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PubMed1999

Conflicting conclusions from two systematic reviews of epidural steroid injections for sciatica: which evidence should general practitioners heed?

Systematic reviews and meta-analyses are becoming increasingly important in informing clinical practice and commissioning. Two systematic reviews of a treatment for low back pain and sciatica using epidural steroid injections, published in the same year, arrived at conflicting conclusions. Only one was reported in a digest for evidence-based medicine. This paper aims to find the reasons for the discordance between the reviews, and draw conclusions for users of reviews. Using comparative analysis of two published systematic reviews and their source material, it was found that the two reviews had the same overall aims and met the criteria for review methods. They differed in their choice of methods, including the judgement of quality of studies for inclusion and for summing-up evidence. Estimation of summary odds ratios in one review led to stronger conclusions about effectiveness. In conclusion, the choice of methods for systematic review may alter views about the current state of evidence. Users should be aware that systematic reviews include an element of judgement, whatever method is used.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy.

CONTEXT: Systematic reviews of the literature are an important resource for clinicians. Unfortunately, the few published strategies for identifying these articles involve MEDLINE interfaces not widely available outside of academic medicine. In addition, the performance of these strategies is unknown. OBJECTIVE: To develop and evaluate a search strategy for identifying systematic reviews by using a publicly available MEDLINE interface (PubMed). DESIGN: Diagnostic test assessment. DEFINITION OF SENSITIVITY: The proportion of recognized systematic reviews (indexed in the Cochrane Library's Database of Abstracts of Reviews of Effectiveness [DARE] or in ACP Journal Club) that are identified by the search strategy. DEFINITION OF POSITIVE PREDICTIVE VALUE: The proportion of articles identified in one of three sample searches (screening for colorectal cancer, thrombolytic therapy for venous thromboembolism, and treatment of dementia) that meet a minimum definition of systematic review. RESULTS: Our PubMed search strategy identified 93 of 100 DARE-indexed systematic reviews, a sensitivity of 93% (95% CI, 86% to 97%). For the sample of systematic reviews drawn from ACP Journal Club (n = 103), the PubMed strategy achieved a sensitivity of 97% (CI, 91% to 99%). When the three sample search strings were used, approximately 50% of retrieved articles met our minimum definition of systematic review. In contrast, the similar precision of a PubMed search restricted to review-type articles (as indexed by MEDLINE) was less than 10%. CONCLUSIONS: This search strategy identified most systematic reviews without over-whelming users with numerous false-positive results. A "single-click" filter based on this strategy is now available as part of the Clinical Queries feature of PubMed.

Evidence-Based Medicine↗
PubMed2003

Patients' views of a pharmacist-run medication review clinic in general practice.

BACKGROUND: Reviewing elderly patients' medication is a requirement of the National Service Framework for Older People. Many general practitioners have insufficient time to review patients' medications in a consultation. Pharmacist review has been offered as an alternative and this will be a new experience for many patients. AIM: To ascertain patients' views of a pharmacist-conducted medication review clinic, run in their general practice surgery. DESIGN OF STUDY: Qualitative study using focus group interviews. SETTING: General practices in Leeds Health Authority area. METHOD: Patients aged 65 years and over, who had attended a medicine review clinic, took part in focus groups that were recorded and transcribed. Units of information representing an idea were identified and similar ideas were grouped together as themes. RESULTS: Patients had a number of prior beliefs about the clinic. Most patients knew that the clinic's purpose was to review repeat medication, to find out more about their medicines, and to ask questions about efficacy and side effects. Some patients were suspicious about the purpose of the clinic but others welcomed the opportunity to have an in-depth review and an explanation of their condition and its treatment; some patients did not accept advice or were disappointed that their expectations were not fulfilled. Most patients were happy to attend a yearly review but some expressed guilt about attending the surgery too frequently. CONCLUSION: Patients who attended the medication review clinics expressed a range of views about the service. Further research into patients' and carers' opinions about medicine review is needed to inform the development of these services.

Aged↗
PubMedDate not supplied

[Systematic reviews and meta-analysis in laboratory medicine: principles and methods].

