Meta-analysis and systematic review (Health Sciences)

Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm?

by Zbys Fedorowicz

Fleming PS, Seehra J, Polychronopoulou A, Fedorowicz Z, Pandis N. Eur J Orthod. 2012 Apr 16. [Epub ahead of print]

The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic... more The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.

Beyond FMEA: The Structured What-If Technique (SWIFT)

by Alan Card

Card AJ, Ward JR, Clarkson PJ. Beyond FMEA: The Structured What-If Technique (SWIFT). Journal of Healthcare Risk Management. 2012;31(4):23-9.

If you would like a copy of the final published version of this paper, and do not have access to the Journal of Healthcare Risk Management, feel free to write me at: alan.j.card [at] gmail.com.

Although it is probably the best-known Prospective Hazard Analysis (PHA) tool, Failure Mode and Effects Analysis... more Although it is probably the best-known Prospective Hazard Analysis (PHA) tool, Failure Mode and Effects Analysis (FMEA) is far from the only option available. This paper introduces one of the alternatives: The Structured What-If Technique (SWIFT). SWIFT is a flexible, high-level risk identification technique that can be used on a standalone basis, or as part of a staged approach to make more efficient use of bottom-up methods like FMEA.

In this paper we describe the method, assess the evidence related to its use in healthcare using a systematic literature review, and suggest ways in which it could be better adapted for use in the healthcare industry. Based on the limited
evidence available, it appears that healthcare workers find it easy to learn, easy to use, and credible. Especially when used as part of a staged approach, SWIFT appears capable of playing a useful role as component of the PHA
armamentarium.

Intelligence in youth and all-cause-mortality: systematic review with meta-analysis

by Candida Fenton

International Journal of Epidemiology 2010;1–19
Catherine M Calvin,1 Ian J Deary,1* Candida Fenton,2 Beverly A Roberts,1 Geoff Der,2 Nicola Leckenby1 and G David Batty1,2,3

1 Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK,
2 Medical Research Council Social & Public Health Sciences Unit, Glasgow, UK and
3 Department of Epidemiology & Public Health, University College London, London, UK
*Corresponding author. Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK. E-mail: ian.deary@ed.ac.uk

Background A number of prospective cohort studies have examined the association between intelligence in childhood or... more Background A number of prospective cohort studies have examined the association between intelligence in childhood or youth and life expectancy in adulthood; however, the effect size of this association is yet to be quantified and previous reviews require updating.

Methods The systematic review included an electronic search of EMBASE, MEDLINE and PSYCHINFO databases. This yielded 16 unrelated studies that met inclusion criteria, comprising 22 453 deaths among 1 107 022 participants. Heterogeneity was assessed, and fixed effects models were applied to the aggregate data. Publication bias was evaluated, and sensitivity analyses were conducted.

Results A 1-standard deviation (SD) advantage in cognitive test scores was associated with a 24% (95% confidence interval 23–25) lower risk of death, during a 17- to 69-year follow-up. There was little evidence of publication bias (Egger’s intercept = 0.10, P = 0.81), and the intelligence–mortality association was similar for men and women. Adjustment for childhood socio-economic status (SES) in the nine studies containing these data had almost no impact on this relationship, suggesting that this is not a confounder of the intelligence–mortality association. Controlling for adult SES in five studies and for education in six studies attenuated the intelligence–mortality hazard ratios by 34 and 54%, respectively.

Conclusions Future investigations should address the extent to which attenuation of the intelligence–mortality link by adult SES indicators is due to mediation, over-adjustment and/or confounding. The explanation(s) for association between higher early-life intelligence and lower risk of adult mortality require further elucidation.

Successful Risk Assessment May Not Always Lead To Successful Risk Control: A Systematic Literature Review of Risk Control after Root Cause Analysis

by Alan Card

Alan J. Card, James Ward, P. John Clarkson. Successful Risk Assessment May Not Always Lead To Successful Risk Control: A Systematic Literature Review of Risk Control after Root Cause Analysis. Journal of Healthcare Risk Management. 2012;31(3):6-12.

