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PubMed2004

Availability of large-scale evidence on specific harms from systematic reviews of randomized trials.

PURPOSE: To assess how frequently systematic reviews of randomized controlled trials convey large-scale evidence on specific, well-defined adverse events. METHODS: We searched the Cochrane Database of Systematic Reviews for reviews containing quantitative data on specific, well-defined harms for at least 4000 randomized subjects, the minimum sample required for adequate power to detect an adverse event due to an intervention in 1% of subjects. Main outcome measures included the number of reviews with eligible large-scale data on adverse events, the number of ineligible reviews, and the magnitude of recorded harms (absolute risk, relative risk) based on large-scale evidence. RESULTS: Of 1727 reviews, 138 included evidence on > or =4000 subjects. Only 25 (18%) had eligible data on adverse events, while 77 had no harms data, and 36 had data on harms that were nonspecific or pertained to <4000 subjects. Of 66 specific adverse events for which there were adequate data in the 25 eligible reviews, 25 showed statistically significant differences between comparison arms; most pertained to serious or severe adverse events and absolute risk differences <4%. In 29% (9/31) of a sample of large trials in reviews with poor reporting of harms, specific harms were presented adequately in the trial reports but were not included in the systematic reviews. CONCLUSION: Systematic reviews can convey useful large-scale information on adverse events. Acknowledging the importance and difficulties of studying harms, reporting of adverse effects must be improved in both randomized trials and systematic reviews.

Humans↗

PubMed2003

Cochrane neonatal systematic reviews: a survey of the evidence for neonatal therapies.

A survey is reported of 113 systematic reviews of therapies in neonatology, based on 559 eligible randomized trials in total. These reviews were prepared by the CNRG and were published in the Cochrane Library, Issue 3,2001. The median number of included trials per review was 3 (range 0 to 32) and participants 207 (range 0 to 5460). Among 90 reviews with a categorical primary outcome, the median number of outcome events per review was 54 (range 1 to 1284). Among reviews finding a statistically significant benefit of treatment, the effect size was large (median relative risk 0.55, range 0.09 to 0.93). Reviews of surfactant for prevention and treatment of respiratory distress syndrome were able to detect moderate-sized treatment effects (median relative risk 0.85) because of the large number and size of trials in this field. Among many reviews finding no evidence of treatment effect, large and potentially important benefits or harms could not be excluded. Most CNRG reviews were current. There is a continuing need to prepare systematic review of therapies not yet covered and to keep an increasing number of reviews up-to-date.

Bibliometrics↗

PubMedDate not supplied

Air medical transport utilization review in North Carolina.

OBJECTIVE: To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN: Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING: All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS: All available flight records for November and December 1989. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS: Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.

Aircraft↗

PubMed2002

Autopsies in trauma do not add to peer review or quality assurance.

OBJECTIVES: The literature supports the concept that autopsies are useful in uncovering missed injuries or undiagnosed conditions that contribute to death after injury, especially late deaths that take place in the intensive care unit. Review of autopsies are also used as part of the trauma quality assurance (QA) process, and autopsy rates are queried by the American College of Surgeons Committee on Trauma in their reviews. Our hypothesis was that autopsies add little useful clinical or diagnostic information compared with QA peer review analysis in a mature trauma program. METHODS: Autopsies for all mortalities at a Level I trauma center between January 1998 and October 1999 were reviewed. The autopsies were reviewed in a "blinded" fashion such that each review occurred before examination of the chart, the trauma registry, and the findings of the trauma QA peer review. Findings from all sources were compared and examined for Goldman type errors (I-IV). RESULTS: Two hundred sixty-three mortalities were identified, with 216 autopsies reviewed. One hundred two (39%) mortalities were considered dead on arrival to the trauma center by QA review, with no management errors identified (group 1) (Immediate Death group). Sixty-one patients survived more than 48 hours after injury (group 2). One hundred sixty-one (61%) patients were admitted to the hospital. Ninety-nine patients died within 48 hours (Early Death group) and 62 died between 2 and 143 days (Late Death group). There were no Goldman type I errors (major diagnostic discrepancies that might have influenced mortality) identified in either group. Autopsy data did uncover one potentially technical error in a death that was considered nonpreventable on peer review analysis. CONCLUSION: We conclude that autopsy information for either group appeared to add little useful information to the QA peer review of deaths in a mature trauma program. This was true even in cases where the final QA determination was held pending the results of the autopsy. Autopsy rates may not be a useful parameter in evaluating a trauma QA program.

