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PubMed2004

Applying an evidence-based approach to the management of patients with ocular hypertension: evaluating and synthesizing published evidence.

PURPOSE: The use of evidence-based medicine in managing patients with ocular hypertension has been constrained by the limited availability of high-quality data from controlled clinical trials and by limited formal training of clinicians in evaluating published evidence. This article will provide strategies and techniques to evaluate critically the quality of published research, synthesize the findings, and integrate published evidence in the care of patients with ocular hypertension. DESIGN: Review of the published literature and consensus of a panel of experts. METHODS: The published literature on evidence-based medicine was reviewed. Strategies and techniques in evaluating the quality of evidence and how to integrate evidence into the practice setting using the following three major questions were discussed by a panel of experts: Are the results of the study valid? What are the results? Do the study outcomes apply to individual patient care? RESULTS: Approaches to assessing study validity and the importance of considering the size of the treatment effect and precision of the effect size were detailed. The importance of using the "number-needed-to-treat" as a tool for translating results of clinical trials to individual patient care and the "number-needed-to-harm" as a method of comparing the potential benefit and harm of a given therapy was acknowledged. CONCLUSION: As the volume of high-quality data increases, the information provided herein may help ophthalmologists apply evidence-based medicine techniques as they seek to optimize the care of individual patients with ocular hypertension.

Evidence-Based Medicine↗
PubMed2005

Published reports of acupuncture trials showed important limitations.

BACKGROUND: Systematic reviewers generally evaluate randomized controlled trials (RCTs) based on the published reports. We evaluated whether the description of methods in the published reports is an accurate and complete reflection of study procedures used. METHODS: The authors of 51 RCTs included in a systematic review of acupuncture for chronic pain were sent a brief survey that included questions related to the following three important study quality dimensions: (1) generation of allocation sequence, (2) allocation concealment, and (3) blinding of outcomes assessor. RESULTS: We received 35 of 51 responses for an overall response rate of 68.6%. Of 35 studies described as randomized in published reports, associated survey responses indicated that four actually used quasi-randomized methods. Among published reports with missing information on these quality dimensions, 27 of 32 studies used adequate methods for the generation of allocation sequence, 13 of 34 used adequate allocation concealment and 2 of 10 were blinded, according to survey responses. Survey responses generally confirmed information about randomization and blinding already described in investigators' RCT publications. CONCLUSION: Surveying RCT investigators uncovered some information about study quality dimensions not described in published reports.

Acupuncture Therapy↗
PubMed1997

Maximum androgen blockade in advanced prostate cancer: a meta-analysis of published randomized controlled trials using nonsteroidal antiandrogens.

OBJECTIVES: To assess the survival benefit of maximum androgen blockade (MAB) using nonsteroidal antiandrogens (NSAAs) through meta-analysis of published randomized controlled trials (RCTs). METHODS: All RCTs comparing treatment with NSAA plus either luteinizing hormone-releasing hormone (LHRH) or orchiectomy versus treatment with LHRH or orchiectomy alone were included if the necessary statistical summaries were present in the publication. Estimates and standard errors of log hazard ratio for overall survival and progression-free survival were derived from published studies using two methods: (1) reconstructing an annual life table from graphical presentations of survival distributions and fitting discrete proportional hazard models, and (2) reconstructing the log hazard ratio from reported P values and numbers of deaths. An alternative set of log hazard ratios was derived from figures presented in a summary report by the Prostate Cancer Trialists' Collaborative Group (PCTCG). Comparative meta-analyses were performed using the random effects approach of DerSimonian and Laird. Additionally, published studies were used in a random-effects-based meta-analysis of objective tumor response. RESULTS: Nine studies provided enough information to perform a meta-analysis for survival using one of the two methods. Estimates of relative risks (RR) comparing treatment with NSAA plus either LHRH or orchiectomy versus treatment with LHRH or orchiectomy alone with respect to overall survival were 0.78 (95% confidence intervals [CIs] 0.67 to 0.90) using method 1, and 0.84 (95% CI 0.76 to 0.93) using method 2. Sensitivity analyses based on PCTCG data showed that a favorable survival result for MAB was associated with NSAAs but not with steroidal antiandrogens and depended on randomization blinding and overall trial quality. Additionally, random-effects-based meta-analysis of published studies showed a significant increase in time-to-progression (RR = 0.74; 95% CI 0.63 to 0.86) and an increase in objective tumor responses for MAB using NSAAs compared with castration alone (odds ratio = 0.65; 95% CI 0.51 to 0.81; P = 0.00022). CONCLUSIONS: Inconsistent results have been published about the benefit of MAB in advanced prostate cancer. This meta-analysis supports a beneficial effect for MAB using NSAAs compared with castration alone, and sensitivity analyses suggest that the design of future trials should carefully address issues of patient characterization, randomization blinding, and other study quality issues.