Root cause analysis is perhaps the most widely used tool in healthcare risk management, but does it actually lead to... more Root cause analysis is perhaps the most widely used tool in healthcare risk management, but does it actually lead to successful risk control? Are there categories of risk control that are more likely to be effective? And do healthcare risk managers have the tools they need to support the risk control process? This systematic review examines how the healthcare sector translates risk analysis to risk control action plans and examines how to do better. It suggests that the hierarchy of risk controls should inform risk control action planning and that new tools should be developed to improve the risk control process.

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Wiley's copyright policies do not allow me to post the published version of the paper, but they do allow me to send out individual copies. So if you don't have access to the Journal of Healthcare Risk Management and would like a copy of this article, please email me at:
alan [dot] j [dot] card [at] gmail [dot] com

Reconceptualising searching and screening: How new technologies might change the way that we identify studies

by Alison O'Mara-Eves

Poster presentation at the 2011 Cochrane Colloquium.

Suggested citation:
Thomas J, & O'Mara AJ. (2011, Oct). Reconceptualising searching and screening: How new technologies might change the way that we identify studies. Presented at the 19th Cochrane Colloquium, 19-22 October 2011, Madrid, Spain.

Background
Typical reviews deal with the ‘information explosion’ by narrowing their search for studies (e.g.,... more Background
Typical reviews deal with the ‘information explosion’ by narrowing their search for studies (e.g., applying search filters). Relevant evidence can be missed through this approach. Current methods to minimise the risk of missing relevant studies involve searching broadly and screening potentially tens of thousands of records, which is not always practical. Resource-efficient approaches that maximise sensitivity are needed.

Objectives
To evaluate whether new technologies allow us to search broadly without increasing the screening workload through semi-automated screening approaches. Specifically, we evaluate two types of text mining: a support vector machine using active learning (Wallace et al., 2010) and TerMine term clustering.

Methods
Text mining techniques were employed in an ongoing review to prioritise records for screening and to classify the records automatically as includes or excludes. Screening prioritisation was assessed by comparison with a ‘baseline inclusion rate’ and through the novel application of power calculations. Classification was assessed through the stability of the classifier and the calculation of performance metrics (precision, recall, F-values).

Results
Screening prioritisation worked when sufficient information was provided to the text mining tool; in the ongoing review, only 25% of all records were screened manually to identify the expected total number of includes. Classification reduced the manual screening required in all reviews evaluated, although it worked better for some datasets than others.

Conclusions
Systematic reviews need to develop ways of handling the growing amount of evidence available. Text mining is a promising approach that shifts the emphasis of identification from the searching stage to screening. Reconceptualising searching permits broad searches to be conducted and allows reviewers to be more precise in estimating the number of potentially missing relevant studies than can be achieved by narrowing the search process. Areas for further development are suggested.

Proton magnetic resonance spectroscopy and illness stage in schizophrenia--a systematic review and meta-analysis.

by Stefan Brugger

Rees R, O’Mara A, Dickson K, Stansfield C, Caird J, Thomas J (2011) Communities that cook: a systematic review of the effectiveness and appropriateness of interventions to introduce adults to home cooking [review protocol]. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.

by Rebecca Rees

Food related ill health has been estimated to account for about 10% of ill-health and death in the UK, similar to that... more Food related ill health has been estimated to account for about 10% of ill-health and death in the UK, similar to that attributable to smoking. The prevalence of unhealthy diets in the UK and other Westernised societies has been linked in particular to increases in the availability of processed foods and pre-prepared and takeaway meals. While the influences on peoples’ diets in the UK are complex and manyfold, there has been concern that opportunities to learn how to prepare and cook food have been lost over the past few decades, leading to a loss of skills, knowledge and confidence. One of the responses to these concerns has been the development of community-based educational initiatives aimed at adults who want to learn to cook. Jamie Oliver’s ‘Ministry of Food’ initiative is perhaps the best-known of the home cooking initiatives currently being provided in the UK, although large numbers of schemes have been set up across the country. Often these initiatives have been part of a wider programme of developments to address barriers to healthy eating and ill-health more generally. While various forms of home cooking interventions have been tried out, and evaluations have been conducted, it appears that there has been no recent systematic attempt to pull together and appraise the findings of the range of evaluation studies that exists. The systematic review described in this protocol aims to address this gap. It will examine claims for home cooking initiatives, exploring their effects on various outcomes, the section of the population that is ultimately reached by them, and what, in practice, is required for their implementation.