Adult↗

PubMed2006

Pharmacist-supported medication review training for general practitioners: feasibility and acceptability.

OBJECTIVES: To investigate the feasibility and acceptability of training for general practitioners (GPs) in medication review provided by practice pharmacists. METHODS: Within the setting of a Scottish Local Health Care Co-operative incorporating 17 general practices, practice pharmacists delivered a 1-hour practice-based group training session to interested GPs, covering a systematic approach to medication review and case studies. One session of funded locum cover was provided for each GP to review up to 6 patients of his or her choice. Practice pharmacists and GPs reviewed patient notes together before GPs saw patients alone. Subsequently pharmacists abstracted data from medical records. Medication-related issues identified during reviews and resultant actions were categorised. The views of GPs on the training were obtained by postal questionnaires. RESULTS: Training was received by 51/74 GPs from 10/17 practices. In 174 reviews analysed, differences in patient medication use from computer records, ineffective medication and missing computer diagnoses were identified most frequently. There was a median of 5 actions per patient, including a median of 2 changes in prescribed drugs. Only 3 reviews resulted in no actions, while 80% of patients had at least 1 prescribing record change. A total of 27 (61%) GPs returned questionnaires; most considered medication review important and were satisfied with the training. Confidence in conducting reviews increased in 14 (52%) GPs. Many indicated they would increase reviews, but time was a barrier for almost all. Although few considered contract or accreditation to be motivating factors, most agreed the training would help them achieve standards for both. CONCLUSIONS: Training by pharmacists was feasible and acceptable, but time constraints may limit the translation of reviews into routine practice.

Attitude of Health Personnel↗

PubMed2003

How to review a paper.

Most scientists acquire their training in manuscript review not through instruction but by actually doing it. Formal training in manuscript analysis is rarely, if ever, provided. Editors usually choose reviewers because of expertise in a given subject area and availability. If an individual repeatedly submits bad reviews, it is likely that that person will not be asked to review a manuscript again. Being invited to review a manuscript is an honor, not only because you are being recognized for your eminence in a particular area of research but also because of the responsibility and service you provide to the journal and scientific community. The purpose of this article is to define how best to peer review an article. We will stipulate several principles of peer review and discuss some of the main elements of a good manuscript review, the basic responsibilities of a reviewer, and the rewards and responsibilities that accompany this process. Proper reviewer conduct is essential for making the peer review process valuable and the journal trustworthy.

Humans↗

PubMed1990

Assessing peer review in the quest for improved medical services and the implications for education in quality assessment: Part IV.

Three court decisions reviewing medical peer review conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning medical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion. Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals. The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the relative lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer review; and (4) to describe the changes that should be anticipated in review of medical services in the future. Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Bias↗

PubMed2002

Reporting of measures of accuracy in systematic reviews of diagnostic literature.

BACKGROUND: There are a variety of ways in which accuracy of clinical tests can be summarised in systematic reviews. Variation in reporting of summary measures has only been assessed in a small survey restricted to meta-analyses of screening studies found in a single database. Therefore, we performed this study to assess the measures of accuracy used for reporting results of primary studies as well as their meta-analysis in systematic reviews of test accuracy studies. METHODS: Relevant reviews on test accuracy were selected from the Database of Abstracts of Reviews of Effectiveness (1994-2000), which electronically searches seven bibliographic databases and manually searches key resources. The structured abstracts of these reviews were screened and information on accuracy measures was extracted from the full texts of 90 relevant reviews, 60 of which used meta-analysis. RESULTS: Sensitivity or specificity was used for reporting the results of primary studies in 65/90 (72%) reviews, predictive values in 26/90 (28%), and likelihood ratios in 20/90 (22%). For meta-analysis, pooled sensitivity or specificity was used in 35/60 (58%) reviews, pooled predictive values in 11/60 (18%), pooled likelihood ratios in 13/60 (22%), and pooled diagnostic odds ratio in 5/60 (8%). Summary ROC was used in 44/60 (73%) of the meta-analyses. There were no significant differences in measures of test accuracy among reviews published earlier (1994-97) and those published later (1998-2000). CONCLUSIONS: There is considerable variation in ways of reporting and summarising results of test accuracy studies in systematic reviews. There is a need for consensus about the best ways of reporting results of test accuracy studies in reviews.