BACKGROUND: Systematic reviews and meta-analyses can help health-care professionals to base their decisions on the highest levels of evidence, and are therefore the cornerstone in practicing evidence-based medicine. In the field of diagnosis in general, and in laboratory medicine in particular, systematic reviews are scarcer, and often of lower quality than in other areas of medicine. AIM: To summarize the principles and methods that can be advised to perform systematic reviews of good quality in laboratory medicine. METHODS: A narrative review of the literature and discussions with members of the Committee on Evidence-Based Laboratory Medicine of the International Federation of Clinical Chemistry and Laboratory Medicine, in particular during our last three meetings, enabled us to adapt to laboratory medicine the methods which are currently being advocated to perform systematic reviews of good quality in other medical areas. RESULTS: The process of systematic reviewing consists of six key steps: 1) preparation: formulation of question(s); 2) systematic search of the literature; 3) selection of primary studies; 4) critical appraisal of the quality of the selected literature; 5) extraction and synthesis of data; 6) interpretation. The main differences between systematic reviews of diagnostic interventions and those of therapeutic interventions bear on question formulation, the choice of study designs to be included or excluded, the assessment of study quality and the statistical methods used to combine their results. The quoted references will help interested readers to deepen by themselves the most technical or controversial points. CONCLUSION: In order to improve quality of care as well as the balance between benefits, harms and costs of practice, each recommendation in guidelines should be based on a systematic review. In addition, such reviews can help to better identify gaps in biomedical knowledge, and improve critical skills, education, and training of professionals. One can therefore reasonably expect that the current multiplication of systematic reviews in laboratory medicine will favor the diffusion of diagnostic technologies with the highest levels of proven efficacy and effectiveness, at the detriment of the others.

Biology↗
PubMed2004

Systematic reviews for evidence-based management: how to find them and what to do with them.

OBJECTIVE: To identify strategies for retrieval and evaluation of systematic reviews from a management perspective. STUDY DESIGN: Review of available literature and resources on systematic reviews. METHODS: From published literature on evidence-based medicine and systematic review, we identified resources and adapted retrieval and evaluation strategies for healthcare managers. A published systematic review then was assessed for quality and relevance to management decisions. RESULTS: Systematic reviews relevant to the organization and delivery of care are available. Criteria for evaluating the relevance and quality of systematic reviews on clinical topics may be adapted for systematic reviews on organizational topics. However, even a systematic review that focuses on an organizational topic can lack important information on costs and study setting. CONCLUSIONS: Greater familiarity with the retrieval and evaluation of systematic reviews can help managers use these sources effectively and encourage the development of evidence-based management.

Databases, Bibliographic↗
PubMed1994

A citation analysis of the impact of blinded peer review.

OBJECTIVE: To determine whether articles published in journals using blinded peer review receive significantly more or fewer citations than those published in journals using nonblinded peer review. DESIGN: Drawing from a sample of 1051 full articles published in 28 economics journals during 1984, we used nonlinear regression and ordered probit techniques to estimate the impact of blinded peer review on citations of these articles in 1985 through 1989. OUTCOMES: Citations of articles. RESULTS: Articles published in journals using blinded peer review were cited significantly more than articles published in journals using nonblinded peer review, controlling for a variety of author, article, and journal attributes. CONCLUSIONS: Nonblinded peer review apparently suffers from type I error to a greater extent than blinded peer review. That is, journals using nonblinded peer review published a larger fraction of papers that should not have been published than do journals using blinded peer review. When reviewers know the identity of the author(s) of an article, they are able to (and evidently do) substitute particularistic criteria for universalistic criteria in their evaluative process.

Authorship↗
PubMed1996

[What do reviewers look for in 'original articles' submitted for publication in the Nederlands Tijdschrift voor Geneeskunde?].

OBJECTIVE: To determine to what extent reviewers of the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine, NTvG) use specific criteria when reviewing original articles. DESIGN: Descriptive. SETTING: Editorial office of the NTvG. METHODS: From 21 October 1993 to 1 March 1994, 89 original research manuscripts were received. Of these, 60 (67%) were submitted to reviewers. Each manuscript was sent to a second reviewer, with the same expertise, as well. On the basis of two checklists with a total of 16 quality elements, the manuscripts were analysed and compared with the chief editor's judgement. The results of each individual referee were correlated with his year of graduation. The duration of the peer review procedure was established. RESULTS: The reviewers of the NTvG responded to 46% of the explicit questions from the editors (list one), while they commented upon 43% of the criteria in the second implicit list. There was no relation with the year of graduation. Approximately 12% of the flaws in the manuscripts, as assessed by the editor, were missed. About 42% of the correct elements in the manuscript were not mentioned in the evaluation. The interrater agreement between paired reviewers was 0.26 (kappa); on average 10.4 of the 16 checkpoints were mentioned or not by both. Peer review took 41 days on average. CONCLUSION: Only a small fraction of the flaws in a manuscript were missed by the reviewers. Peer review is reasonably uniform at the NTvG, but would probably benefit from standardization.

