collaboration back review group.

STUDY DESIGN: Descriptive method guidelines. OBJECTIVES: To help reviewers design, conduct, and report reviews of trials in the field of back and neck pain. SUMMARY OF BACKGROUND DATA: In 1997, the Cochrane Collaboration Back Review Group published method guidelines for systematic reviews. Since its publication, new methodologic evidence emerged and more experience was acquired in conducting reviews. METHODS: All reviews and protocols of the Back Review Group were assessed for compliance with the 1997 method guidelines. Also, the most recent version of the Cochrane Handbook (4.1) was checked for new recommendations. In addition, some important topics that were not addressed in the 1997 method guidelines were included (e.g., methods for qualitative analysis, reporting of conclusions, and discussion of clinical relevance of the results). In May 2002, preliminary results were presented and discussed in a workshop. In two rounds, a list of all possible recommendations and the final draft were circulated for comments among the editors of the Back Review Group. RESULTS: The recommendations are divided in five categories: literature search, inclusion criteria, methodologic quality assessment, data extraction, and data analysis. Each recommendation is classified in minimum criteria and further guidance. Additional recommendations are included regarding assessment of clinical relevance, and reporting of results and conclusions. CONCLUSIONS: Systematic reviews need to be conducted as carefully as the trials they report and, to achieve full impact, systematic reviews need to meet high methodologic standards.

Back Pain↗
PubMed1997

Is review of videotape necessary after review of digitized cine-loop images in stress echocardiography? A prospective study in 306 patients.

The interpretation of stress echocardiography has been made easier by the comparison of digitized prestress and poststress frame-grabbed images (cine-loops), each representing a portion of a single cardiac cycle. Often, review of these digitized images is substituted for review of the complete videotape record of the examination. An alternative is to review both the digitized images as well as the videotape record of the rest and stress images. To date, there has been insufficient documentation of whether these options (cine-loop images alone versus cine-loop images plus videotape) provide comparable or additive information. Therefore, we prospectively evaluated information obtained from review of cine-loop images versus combined review of cine-loop images and videotape records in 306 consecutive patients undergoing treadmill (213 patients, 70%) or dobutamine (93 patients, 30%) stress echocardiography. An experienced echocardiologist first reviewed the cine-loop images and scored the wall motion in 16 segments at rest and with stress. Next, the complete videotape record was reviewed with repeated wall motion scoring. A questionnaire comparing cine-loop and videotape images was completed at the end of each review. Digitization of images was technically inadequate in 14 patients (4%). In 116 (40%) of the other 292 patients, the regional wall motion assessment, after relying solely on cine-loop images, was modified with subsequent videotape review. In 40 patients (14%), these modifications resulted in a change in the final impression regarding whether the study result was normal or abnormal. In a multivariate analysis, age, gender, and type of stress echocardiography had no significant influence on discordance of the cine-loop image and combined cine-loop and video information. Stepwise logistic regression analysis identified poorer image quality (p < 0.0001) and regional wall motion abnormalities (p < 0.0001) as predictors of discordance between cine-loop and combined review. We conclude that relying solely on digitized cine-loop images representing a single cardiac cycle is not optimal, especially if the quality of the digitized images is suboptimal and if regional wall motion abnormalities are present. Thus we recommend a combined review of both cine-loop images and videotape images in the interpretation of stress echocardiography.

Aged↗