Bias↗

PubMed2004

Population-based medication reviews: a descriptive analysis of the medication issues identified in a medicare not-for-profit prescription discount program.

BACKGROUND: Medication reviews may be an important strategy to improve medication use, especially for individuals receiving many drugs. OBJECTIVE: To describe the types of medication issues and recommendations identified in the Iowa Priority Brown Bag Medication Reviews, compare individuals with medication issues with those without medication issues, and describe Iowa Priority enrollees' experiences with and satisfaction of the review. METHODS: A retrospective review of enrollment forms and medication review records and a survey of Iowa Priority members were conducted in 2002. Subjects were Medicare-eligible individuals who joined the Iowa Priority Prescription Savings Program. Frequency distributions and descriptive statistics were calculated. Analysis using t-test and chi(2) test determined differences between individuals with and without issues regarding use of drug therapy. RESULTS: Almost 13% of Iowa Priority enrollees received a review. There were 1167 individuals with 2123 medication issues identified. Nonprescription medications accounted for one-third of drug interactions and >40% of duplications. People with issues had poorer health, more chronic conditions, and took more drugs than people without medication issues. One-third of survey respondents discussed the review with their physicians, and 17.7% reported medication changes. Satisfaction with the review was good; however, only 24% were likely to have received an annual review. CONCLUSIONS: Iowa Priority Brown Bag Medication Reviews showed that individuals with fair/poor health, higher numbers of medications, and more chronic conditions were likely to have medication issues. Reviews generated discussions between physicians and patients, produced some medication changes, and helped individuals save money.

Aged↗

PubMed1991

How blind is blind review?

BACKGROUND: No representative surveys of scientific opinion about blind review have been published, and there is very little information on the success of the blinding process. The American Journal of Public Health has practiced blind review since 1977. METHODS: In 1989 to 1990 312 of its reviewers were asked to identify author and institution in the manuscript they reviewed, to provide clues to such identification, to express their opinion concerning blind review, and to offer reasons for their opinion. RESULTS: Reviewers claimed to be able to identify author and/or institution in 47% of the 614 chances offered; identification was incorrect 16% of the time, overall identification correct 39% of the time. Self-referencing was the clue to identification in 62%, personal knowledge in 38% of the cases. If only personal knowledge cases are considered, blinding was successful 83% of the time. Blinding was favored by 75% of the reviewers with most asserting it eliminated bias. Reasons given for opposing blind review included the following: blinding not possible, identification will not influence judgment, and its obverse, identification assists judgment. CONCLUSIONS: For the American Journal of Public Health blinding is usually, but not always, successful; and the majority of its reviewers favor current policy. Until more definitive data are in, reviewer preference, which differs from journal to journal, seems the most legitimate guide to journal policy on blind review.

Attitude of Health Personnel↗

PubMed2006

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model.