Androgen Antagonists↗
PubMed1999

Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published TNM staging.

PURPOSE: To examine the usefulness of MR imaging for predicting local control of nasopharyngeal carcinoma (NPC) and the value of MR imaging in the newly published fifth edition of the TNM classification. METHODS AND MATERIALS: We studied 29 patients with NPC with MR imaging and CT before and after treatment. Staging was done according to the fourth and newly published fifth editions of the International Union Against Cancer (UICC) staging system. The radiotherapy protocol was designed to deliver 66 to 68 Gy to the primary tumor and clinically involved nodes. RESULTS: MR proved better than CT at identifying obliteration of the pharyngobasilar fascia, invasion of the sinus of Morgagni, through which the cartilaginous portion of the eustachian tube and the levator veli palatini muscle pass, invasion of the skull base, and metastases to lymph nodes in the carotid and retropharyngeal spaces. All seven patients without invasion of the pharyngobasilar fascia had local control. The local control rates of patients with invasion of the skull base were not good (60 to 73%). There was no apparent relationship between tumor volume determined by T1-weighted MR images and local control when the tumor volume was more than 20 cc. The newly published N staging system appears to successfully identify the high-risk group for distant metastasis as N3. In our series, four of five patients with N3 disease developed distant metastases. CONCLUSION: Deep infiltration of the tumor is a more important prognostic factor in NPC than tumor volume. Since the newly published T staging system requires a search for tumor invasion into soft tissue such as parapharyngeal space and bony structures, MR imaging may be indispensable for the newly published NPC staging system.

Adolescent↗
PubMed1997

Response rates to mail surveys published in medical journals.

OBJECTIVE: The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates. METHODS: One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information. RESULTS: The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates. CONCLUSIONS: Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.

Allied Health Personnel↗
PubMed2006

Lost in publication: Half of all renal practice evidence is published in non-renal journals.

Physicians often scan a select number of journals to keep up to date with practice evidence for patients with kidney conditions. This raises the question of where relevant studies are published. We performed a bibliometric analysis using 195 renal systematic reviews. Each review used a comprehensive method to identify all primary studies for a focused clinical question relevant to patient care. We compiled all the primary studies included in these reviews, and considered where each study was published. Of the 2779 studies, 1351 (49%) were published in the top 20 journals. Predictably, this list included Transplantation Proceedings (5.9% of studies), Kidney International (5.3%), American Journal of Kidney Diseases (4.7%), Nephrology Dialysis Transplantation (4.3%), Transplantation (4.2%), and Journal of the American Society of Nephrology (2.4%). Ten non-renal journals were also on this list, including New England Journal of Medicine (2.4%), Lancet (2.3%), and Diabetes Care (2.2%). The remaining 1428 (51%) studies were published across other 446 journals. When the disciplines of all journals were considered, 59 were classified as renal or transplant journals (42% of articles). Other specialties included general and internal medicine (16%), endocrinology (diabetes) and metabolism (6.5%), surgery (6.2%), cardiovascular diseases (6.1%), pediatrics (4.3%), and radiology (3.3%). About half of all renal practice evidence is published in non-renal journals. Browsing the top journals is important. However, relevant studies are also scattered across a large range of journals that may not be routinely scanned by busy physicians, and keeping up with this literature requires other continuing education strategies.

Evidence-Based Medicine↗
PubMed2000

JESAM: CORBA software components to create and publish EST alignments and clusters.