Association between bullying and psychosomatic problems: a meta-analysis

by Gianluca Gini

Tuberculosis evidence review 1: Review of barriers and facilitators

by Alison O'Mara-Eves

Suggested citation:
O‘Mara, A. J., Marrero-Guillamón, I. Jamal, F., Lehmann, A., Cooper, C., and Lorenc, T. (2011). Tuberculosis evidence review 1: Review of barriers and facilitators. London: National Institute for Health and Clinical Excellence (NICE). Available for download from http://www.nice.org.uk/nicemedia/live/11978/56315/56315.pdf.

[Extract from the executive summary]

1.1. Introduction
This report presents the findings of a... more [Extract from the executive summary]

1.1. Introduction
This report presents the findings of a systematic review of qualitative evidence on the factors that help or hinder the uptake of TB diagnosis and treatment services by people from hard-to-reach groups.
The primary research question for the review was: What factors help or hinder the uptake of TB diagnosis and treatment services by people from hard-to-reach groups, for example, the stigma associated with diagnosis, and how can the barriers be overcome?
The secondary research questions were:
- How do views vary between different hard-to-reach groups?
- What are the views of service providers?

1.2 Methods
To locate evidence, a range of databases and websites indexing relevant literature were searched. Study reports were included if they:
- had a focus on TB services of any kind;
- were conducted in an OECD country;
- were published in 1990 or later;
- presented data on the views of hard-to-reach people regarding perceptions of or attitudes to TB services;
- presented qualitative data;
- included data from any hard-to-reach group (hard-to-reach groups include: prisoners; problem drug users or people with alcohol problems; homeless people or people in temporary accommodation; asylum seekers, refugees and recent immigrants; travellers; and sex workers). Only migrant groups of relevance to England were included. Respondents did not necessarily have to be diagnosed with TB; and
- were reported in English.

The quality of included studies was assessed, and data were extracted, using the standard tools for NICE public health evidence reviews. Study findings were synthesised thematically using a framework adapted from the Health Belief Model because the themes identified in the evidence mapped well onto the model. This is perhaps unsurprising given that the model originally developed in the context of TB screening uptake.

1.3 Findings
Twenty-five study reports were included in the review. Of these, nine came from the UK, ten from the USA, and two from Canada. The remaining four studies were from Italy, Norway, New Zealand, and Israel...

Gastrointestinal adverse effects of varenicline at maintenance dose: a meta-analysis. Leung L. et al.

by Lawrence Leung

Lawrence K Leung l, Francis M Patafio and Walter W Rosser

BMC Clinical Pharmacology 2011, 11:15

Background

Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most... more Background

Tobacco smoking remains the leading modifiable health hazard and varenicline is amongst the most popular pharmacological options for smoking cessation. The purpose of this study is to critically evaluate the extent of gastrointestinal adverse effects of varenicline when used at maintenance dose (1mg twice a day) for smoking cessation.
Methods

We conducted a meta-analysis of randomised controlled trials published in PUBMED and EMBASE according to the PRISMA guidelines. Selected studies satisfied the following criteria: (i) duration of at least 6 weeks, (ii) titrated dose of varenicline for 7 days then a maintenance dose of 1mg twice-per-day, (iii) randomized placebo-controlled design, (iv) extractable data on adverse event - nausea, constipation or flatulence. Data was synthesized into pooled odd ratios (OR) basing on random effects model. Quality of studies was also rated as per Cochrane risk-of-bias assessment. Number need to harm (NNH) was calculated for each adverse effect.
Results