OBJECTIVES: To determine the diagnostic accuracy of tests for detecting urinary tract infection (UTI) in children under 5 years of age and to evaluate the effectiveness of tests used to investigate further children with confirmed UTI. Also, to evaluate the effectiveness of following up children with UTI and the cost-effectiveness of diagnostic and imaging tests for the diagnosis and follow-up of UTI in children under 5. An additional objective was to develop a preliminary diagnostic algorithm for healthcare professionals. DATA SOURCES: Electronic databases were searched up to the end of 2002/early 2003. Consultation with experts in the field. REVIEW METHODS: A systematic review was undertaken using published guidelines and results were analysed according to test grouping: diagnosis of UTI and further investigation of UTI. The cost-effectiveness results from existing evaluations were synthesised. A separate cost-effectiveness model was developed using the best available evidence, in part derived from the results of the systematic review, to illustrate the potential cost-effectiveness of some alternative management strategies in a UK setting. The results of the systematic review were used to propose diagnostic algorithms for the diagnosis and further investigation of UTI in children. Economic analyses did not contribute directly to the development of these algorithms. RESULTS: The studies included in the review provided very little data on the accuracy of clinical investigations for the diagnosis of UTI, and criteria for clinical suspicion of UTI were not further defined. The majority of studies included in the review found that clean voided midstream urine (CVU) samples had similar accuracy to suprapubic aspiration (SPA) samples when cultured with the advantage of being a non-invasive collection method that can be used in the GP's surgery. Pad, nappy or bag specimens may be appropriate methods for obtaining a urine sample in non-toilet-trained children, although only limited data were available. Although the glucose test was reported to have the highest accuracy in terms of both ruling in and ruling out disease, only a limited number of studies of this test were included and these were conducted over 30 years ago. Dipstick tests are easy to perform in the GP's surgery, give an immediate result and are relatively cheap. The results of the systematic review showed that a dipstick for leucocyte esterase (LE) and nitrite, where both test results are interpreted in combination, was a good test both for ruling in (both positive) and ruling out (both negative) a UTI. A dipstick positive for either LE or nitrite and negative for the other provides inconclusive diagnostic information and further testing is therefore required in these patients. Microscopy is more time consuming and expensive to perform than a dipstick test, but potentially quicker and cheaper than culture. As with dipstick tests, a combination of microscopy for pyuria and bacteriuria can be used accurately to rule in and rule out a UTI. An indeterminate test result is again obtained if microscopy is positive for either pyuria or bacteriuria, and negative for the other. Confirmatory culture is required in these patients. In patients considered to have a UTI, further culture to determine antibiotic sensitivities may be an option to inform treatment decisions. Only one study satisfied the inclusion criteria of the economic review and the review highlighted a number of potential limitations of this study for NHS decision-making. A separate decision-analytic model was therefore developed to provide a more reliable estimate of the optimal strategy regarding the diagnosis and further investigation of children under 5 with suspected UTI from the perspective of the NHS. The economic model found that the optimal diagnostic strategy for children presenting with symptoms suggestive of UTI depends on a number of key factors. These included the relevant subgroup of children concerned, in terms of gender and age, and the health service's maximum willingness to pay for an additional quality-adjusted life-year. CONCLUSIONS: The results of the systematic review were used to derive an algorithm for the diagnosis of UTI in children under 5. This algorithm represents the conclusions of the review in terms of effective practice. There were insufficient data to propose an algorithm for the further investigation of UTI in children under 5. The quality assessment highlighted several areas that could be improved upon in future diagnostic accuracy studies.

Algorithms↗

PubMed2001

Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature.

BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are common diseases of the airways and lungs that have a major impact on the health of the population. The mainstay of treatment is by inhalation of medication to the site of the disease process. This can be achieved by a number of different device types, which have wide variations in costs to the health service. A number of different inhalation devices are available. The pressurised metered-dose inhaler (pMDI) is the most commonly used and cheapest device, which may also be used in conjunction with a spacer device. Newer chlorofluorocarbons (CFC)-free inhaler devices using hydrofluoroalkanes (HFAs) have also been developed. The drug is dissolved or suspended in the propellant under pressure. When activated, a valve system releases a metered volume of drug and propellant. Other devices include breath-actuated pMDIs (BA-pMDI), such as Autohaler and Easi-Breathe. They incorporate a mechanism activated during inhalation that triggers the metered-dose inhaler. Dry powder inhalers (DPI), such as Turbohaler, Diskhaler, Accuhaler and Rotahaler, are activated by inspiration by the patient. The powdered drug is dispersed into particles by the inspiration. With nebulisers oxygen, compressed air, or ultrasonic power is used to break up solutions or suspensions of medication into droplets for inhalation. The aerosol is administered by mask or by a mouthpiece. There has been no previous systematic review of the evidence of clinical effectiveness and cost-effectiveness of these different inhaler devices. OBJECTIVES: To review systematically the clinical effectiveness and cost-effectiveness of inhaler devices in asthma and COPD. METHODS: The different aspects of inhaler devices were separated into the most clinically relevant comparisons. Methods involved systematic searching of electronic databases and bibliographies for randomised controlled trials (RCTs) and systematic reviews. Pharmaceutical companies and experts in the field were contacted for further information. Trials that met the inclusion criteria were appraised and data extraction was under-taken by one reviewer and checked by a second reviewer, with any discrepancies being resolved through agreement. RESULTS--IN VITRO CHARACTERISTICS VERSUS IN VIVO TESTING AND CLINICAL RESPONSE: There is evidence that when comparative testing is performed on inhaler devices using the same methods, there is some correlation between particle size measurements and clinical response. However, the measurements are dependent upon the methods used, and a single measure of a device in isolation is of limited value. Also, there is little data on comparing devices of different types. There is currently insufficient data to verify the ability of in vitro assessments to predict inhaler performance in vivo. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF CORTICOSTEROIDS IN ASTHMA: The review of three trials in children and 21 trials in adults demonstrated no evidence to suggest clinical benefits of any other inhaler device over a pMDI in corticosteroid delivery. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF BETA-AGONISTS IN STABLE ASTHMA: In children, 11 studies were reviewed, of which seven compared the Turbohaler with the pMDI. One study found a significant treatment difference in peak expiratory flow rate, although there were differences in the patients' baseline characteristics. In adults, a review of 70 studies found no demonstrable difference in the clinical bronchodilator effect of short-acting b2-agonists delivered by the standard pMDI compared with that produced by any other DPI, HFA-pMDI or the Autohaler device. The finding that HFA-pMDIs may reduce treatment failure and oral steroid requirement in beta-agonist delivery needs further confirmatory research in adequately randomised clinical trials. RESULTS--EFFECTIVENESS OF NEBULISERS VERSUS METERED-DOSE INHALERS FOR THE DELIVERY OF BRONCHODILATORS IN STABLE ASTHMA: In children, three included trials compared different devices with a nebuliser and demonstrated no evidence of clinical superiority of nebulisers over inhaler devices in bronchodilator delivery. A total of 23 studies in adults found no equivalence for the main pulmonary outcomes and no evidence of difference in other outcomes. RESULTS--EFFECTIVENESS OF METERED-DOSE INHALERS FOR THE DELIVERY OF BETA-AGONISTS IN COPD: Only two studies were included in this review. No evidence of clinical difference was found in beta-agonist delivery. RESULTS--EFFECTIVENESS OF NEBULISERS VERSUS METERED-DOSE INHALERS FOR THE DELIVERY OF BRONCHODILATORS IN COPD: Evidence from 14 trials demonstrated equivalence for the main outcomes of pulmonary function. For other outcomes there was no evidence of treatment difference in bronchodilator delivery. RESULTS--PATIENTS' ABILITY TO USE METERED-DOSE INHALERS: Differences among studies and the heterogeneity of the results make it difficult to draw conclusions about inhaler technique differences between device types. The review of technique after teaching the correct technique suggests that there is no difference in patients' ability to use DPI or pMDIs. RESULTS--ECONOMIC ANALYSIS: The total number of NHS prescriptions for inhaler therapy for asthma in 1998 was over 31 million, with a net ingredient cost in excess of 392 million GB pounds. This economic assessment uses decision analysis to estimate the relative cost-effectiveness of inhaler devices for the delivery of bronchodilator and corticosteroid inhaled therapy. Overall, there were no differences in patient outcomes among the devices. On the assumption that the devices were clinically equivalent, pMDIs were the most cost-effective devices for asthma treatment. CONCLUSIONS: This systematic review examined the evidence from clinical trials evaluating the clinical effectiveness of different inhaler devices in the delivery of inhaled corticosteroids and beta2-bronchodilators for patients with asthma and COPD. The evidence from the published clinical literature demonstrates no difference in clinical effectiveness between nebulisers and alternative inhaler devices compared to standard pMDI with or without a spacer device. The cost-effectiveness evidence therefore favours pMDIs (or the cheapest inhaler device) as first-line treatment in all patients with stable asthma unless other specific reasons are identified. Patients can use pMDIs as effectively as other inhaler devices as long as the correct inhalation technique is taught. CONCLUSIONS--RECOMMENDATIONS FOR RESEARCH: Further clinical trials are required to demonstrate any differences in the clinical effectiveness and cost-effectiveness of inhaler devices and nebulisers compared with pMDIs. These should be of sufficient statistical power and methodological rigour to demonstrate any clinical benefit. Trials should be undertaken in community settings to ensure the generalisability of results. Outcome measures should be more patient-centred and report adverse effects more completely. Reporting of data from trials should be improved.

Adolescent↗

PubMed1997

Locating and appraising systematic reviews.