Manuscripts, Medical as Topic↗
PubMed1998

Why review articles on the health effects of passive smoking reach different conclusions.

OBJECTIVE: To determine whether the conclusions of review articles on the health effects of passive smoking are associated with article quality, the affiliations of their authors, or other article characteristics. DATA SOURCES: Review articles published from 1980 to 1995 were identified through electronic searches of MEDLINE and EMBASE and from a database of symposium proceedings on passive smoking. ARTICLE SELECTION: An article was included if its stated or implied purpose was to review the scientific evidence that passive smoking is associated with 1 or more health outcomes. Articles were excluded if they did not focus specifically on the health effects of passive smoking or if they were not written in English. DATA EXTRACTION: Review article quality was evaluated by 2 independent assessors who were trained, followed a written protocol, had no disclosed conflicts of interest, and were blinded to all study hypotheses and identifying characteristics of articles. Article conclusions were categorized by the 2 assessors and by one of the authors. Author affiliation was classified as either tobacco industry affiliated or not, based on whether the authors were known to have received funding from or participated in activities sponsored by the tobacco industry. Other article characteristics were classified by one of the authors using predefined criteria. DATA SYNTHESIS: A total of 106 reviews were identified. Overall, 37% (39/106) of reviews concluded that passive smoking is not harmful to health; 74% (29/39) of these were written by authors with tobacco industry affiliations. In multiple logistic regression analyses controlling for article quality, peer review status, article topic, and year of publication, the only factor associated with concluding that passive smoking is not harmful was whether an author was affiliated with the tobacco industry (odds ratio, 88.4; 95% confidence interval, 16.4-476.5; P<.001). CONCLUSIONS: The conclusions of review articles are strongly associated with the affiliations of their authors. Authors of review articles should disclose potential financial conflicts of interest, and readers of review articles should consider authors' affiliations when deciding how to judge an article's conclusions.

Analysis of Variance↗
PubMed1998

Spontaneous neoplasms in control Wistar rats: a comparison of reviews.

Spontaneous neoplasms in 930 control Wistar rats from five carcinogenicity bioassays conducted between 1990 and 1995 were reviewed and compared with review findings in studies between 1980 and 1990. Mean survival at 104 weeks was 55% for males and 60% for females, similar to that of the previous review. A total of 1599 neoplasms was diagnosed in 361 (78%) male and 415 (89%) female rats; 1293 (81%) of these were benign and 306 (19%) were malignant (11% with metastases). Sixty-eight percent of all neoplasms were in endocrine and integumentary systems, similar to 74% seen in the previous review. Most common neoplasms (affecting > 7% of either sex) were pituitary adenoma (34% of males, 50% of females), benign adrenal pheochromocytoma (10% of males, 1% of females), thyroid C cell adenoma (6% of males, 8% of females), mammary fibroadenoma (3% of males, 36% of females), keratoacanthoma (11% of males, 0.6% of females), testicular interstitial cell tumor (11% of males), uterine stromal polyp (16% of females), pancreatic acinar cell adenoma (13% of males, 0.6% of females), and benign thymoma (3% of males, 8% of females). Seventeen neoplasms affecting 2 to 6.9% of either sex included adrenal cortical adenoma, thyroid follicular adenoma, pancreatic islet cell adenoma, pituitary carcinoma, mammary adenoma, mammary adenocarcinoma, fibroma, fibrosarcoma, dermal papilloma, uterine schwannoma, uterine granular cell tumor, pancreatic acinar cell carcinoma, hepatocellular adenoma, lymphoma, granular cell meningioma, renal mesenchymal tumor, and hemangiosarcoma. Remaining neoplasms occurred in fewer than 2% of animals. Mean tumor incidence did not differ significantly between our two reviews. Ratios of benign to malignant neoplasms were similar in both reviews and percentages of survival at 104 weeks were similar. Between the two reviews, greater than threefold increase in frequency of some neoplasms occurred only in males and included keratoacanthomas, pancreatic acinar cell adenomas/carcinomas, and astrocytomas. Frequencies of remaining neoplasms were within twofold or within 10% of previous frequencies. Some neoplasms diagnosed in this review but not in the previous review included cardiac schwannoma, pilomatrixoma, parathyroid adenoma, and prostatic adenoma but incidence was approximately 1% for any one tumor. Based on these reviews, Wistar rats appear to have a predilection to pituitary neoplasms and mammary fibroadenomas (females).