MOTIVATION: Expressed Sequence Tags (ESTs) are cheap, easy and quick to obtain relative to full genomic sequencing and currently sample more eukaryotic genes than any other data source. They are particularly useful for developing Sequence Tag Sites (STSs for mapping), polymorphism discovery, disease gene hunting, mass spectrometer proteomics, and most ironically for finding genes and predicting gene structure after the great effort of genomic sequencing. However, ESTs have many problems and the public EST databases contain all the errors and high redundancy intrinsic to the submitted data so it is often found that derived database views, which reduce both errors and redundancy, are more effective starting points for research than the original raw submissions. Existing derived views such as EST cluster databases and consensus databases have never published supporting evidence or intermediary results leading to difficulties trusting, correcting, and customizing the final published database. These difficulties have lead many groups to wastefully repeat the complex intermediary work of others in order to offer slightly different final views. A better approach might be to discover the most expensive common calculations used by all the approaches and then publish all intermediary results. Given a globally accessible database with a suitable component interface, like the JESAM software described in this paper, the creation of customized EST-derived databases could be achieved with minimum effort. RESULTS: Databases of EST and full-length mRNA sequences for four model organisms have been self-compared by searching for overlaps consistent with contiguity. The sequence comparisons are performed in parallel using a PVM process farm and previous results are stored to allow incremental updates with minimal effort. The overlap databases have been published with CORBA interfaces to enable flexible global access as demonstrated by example Java applet browsers. Simple cDNA supercluster databases built as alignment database clients are themselves published via CORBA interfaces browsable with prototypical applets. A comparison with UniGene Mouse and Rat databases revealed undesirable features in both and the advantages of contrasting perspectives on complex data. AVAILABILITY: The software is packaged as two Jar files available from: URL: http://corba.ebi.ac.uk/EST/jesam/jesam. html. One jar contains all the Java source code, and the other contains all the C, C++ and IDL code. Links to working examples of the alignment and cluster viewers (if remote firewall permits) can be found at http://corba.ebi.ac.uk/EST. All the Washington University mouse EST traces are available for browsing at the same URL.

Animals↗
PubMed2005

An assessment of the methodological quality of research published in The American Journal of Sports Medicine.

BACKGROUND: Evidence-based medicine has become a popular topic in academic medicine during the past several decades and more recently in orthopaedics and sports medicine. HYPOTHESIS: Articles published in The American Journal of Sports Medicine have shown an improvement in methodological quality in 2001-2003, compared with 1991-1993. STUDY DESIGN: Systematic review. METHODS: All articles published in The American Journal of Sports Medicine during the periods 1991-1993 and 2001-2003 were reviewed and classified by type of study. The use of pertinent methodologies such as prospective data collection, randomization, blinding, and controlled studies was noted for each article. The frequency of each article type and the use of evidence-based techniques were compared across study periods. RESULTS: Case series and descriptive studies decreased during the study period, from 27.4% to 15.3% (P = .00003) and from 11.9% to 5.6% (P = .001), respectively, of articles published. Prospective cohort studies increased from 4.7% to 14.1% (P = .000005), and randomized, prospective clinical trials increased from 2.7% to 5.9% of articles (P = .04). More studies tested an explicit hypothesis (P = .0000002), used prospective data collection (P = .000003), and used blinding (P = .02), and more studies identified a funding source (P = .004). CONCLUSIONS: Overall, there was a shift toward more prospective and randomized research designs published in The American Journal of Sports Medicine during 2001-2003 compared to 1991-1993, demonstrating an improvement in the methodological quality of published research.

Case-Control Studies↗
PubMed2007

HEE-GER: a systematic review of German economic evaluations of health care published 1990-2004.

BACKGROUND: Studies published in non-English languages are systematically missing in systematic reviews of growth and quality of economic evaluations of health care. The aims of this study were: to characterize German evaluations, published in English or German-language, in terms of various key parameters; to investigate methods to derive quality-of-life weights in cost-utility studies; and to examine changes in study characteristics over the years. METHODS: We conducted a country-specific systematic review of the German and English-language literature of German economic evaluations (assessment of or application to the German health care system) published 1990-2004. Generic and specialized health economic databases were searched. Two independent reviewers verified fulfillment of inclusion criteria and extracted study characteristics. RESULTS: The fulltexts of 730 articles were reviewed of which 283 fulfilled all entry criteria. 32% of included studies were published in German-language. 51% of studies evaluated pharmaceuticals and 63% were cost-effectiveness analyses. Economic appraisals concentrate on few disease categories and important health areas are strongly underrepresented. Declaration of sponsorship was associated with article language (49% English articles vs. 29% German articles, p < 0.001). The methodology used to obtain quality-of-life weights in published cost-utility studies was very diverse, poorly reported and most studies did not use German patients' or community health state evaluations. CONCLUSION: Many of the German-language evaluations included in our study are likely to be missing in international reviews and may be systematically different from English-language reviews from Germany. Lack of transparency and adherence to recommended reporting practices constitute a serious problem in German economic evaluations.