Several methods can be used to identify systematic reviews. These include bibliographic databases, such as MEDLINE, Best Evidence, and the Cochrane Library. In the future, the Cochrane Library could become the source of choice for systematic reviews because it provides the full text for Cochrane reviews and citations to many other systematic reviews. Moreover, the Library is growing rapidly and becoming more readily available, and its searching capabilities are being improved with each update. Although Best Evidence contains fewer systematic reviews than the Cochrane Library, it is specifically designed for practicing internists and primary care physicians and includes systematic reviews on diagnosis, cause, prognosis, and quality improvement. At present, however, MEDLINE and other bibliographic databases are probably the most up-to-date and readily available sources of systematic reviews. Systematic reviews are a powerful and useful way to assemble evidence; however, just because a review has been done using systematic review methods does not guarantee that its results are credible. Regardless of the source, all systematic reviews (like all types of research evidence) require critical appraisal to determine their validity and to establish whether and how they will be useful in practice.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

A comparison of yield in a non-systematic and a systematic review.

OBJECTIVES: To compare the results of a non-systematic (A) and a systematic review (B) of test performance in oral cancer and precancer screening in terms of literature coverage, and qualitative and quantitative information yield. METHOD: For A, two databases were searched using basic search terms. Review B followed published guidelines. Nine databases were searched using three complex facets. In both reviews, one reviewer made the initial selection of relevant studies and, in A, carried out full text screening. In B, two independent reviewers carried out full text screening and then conferred on a final list of studies for inclusion and meta-analysis. RESULTS: In search A, 60 papers, and in B, 481 papers, were retrieved. Thirty from A, and 47 from B were selected for full text screening. From A, six papers, and from B, eight papers (six selected by the first reviewer and eight by the second; kappa = 0.83), were designated for inclusion in meta-analysis. The six papers from A were common to all selections. Seven papers were finally included in B. Compared with the non-systematic review, meta-analysis in the systematic review reduced the 95% CI for sensitivity from 0.594, 0.912 (= 0.318) to 0.713, 0.919 (= 0.189) resulting from the inclusion of a larger number of verified cases. The 95% CI for specificity changed only from 0.941, 0.991 (= 0.050) to 0.930, 0.982 (= 0.052). DISCUSSION: Both reviews had the same exacting and specific inclusion criteria. The papers ultimately included in each were closely matched. Advantages of the systematic review were 1) it afforded a degree of confidence that the literature had been exhaustively and systematically searched, 2) the use of a formal data extraction process ensured that clinical heterogeneity among the studies and its consequences were thoroughly explored, 3) the increased number of verified cases included in the systematic review meta-analysis led to the pooled estimate for sensitivity having greater precision.

Confidence Intervals↗

PubMed1994

Inappropriate and appropriate selection of 'peers' in grant review.

OBJECTIVE: To assess the members of the California Tobacco Related Diseases Research Program Behavioral and Public Health Research on Tobacco Study Section and those of the Agency for Health Care Policy and Research (AHCPR) Dissemination Study Section as "peers" to review tobacco policy research. Both study sections reviewed a similar grant application on tobacco policy research written by one of us (S.A.G.). DESIGN: Search of MEDLINE for 1989 through 1993 with the keyword tobacco for Tobacco Related Diseases Research Program and AHCPR reviewers. As a control, the National Institutes of Health Cardiovascular Study Section, which reviewed a ventricular function grant submitted by the same author with the keyword heart, was analyzed. SETTING: Not applicable. PATIENTS OR OTHER PARTICIPANTS: Study section members. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Publications by study section members in areas germane to the proposal being reviewed. RESULTS: Six (33%) of 18 Tobacco Related Diseases Research Program reviewers had no "tobacco" publications (median, two publications; interquartile range, zero to four). The members' "tobacco" publications concentrated on well-controlled experimental interventions on smoking cessation and prevention strategies, not tobacco policy. Only one member had primary expertise in tobacco policy research. None of the AHCPR reviewers had "tobacco" publications. All 31 (100%) of the National Institutes of Health reviewers had "heart" publications (median, nine publications; interquartile range, seven to 19). Five members had a primary interest in the subject of the National Heart, Lung, and Blood Institute application. CONCLUSIONS: Study section members' professional interests play a critical role in the level of interest and enthusiasm they will have for a proposal, which affects the priority score. In contrast to the study section that reviewed the heart grant, the study sections that reviewed the tobacco control grant were not "peers." The membership of these review committees has effectively precluded research on tobacco control policy.