98 potentially relevant studies were identified, 12 of which met the final inclusion criteria (n=5114). All 12 studies reported adverse events on nausea, which led to an OR of 4.45 (95% CI=3.79-5.23, p< 0.001; I2 = 0.06%, CI=0%-58.34%) and a NNH of 5. Eight studies (n=3539) contain data on constipation pooled into an OR of 2.45 (95% CI=1.61-3.72, p< 0.001; I2 = 34.09%, CI= 0%-70.81%) with a NNH of 24. Finally, five studies (n=2516) reported adverse events of flatulence, which pooled an OR of 1.74 (95% CI=1.23-2.48, p= 0.002; I2 = 0%, CI= 0%- 79.2%) with a NNH of 35.
Conclusions

Use of varenicline at maintenance dose of 1mg twice a day for longer than 6 weeks is associated with adverse gastrointestinal effects. In realistic terms, for every 5 treated subjects, there will be an event of nausea, and for every 24 and 35 treated subjects, we will expect an event of constipation and flatulence respectively. Family physicians should counsel patients of such risks accordingly during their maintenance therapy with varenicline.

Young people and mental health: a systematic review of research on barriers and facilitators

by Rebecca Rees

Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database of Systematic Reviews (update)

by Marian Brady

Brady MC, Furlanetto D, Hunter RV, Lewis S, Milne V.

Background:
For people with limitations due to neurological conditions such as stroke, the routine practice of... more Background:
For people with limitations due to neurological conditions such as stroke, the routine practice of oral health care (OHC) may become a challenge. Evidence-based supported oral care intervention is essential for this patient group.


Objectives:
To compare the effectiveness of staff-led OHC interventions with standard care for ensuring oral hygiene for individuals after a stroke.


Search strategy:
We searched the trials registers of the Cochrane Stroke Group (last searched April 2010) and Cochrane Oral Health Group (last searched May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library May 2010), MEDLINE (1966 to May 2010), CINAHL (1982 to May 2010), Research Findings Electronic Register (February 2006), National Research Register (Issue 1, 2006), ISI Science and Technology Proceedings (July 2010), Dissertation Abstracts and Conference Papers Index (August 2005), Zetoc (2000 to July 2010) and Proquest Dissertations and Theses (2000 to July 2010). We scanned reference lists from relevant papers and contacted authors and researchers in the field.


Selection criteria:
Randomised controlled trials that evaluated one or more interventions designed to improve oral hygiene. We included trials with a mixed population provided we could extract the stroke-specific data.


Data collection and analysis:
Two review authors independently classified trials according to the inclusion and exclusion criteria, assessed the trial quality and extracted data. We sought clarification from study authors when required.


Main results:
We included three studies involving 470 participants. These trials were of limited comparability evaluating an OHC education training programme, a decontamination gel and a ventilator-associated pneumonia bundle of care augmented with an OHC component by comparing them to a deferred intervention, a placebo gel or standard care respectively. The OHC educational intervention demonstrated a significant reduction in denture plaque scores up to six months (P < 0.00001) after the intervention but not dental plaque. Staff knowledge (P = 0.0008) and attitudes (P = 0.0001) towards oral care also improved. The decontamination gel reduced the incidence of pneumonia amongst the intervention group (P = 0.03).


Authors' conclusions:
Based on two trials involving a small number of stroke survivors, OHC interventions can improve staff knowledge and attitudes, the cleanliness of patients' dentures and reduce the incidence of pneumonia. Improvements in the cleanliness of patients teeth were not observed. Further evidence relating to staff-led oral care interventions is severely lacking.


This record should be cited as:


Brady MC, Furlanetto D, Hunter R, Lewis SC, Milne V. Staff-led interventions for improving oral hygiene in patients following stroke. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003864. DOI: 10.1002/14651858.CD003864.pub2

A Guide to Conducting a Systematic Literature Review of Information Systems Research

by Chitu Okoli

Protocol for a Systematic Literature Review of Research on the Wikipedia

by Chitu Okoli

Shyness and social phobia in children and adolescents: an emerging field

by Jose A. Piqueras

Reference:

Olivares, J., Rosa, A. I., Piqueras, J. A., Sánchez-Meca, J. Méndez, F. X. y García-López, L. J. (2002). Timidez y fobia social en niños y adolescentes: un campo emergente. Psicología Conductual, 10, 523-542

"In Spanish"

In this paper the results of a meta-analysis of the effectiveness of psychological treatment for relationship problems... more In this paper the results of a meta-analysis of the effectiveness of psychological treatment for relationship problems in children and adolescents are presented. A total of 15 articles, which fulfilled the selection criteria, were identified leading to 24 independent studies. They were used to work out the standardized mean difference between the treated group mean minus the control group mean. The mean effect size at the pos-test (d+ = 0.59) and follow-up (d+ = 0.64) showed the effectiveness of the treatment for decreasing and eliminating shyness and social phobia, as well as the symptoms of maladjustment, improving self-esteem and social skills. All in all, significant differences were found among the different treatment components, and the combination of exposure, social skills and cognitive techniques proved to be the best method. Other outstanding variables were the duration, frequency and intensity of the treatment, age and gender of the samples, mortality and experimental quality. Finally, the results are discussed and several suggestions are made to help in future research into these behavioral problems.

A Synthesis of Research Addressing Children's Young People's and Parents' Views of Walking and Cycling for Transport

by Kathryn Oliver

Health Promotion, Inequalities and Young People's Health: a Systematic Review of Research

by Kathryn Oliver

Cost sharing and Copayment: Lessons from 10 Countries

by Krit Pongpirul

Research Report for Health Insurance System Research Office (HSRO) 2008. (in Thai)

กฤษณ์ พงศ์พิรุฬห์. การมีส่วนร่วมจ่ายค่าบริการสุขภาพ: ประสบการณ์จาก 10 ประเทศ. นนทบุรี: สำนักงานวิจัยเพื่อการพัฒนาหลักประกันสุขภาพไทย 2551.

The rising health care cost has reached the point where cost sharing from patients might be essential to sustain the... more The rising health care cost has reached the point where cost sharing from patients might be essential to sustain the health system. This report is aimed to synthesize lessons on cost charing policies in 10 countries; namely, Australia, Canada, Finland, Germany, Japan, Singapore, South Korea, Taiwan, R.O.C., United Kingdom, and United States of America.
The study comprises two components. The first is literature review general information of each country on its current health insurance systems, basic principles for cost sharing, approaches and rates used for cost sharing, mechanisms to protect the disadvantaged population, as well key concerns about implementing cost sharing policy. Second, a systematic review is used to explore the effects of cost sharing and copayment policies on health services access/utilization, out-of-pocket expenditures, health care expenditures, quality of care, administrative cost.

Factors affecting uptake of childhood immunisation: a Bayesian synthesis of qualitative and quantitative evidence

by Mary Dixon-Woods

Falls in levels of measles, mumps, and rubella (MMR) immunisation in the UK and the continuing debate on how to... more Falls in levels of measles, mumps, and rubella (MMR) immunisation in the UK and the continuing debate on how to respond to this situation emphasise the importance of identifying and understanding the factors that affect the uptake of recommended childhood immunisations. Both qualitative and quantitative evidence could be useful in this process. We aimed to explore the feasibility and value of an approach to formal synthesis of qualitative and quantitative evidence in the context of factors affecting the uptake of childhood immunisation in developed countries. We used a Bayesian approach to meta-analysis. Evidence from 11 qualitative and 32 quantitative studies of factors affecting uptake of childhood immunisation was combined and assessed. We conclude that use of either qualitative or quantitative research alone might not identify all relevant factors, or might result in inappropriate judgments about their importance, and could thus lead to inappropriate formulation of evidence-based policy. Further development of our methods might enable rigorous synthesis of qualitative and quantitative evidence in this and other contexts.

Risk assessment techniques in public health administration: A systematic review

by Alan Card

Alan Card, James Ward, P John Clarkson. Risk assessment techniques in public health administration: A systematic review. The American Public Health Association's 139th Annual Meeting, Washington, DC. Oct 29 - Nov 2, 2011. Available at: http://apha.confex.com/apha/139am/webprogram/Paper243596.html