Cost-Benefit Analysis↗
PubMed2000

Content and quality of currently published phase II cancer trials.

PURPOSE: A number of statistical methods have been proposed for the design and analysis of phase II studies based on dichotomous outcomes. To investigate to what extent such methods are in current use, we conducted a survey of published studies. MATERIALS AND METHODS: We identified studies by conducting a computerized literature search of MEDLINE. We considered trials on systemic antineoplastic treatments described as phase II or pilot. The search was limited to articles written in English and published in 1997. RESULTS: Three hundred eight trials were identified. The majority, ie, 295 (95.8%), had been conducted as single-arm studies, with objective tumor response as the primary efficacy end point. An identifiable statistical design was reported for only 58 (19.7%) of these trials. The quality in reporting the statistical design and compliance with the design in carrying out the study or results interpretation were frequently poor. The frequency of reporting the statistical design was not shown to increase over the years of study start and was not associated with sample size or study duration. Instead, a significant association was found with trial results (which were less frequently positive among studies with a statistical design) and with the impact factor of the publishing journal. CONCLUSION: This survey shows that the quality of the statistical component of published phase II cancer trials is generally poor and raises suspicion that low quality is likely to bias study findings. Journals might improve the methodologic standard of published articles through a more vigilant reviewing policy.

Clinical Trials, Phase II as Topic↗
PubMed2005

Corticosteroid-associated tendinopathies: an analysis of the published literature and spontaneous pharmacovigilance data.

INTRODUCTION AND OBJECTIVE: Corticosteroids may cause tendinopathies, an adverse effect that is not well known and characterised, although it was initially described more than 40 years ago. This study was conducted in order to characterise the important aspects of this adverse reaction, such as the role played by routes of corticosteroid administration, therapy duration, comedication, cumulative corticosteroid dose and underlying disease. STUDY DESIGN AND METHODS: Published case reports of tendinopathies that were associated with corticosteroid use were identified by a comprehensive literature search using the databases MEDLINE, Pharm-line, EMBASE, ToxFile, Adis Inpharma, International Pharmaceutical Abstracts, Drug Information Fulltext and PASCAL. The reference lists of all pertinent articles were cross-referenced to retrieve additional cases. Spontaneous reports were requested from the Uppsala Monitoring Centre (the WHO Collaborating Centre for International Drug Monitoring). Information of published and spontaneous reports was analysed with regard to age, sex, underlying disease, individual corticosteroids, equivalent corticosteroid dose, latency time, cumulative dose, route of administration, comedication and type of tendinopathy. RESULTS: We included and analysed 73 published case reports and case series involving 133 patients and 191 spontaneous reports of corticosteroid-associated tendinopathies. The proportion of women with tendinopathies was 50.8% and 41.0%, respectively. The mean age (+/- standard deviation) of patients with a tendinopathy was 50 +/- 17 years and 61 +/- 16 years, respectively. The predominant routes of administration were oral (33% of published cases and 47% of spontaneous cases) and intra-articular (35% of the published cases or parenteral (7% of the spontaneous cases). There were isolated cases of tendinopathy after inhaled or topical (i.e. ocular, cutaneous, nasal) corticosteroid use. Tendinopathies that were reported in the literature cases consisted mainly of tendon ruptures (93%), predominantly of the Achilles tendon. Of the spontaneous cases, 31% had a rupture and the remaining cases had a tendinitis or an unspecified tendon disorder. CONCLUSION: Oral and parenteral applications, especially intra-articular use, were the most prevalent routes of administration in cases with corticosteroid-associated tendinopathies. However, topical application has also been rarely associated with tendinopathies. Future pharmacoepidemiological studies should further address this issue to quantify the risk of corticosteroid-associated tendinopathies.

Adolescent↗
PubMed2000

The quality of reporting in published cost-utility analyses, 1976-1997.