Peer Review, Research↗

PubMed1993

[Message from editors to authors: review articles. How can the scientific and educational results be improved?].

Most biomedical journals include review articles that pretend to provide the readers with an updated, synthetic and critical appraisal of some important topic. These articles are usually written by experts in the topics reviewed. There are no conventional or universally accepted requisites for the formal organization of contents in a review article. This is in contrast with other kinds of original articles. Therefore, to guide the authors on how to improve the review articles to be submitted to Revista Medica de Chile, some recommendations are proposed. These recommendations were based in the editors' experience and in other pertinent publications: 1) The scope and purpose of the review article should be established in the introductory paragraphs; 2) The methodology used in the selection of the literature reviewed and the time span covered by the search, should also be specified; 3) The author of the review article should systematically appraise the validity of the methods employed in the papers reviewed. A similar attitude should be observed with regards to the results, discussions and conclusions. The limitations and inconsistencies found should be pointed out; 4) The author of the review article should state his (her) own conclusions, identifying the solid as well as the weakly established facts; 5) Whenever feasible, a proposal of future lines of research envisioned after reviewing the literature, is commendable; 6) The literary style of the article should be kept as interesting as possible, to motivate the prospective readers; 7) The scope of the specific journal where the author intends to submit the review article, should always be kept in mind.

Publishing↗

PubMed1998

Developing search strategies for detecting high quality reviews in a hypertext test collection.

OBJECTIVE: To identify search strategies for retrieving high quality review studies about etiology, prognosis, therapy, and diagnosis from World Wide Web (WWW) medical documents. DESIGN: Observational study of the performance of search strategies based on terms found in high quality review articles in a collection of hypertext medical documents from the WWW. MEASUREMENTS: The sensitivity and specificity of search strategies for review articles in general and with a specific focus were determined by comparison to a manual review of a collection of hypertext medical documents. RESULTS: A total of 1058 hypertext medical documents from seven governmental and academic WWW sites were included in the study collection. About 16% of the documents in the collection met the criteria for high quality review documents. Search strategies for review documents were identified that had 87% sensitivity and 95% specificity. Compared to simple strategies combining the term "review" and the article focus, more complex strategies based on terms found in high quality studies were more sensitive in identifying review articles of a given focus. These more complex strategies had a sensitivity of 83% for diagnosis, 85% for therapy, 79% for prognosis, and 88% for etiology, while the simple strategies had a sensitivity of 88%, 74%, 38%, and 46%, respectively. In addition, the more complex strategies were more specific for high quality review articles on diagnosis and therapy. CONCLUSION: Search strategies can be identified that enhance retrieval of review documents and review documents of specific focus from a collection of WWW hypertext medical documents.

Abstracting and Indexing↗

PubMed2026

Performance of Automated Hematology Analyzer Criteria in Detecting Peripheral Blood Smear Abnormalities: A Systematic Literature Review.

OBJECTIVES: Criteria for visual examination of stained peripheral blood smear (PBS) differ among institutions in the United States and internationally. In an effort to standardize review criteria, the International Consensus Group for Hematology Review (ICGHR) proposed in 2005 a consensus list of rules for CBC findings that should trigger a review of automated cell counter results and potentially lead to further testing or blood smear review. The primary aim of this paper is to report on the published literature in the past 20 years regarding PBS review criteria and their ability to identify relevant peripheral blood abnormalities. METHODS: We performed a systematic review of the published literature from 2005 to 2025 to investigate and summarize PBS review criteria and performance in the context of automated hematology analyzers in clinical laboratories. RESULTS: Of 5351 citations, 68 studies met our search criteria. These studies included 22 countries and all major hematology analyzer manufacturers. Marked variability was observed in study populations, analyzer flagging criteria, details of PBS visual review, definitions of a "positive" smear, and approaches to statistical data analysis. Across studies, the blast flag sensitivity ranged from 18% to 100% while the blast flag specificity ranged from 17% to 100%. Wide ranges in sensitivity/specificity were also seen for atypical and/or abnormal lymphocyte flags across studies. For studies analyzing the same patient population, less striking variation was seen across instruments. CONCLUSIONS: This systematic review provides a 20-year overview of the literature, highlighting significant variability in PBS review criteria, dependence on study design and hematology analyzer, and the importance of developing harmonized evidence-based guidelines.

Humans↗