Animals↗
PubMed1996

Phase II of the AHCPR-sponsored heart failure guideline: translating practice recommendations into review criteria.

BACKGROUND: In 1992, under the sponsorship of the U.S. Agency for Health Care Policy and Research, RAND assembled an expert panel to develop the Heart Failure Clinical Practice Guideline. Phase II of the effort was intended to identify which of the guideline's recommendations the panel felt were suitable for use in retrospective utilization review and quality assessment programs and to develop review criteria, performance measures, and standards of quality for use in monitoring compliance with those recommendations. SELECTION OF RECOMMENDATIONS: Selecting guideline recommendations for translation into review criteria and ultimately into standards of care was a multistep process comprising (1) identification of 34 recommendations from the guideline, (2) rating them on the basis of importance to quality of care and feasibility of monitoring, (3) review by a subcommittee and the full guideline panel, (4) translation into review criteria, and (5) further review and input by panelists and peer and pilot reviewers. Finally, standards of care (the minimum proportion of cases expected to be in accordance with guideline recommendations) were determined to be 90%-95% for six of the final criteria and 75%-80% for the other two. CONCLUSION: Despite some reservations, physicians and other health care professionals agreed to be held accountable for following a core set of guideline recommendations for the treatment of heart failure. Substantial progress was made in identifying recommendations that panelists and reviewers were willing to endorse in utilization review activities, including adoption of improved documentation standards. The review criteria's major impact may be the knowledge that the criteria are in place and that care is being monitored based on those standards.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

The Cochrane Collaboration Pain, Palliative Care and Supportive Care Collaborative Review Group.

The Pain, Palliative and Supportive care group is one of 50 collaborative review groups that make up the Cochrane Collaboration, an international organization with the task of preparing, maintaining and disseminating systematic reviews of the effects of healthcare. Cochrane reviews are published cumulatively four times a year on the Cochrane library (CD-ROM and Web-based), along with other useful material such as a register of some 300,000 randomized controlled trials. The group has identified some 20,000 randomized trials in pain and 1,200 in palliative care. Reviews in progress are also published on the library as protocols. Full peer-review is undertaken for protocols and reviews. The Pain, Palliative and Supportive care group is an informal international team involving some 100 people from some 18 countries. The group has published 26 protocols and 17 full reviews with a further 50 reviews in progress. The task is huge and there is scope for further volunteers to help with the various tasks of writing reviews, peer reviewing and literature searching.

Databases, Factual↗
PubMed1997

Adult asthma review in general practice: nurses' perception of their role.

BACKGROUND: Asthma clinics have become widespread in general practice with nurses now playing an important role in asthma review. However, little is known about training of nurses carrying out reviews and how this affects the nurse role in patient management. OBJECTIVES: We aimed to discover the level of asthma training of practice nurses carrying out review of adult asthma patients in one Health Authority and to see if this has any effect on their perception of their role. METHOD: All 187 practice nurses in Grampian were sent a postal questionnaire investigating how asthma review is organized in general practice, their role in review and the asthma training they had received. Personal interviews were carried out with 17 nurses, exploring in more depth the topics covered in the questionnaire. RESULTS: A total of 167 nurses from 92% of the practices in Grampian responded, of whom 61% carried out asthma reviews. Among nurses carrying out reviews 71% did so on their own. 49% of nurses had or were training for advanced asthma qualification. Nurses without an asthma qualification were significantly more likely to feel that their training was not sufficient for their asthma related tasks (54% versus 11%, P = 0.0002). Nurses without advanced asthma qualifications were less likely to provide or review a self-management plan (29% versus 49%, P = 0.01), to review patient PEF recording (38% versus 65%, P < 0.01), to discuss patient worries (75% versus 94%, P < 0.05) or to make the initial diagnosis of asthma (24% versus 76%, P < 0.005). Nurses were unlikely to view their role as fully responsible unless they had an asthma qualification (13% versus 49%, P < 0.001). CONCLUSION: Nurses without advanced asthma qualifications do not feel fully confident in responsibility for patient management. Nurses without training are more likely to only carry out routine monitoring at reviews while nurses with asthma training are more likely to actively develop patient self-management skills. This suggests that nurses should be supported to obtain asthma qualifications if they are to give the best possible care to asthma patients.