PURPOSE: Cost-utility analysis is a type of cost-effectiveness analysis in which health effects are measured in terms of quality-adjusted life-years (QALYs) gained. Such analyses have become popular for examining the health and economic consequences of health and medical interventions, and they have been recommended by leaders in the field. These recommendations emphasize the importance of good reporting practices. This study determined 1) the quality of reporting in published cost-utility analyses through 1997 and 2) whether reporting practices have improved over time. We examined quality of reporting by journal type and number of cost-utility analyses a journal has published. DATA SOURCES: Computerized databases were searched through 1997 for the Medical Subject Headings or text keywords quality-adjusted, QALY, and cost-utility analysis. Published bibliographies of the field were also searched. STUDY SELECTION: Original cost-utility analyses written in English were included. Cost-effectiveness analyses that measured health effects in units other than QALYs and review, editorial, or methodologic articles were excluded. DATA EXTRACTION: Each of the 228 articles found was audited independently by two trained readers who used a standard data collection form to determine the quality of reporting in several categories: disclosure of funding, framing, reporting of costs, reporting of preference weights, reporting of results, and discussion. RESULTS: The number of cost-utility analyses in the medical literature increased greatly between 1976 and 1997. Analyses covered a wide range of diseases and interventions. Most studies listed modeling assumptions (82%), described the comparator intervention (83%), reported sensitivity analysis (89%), and noted study limitations (84%). Only 52% clearly stated the study perspective; 34% did not disclose the funding source. Methods of reporting costs and preference weights varied widely. The quality of published analyses improved slightly over time and was higher in general clinical journals and in journals that published more of these analyses. CONCLUSIONS: The study results reveal an active and evolving field but also underscore the need for more consistency and clarity in reporting. Better peer review and independent, third-party audits may help in this regard. Future investigations should examine the quality of clinical and economic assumptions used in cost-utility analyses, in addition to whether analysts followed recommended protocols for performance and reporting.

Cost-Benefit Analysis↗
PubMed1999

Publishing in dental education: a history and systematic analysis.

The aim of this paper is to provide an overview of the development of dental education and its present status as evidenced by published articles in the dental literature. The method used has been a stratified sampling review of 3 journals. The analysis of articles in the British Dental Journal (BDJ) covers 4 periods between 1903 and 1994. A separate study of more recent trends sampled the Journal of Dental Education (J Dent Educ) at 5-year intervals between 1977 and 1997 as well as all the articles published in the European Journal of Dental Education (EJDE) in 1997-98. The long-term survey (BDJ) indicated that the subject of dental education was already being seriously addressed in the early years of this century although articles were few. There was a progressive increase in the number and types of article published over the period of the analysis. Many of the issues addressed in the first half of the century were similar to controversial topics in the present day. In the analysis of recent years (J Dent Educ 1977-1997) the number of articles devoted to strictly educational subjects fell to be replaced by articles only indirectly related to dental education. No consistent pattern was discernible in the type of articles published. There was a paucity of review articles throughout the period. Research articles were proportionally higher in the middle years of the period of the study. Both in the J Dent Educ and the EJDE, the highest proportions of articles were those concerned with curriculum, teaching methods, assessment and quality issues. The paper advocates more evidence-based studies, qualitative research and systematic reviews of the dental educational literature. It concludes that there is a need and an opportunity for expansion of both the quantity and quality of published articles in dental education.

Education, Dental↗
PubMed2002

[Agreement between guidelines for pharmaco-economic research and never-before-published health-economics evaluations].

OBJECTIVE: To investigate whether the health-economics research published in Dutch journals is in agreement with the guidelines for pharmaco-economic research as published in 1999 by the Dutch 'College voor zorgverzekeringen' [Healthcare Insurance Board]. DESIGN: Descriptive. METHOD: A literature search was performed for health-economic evaluations published during 1990-1999 in Dutch journals such as Nederlands Tijdschrift voor Geneeskunde (NTvG), Pharmaceutisch Weekblad and Tijdschrift voor Gezondheidswetenschappen. The resulting 19 studies, primarily published in the NTvG, were compared with the pharmaco-economic guidelines, summarised in 9 criteria. RESULTS: The social perspective was taken in 5 studies (26%), non-related medical costs were excluded in 19 (100%), relevant subgroup analyses were performed in 16 (84%), effectiveness was explicitly differentiated from efficacy in 15 (79%), incremental analysis was performed in 18 (95%), an adequate period of analysis was chosen in 16 (84%), costs, benefits and health gains were discounted in 13 (68%), sensitivity analysis was included in the investigation in 10 (53%), and estimated cost prices were used in 9 (47%). CONCLUSION: The methodology in recently published Dutch health-economics research was partly in agreement with the later official guidelines for pharmaco-economic studies in the Netherlands.

Bibliometrics↗
PubMed1985

[Analysis of scientific information published in Brazil in 5 years on Chagas disease, schistosomiasis, malaria, leishmaniasis and filariasis].

This paper offers a quantitative evaluation of the scientific information produced in Brazil on several endemic diseases: Chagas' disease, schistosomiasis, leishmaniasis, leprosy, malaria and filariasis. The source of data was the Index Medicus Latino Americano (IMLA), and the published scientific information was analyzed in general and specifically, by type of disease and year of publication. The indexed production of articles on the material of the Latin American countries as a whole increased from 3,506 articles in 1978 to 5,528 in 1982 (for an increase of 52.7%), whereas that of Brazil alone rose from 1,781 to 2,531 (an increase of 42.1%) during the same period. The output of articles on endemic diseases totaled 703 papers (6.3% of the total indexed production). Of this total, 441 (62.7%) was on applied research and 262 (37.3%) were on basic research, and these proportions held relatively constant. Chagas' disease and schistosomiasis accounted for 75.2% of that total over the period considered. The production of papers on the diseases of interest grew 79.2%, at the same rate as that of all biomedical information published in Brazil over the period. An equilibrium was reached between the numbers of basic and applied papers. The analysis also identified the core of Brazilian periodicals that most frequently publish information on those endemics. It was also found that a large proportion of articles by Brazilian authors are published in journals of international circulation, and the foreign journals that publish papers by researchers in Brazil were identified.

Brazil↗
PubMed1998

The content and methodology of research papers published in three United Kingdom primary care journals.

BACKGROUND: With the expansion of academic departments, the National Research and Development initiative, and the Culyer report, United Kingdom (UK) general practice research is undergoing a period of investment and change. AIM: To examine the content and methodological quality of UK-published general practice research, and in particular to focus on the quantity and proportion of studies that were of high methodological quality, namely randomized controlled trials (RCTs). METHOD: We manually searched three UK-published journals over a five-year period: the British Journal of General Practice (BJGP), Family Practice, and the British Medical Journal (BMJ), which has a section devoted to general practice research. Studies were classified according to the International Classification of Health Problems of Primary Health Care (ICHPPC-2). RESULTS: Nearly half of published studies in UK primary care journals were concerned with either organization and administration issues in primary care or social problems (509 studies, 48%). Just over half were either qualitative studies or surveys of opinion or attitudes (528 studies, 50%). The overall number of RCTs was low (67 studies, 6%), and the proportion published has not changed over time (chi 2 for trend = 3.79, df = 1, P = 0.051). In contrast to surgical journals, nearly one-fifth of studies in general practice followed a longitudinal design (186 studies, 18%). CONCLUSIONS: The content and design of published general practice research in the UK is varied and broad. The most robust methodological design should be the aim of all prospective researchers in general practice.

Humans↗
PubMed2002

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

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

Consumer Behavior↗
PubMed1994

Quality of published reports of the prognosis of community-acquired pneumonia.

OBJECTIVE: To systematically assess the quality of published reports of the prognosis of community-acquired pneumonia using a formal quality assessment instrument. DESIGN: Retrospective review of studies published during 1966-1991. ARTICLES: 108 articles related to the prognosis of community-acquired pneumonia retrieved by a computerized search. INTERVENTION: All articles, blinded to author(s), journal title, year of publication, and study institution(s), were independently reviewed by two investigators using a ten-item quality assessment instrument designed to evaluate: 1) identification of the inception cohort (4 items), 2) description of referral patterns (1 item), 3) subject follow-up (2 items), and 4) statistical methods (3 items). Adherence to each of the ten individual quality items and an overall quality score were calculated for all articles and across three time periods. MAIN RESULTS: Among all 108 articles that underwent quality assessment, 30 were published from 1966 to 1979, 61 from 1980 through 1989, and 17 from 1990 through 1991. The mean total quality score of all articles was 0.55 (range 0.22-0.90). There was a significant trend toward improvement in total quality scores over the three time periods (0.50 to 0.56 to 0.65; p < 0.001). However, several systematic errors in the study design or reporting of these studies were discovered throughout time: only 3.7% provided comparative information about nonenrolled patients, 28.7% determined whether the study institution was a referral center, 36.1% specified inclusion or exclusion criteria, and 45.5% used appropriate statistical analyses to adjust for more than one prognostic factor. CONCLUSIONS: Despite improvement in overall quality of published articles, systematic errors exist in the design and reporting of studies related to the prognosis of community-acquired pneumonia. The quality assessment tool employed in this study could be used to guide the development of high-quality outcomes research in the future.

Adult↗