Adult↗
PubMed1997

An evaluation of 'rapid review' as a method of quality control of cervical smears using the AxioHOME microscope.

One method of quality control which has recently been recommended by professional bodies in the UK is the 'rapid review' method. This involves the microscopic 30 s review of all negative cervical smears with the intention of flagging potential missed abnormalities. Although it has been suggested that rapid review is better than 10% random rescreening of negative smears, the efficiency and efficacy of this method of quality control have not been thoroughly evaluated. We have used the AxioHOME system, which can record the area of a slide covered and the screening time, to investigate slide coverage during rapid review quality control, as performed by 15 cytoscreeners and MLSOs reviewing a test set of 22 slides each. The test set comprised 18 negative slides, three positive slides, and one unsatisfactory slide. We have recorded two distinct methods of rapid review in use amongst cytotechnologists, the step method and the whole slide method. The data show that rapid review takes longer on average than the recommended 30 s, the mean screening times being 76 s and 82 s for the step and whole slide methods, respectively. Abnormal smears were missed on three of 15 occasions by the step method (sensitivity 80%, positive predictive value 85%), and on seven of 30 occasions by the whole slide method (sensitivity 76.6%, positive predictive value 45%). However, the 95% confidence intervals were wide (57.7-90.7% for the step method, and 51.9-95.7% for the whole slide method). Analysis of scanning tracks and screening rates shows significant flaws in the methodology of rapid review. Abnormal cells were not identified, although dyskaryotic cells were included in the scanning track on nine occasions, seven using the whole slide method and two using the step method. On one occasion (using the step method) abnormal cells were not identified because they were not included in the scanning track. Further research is in progress to determine optimal methods of rapid review, and whether the rapid review technique is as effective as automated screening systems for quality assurance in cytology.

False Negative Reactions↗
PubMed2006

Impact of institutional review board practice variation on observational health services research.

OBJECTIVE: To describe, qualitatively and quantitatively, the impact of a review by multiple institutional review boards (IRBs) on the conduct of a multisite observational health services research study. DATA SOURCE AND SETTING: Primary data collection during 2002, 2003, and 2004 at 43 United States Department of Veterans Affairs (VA) primary care clinics. DESIGN: Explanatory sequential mixed methods design incorporating qualitative and quantitative elements in sequence. DATA COLLECTION AND ABSTRACTION METHODS: Field notes and documents collected by research staff during a multisite observational health services research study were used in thematic analysis. Themes were quantified descriptively and merged with timeline data. PRINCIPAL FINDINGS: Approximately 4,680 hours of staff time over a 19-month period were devoted solely to the IRB process. Four categories of phenomena impacting research were observed: (1) Recruitment, retention, and communication issues with local site principal investigators (PIs). Local PIs had no real role but were required by IRBs. Twenty-one percent of sites experienced turnover in local PIs, and local PI issues added significant delay to most sites. (2) Wide variation in standards applied to review and approval of IRB applications. The study was designed to be qualified under U.S. government regulations for expedited review. One site exempted it from review (although it did not qualify for exemption), 10 granted expedited review, 31 required full review, and one rejected it as being too risky to be permitted. Twenty-three required inapplicable sections in the consent form and five required HIPAA (Health Insurance Portability and Accountability Act of 1996) consent from physicians although no health information was asked of them. Twelve sites requested, and two insisted upon, provisions that directly increased the risk to participants. (3) Multiple returns for revision of IRB applications, consent documents, and ancillary forms. Seventy-six percent of sites required at least one resubmission, and 15 percent of sites required three or more (up to six) resubmissions. Only 12 percent of sites required any procedural or substantive revision; most resubmissions were editorial changes to the wording of the consent document. (4) Process failures (long turnaround times, lost paperwork, difficulty in obtaining necessary forms, unavailability of key personnel at IRBs). The process required from 52 to 798 (median 286) days to obtain approval at each site. CONCLUSIONS: Several features of the IRB system as currently configured impose costly burdens of administrative activity and delay on observational health services research studies, and paradoxically decrease protection of human subjects. Central review with local opt-out, cooperative review, or a system of peer review could reduce costs and improve protection of human subjects.

Ethics Committees↗
PubMed2003

Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial.

OBJECTIVE: To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices. DESIGN: Pragmatic, randomised controlled trial. SETTING: Four general practices in England. PARTICIPANTS: 278 adults who had not been reviewed in the previous 11 months. INTERVENTION: Participants were randomised to either telephone review or face to face consultation with the asthma nurse. MAIN OUTCOME MEASURES: Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated "short Q" asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation. RESULTS: Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P<0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference -0.07 (95% confidence interval -0.40 to 0.27) or in satisfaction with the consultation (risk difference -0.07 (-0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P<0.001)). CONCLUSIONS: Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma.

Asthma↗
PubMed2000

Radiological review of interval cancers in an Australian mammographic screening programme. Radiology Quality Assurance Group of BreastScreen Victoria.

OBJECTIVES: To determine the proportion and features of invasive interval cancers that could be considered detectable at the time of the previous screen and the proportion of cases that could be classified as true intervals, false negatives, minimal signs, or radiographically occult lesions. SETTING: BreastScreen Victoria, the Victorian component of the BreastScreen Australia mammography screening programme. METHODS: Two separate review methodologies were adopted. Firstly a blinded review of interval, screen detected, and normal cases was undertaken, followed by a confirmation exercise to determine the proportion of invasive interval cancers that could be considered detectable at the time of the previous screen. Secondly, an unblinded review was performed to classify interval cases as true interval, false negative, minimal signs, or radiographically occult. RESULTS: From the blinded review, it was estimated that 38% of interval cases may be considered "potentially detectable" at the time of screening. Comparison of the characteristics of interval and screen detected cases indicates that interval cases are more likely to be smaller, equivocal, ill defined masses. In the unblinded exercise, 41% of interval cases were classified as false negatives and a further 16% as minimal signs, 33% true intervals, and 10% radiographically occult. Of the interval cancers considered potentially detectable at screening, 97% were classified as false negatives in the unblinded review. CONCLUSIONS: This study highlights the importance of adopting staged review methods with both blinded and unblinded components. The blinded review and confirmation exercise allows the determination of the proportion of interval cases that could be considered potentially detectable at screening. The unblinded review provides an active important opportunity for professional development and review and a mechanism to link into the blinded review through further classification of interval cases.

Australia↗
PubMed2005

Review of patients in general practice with a diagnosis of epilepsy: development of a practice nurse checklist and an assessment of resource implications.

BACKGROUND: SIGN has recommended annual review of all patients with epilepsy. Annual review is rewarded in the new GMS contract. There is no information on how or by whom reviews should be carried out, nor on resource implications for secondary care. AIMS: To determine whether a practice nurse can deliver annual review of patients with epilepsy, and to estimate the resource implications of such review. METHODS: Evaluation of a practice nurse checklist against review by neurologist in 62 patients with epilepsy identified from a practice list of 6240 from Southwest Glasgow LHCC, and audit of case records in 1259 patients with epilepsy identified from the whole LHCC population of 96,565. RESULTS: There were 8 discrepancies between nurse and doctor reviews in a first iteration, but none in the second. Changes suggested a training effect. The review process generated 19 epilepsy nurse appointments, 7 requests for cerebral imaging and 3 requests for video EEG. Twelve patients required continuing follow up. The LHCC audit identified a large number of patients who had inadequate documentation of information and advice (over 90% in some domains). 28.6% had not been seen by a specialist, 40.7% had not had cerebral imaging, and only 37.4% were seizure free. CONCLUSION: Annual reviews of patients with epilepsy can be carried out by practice nurses, but some training is required. The review process is likely to increase the burden on secondary care and have a significant adverse effect on neurology waiting times.

Adolescent↗
PubMed2002

Training practitioners in preparing systematic reviews: a cross-sectional survey of participants in the Australasian Cochrane Centre training program.

BACKGROUND: Although systematic reviews of health care interventions are an invaluable tool for health care providers and researchers, many potential authors never publish reviews. This study attempts to determine why some people with interest in performing systematic reviews do not subsequently publish a review; and what steps could possibly increase review completion. METHODS: Cross-sectional survey by email and facsimile of the 179 participants in Australasian Cochrane Centre training events between 1998 and 2000. RESULTS: Ninety-two participants responded to the survey (51 percent). Response rate of deliverable surveys was 82 percent (92/112). The remainder of the participants had invalid or no contact information on file. More than 75 percent of respondents felt that the current workshops met their needs for training. The most critical barriers to completion of a Cochrane review were: lack of time (80 percent), lack of financial support (36 percent), methodological problems (23 percent) and problems with group dynamics (10 percent). CONCLUSIONS: Strategies to protect reviewer time and increase the efficiency of the review process may increase the numbers of trained reviewers completing a systematic review.

Attitude of Health Personnel↗