Systematic Reviews In Health Care Research Articles

The quality of COVID-19 systematic reviews during the coronavirus 2019 pandemic: an exploratory comparison

BackgroundThe unprecedented volume and speed at which COVID-19-related systematic reviews (SRs) may have been produced has raised questions regarding the quality of this evidence. It is feasible that pandemic-related factors may have led to an impairment in quality (reduced internal validity, increased risk of bias [RoB]). This may have serious implications for decision-making related to public health and individual healthcare.ObjectiveThe primary objective was to compare the quality of SRs published during the pandemic that were related to COVID-19 with SRs published during the pandemic that were unrelated to COVID-19 (all of which were fully appraised in the KSR Evidence database of SRs in healthcare). Our secondary objective was to compare the quality of SRs published during the pandemic (regardless of research topic), with SRs published pre-pandemic.MethodsWe compared all SRs related to COVID-19 to all SRs unrelated to COVID-19 that (i) were published during the pandemic (between 1st March 2020 and September 14, 2022), (ii) were included in KSR Evidence, and (iii) had been appraised using the ROBIS tool. We then compared all SRs published during the pandemic (regardless of research topic) with a pre-pandemic sample of SRs.ResultsFor SRs published during the pandemic, we found there was no statistically significant difference in quality between those SRs tagged as being related to COVID-19 and those that were not [relative risk (RR) of low RoB for COVID-19 versus COVID-19-unrelated reviews: 0.94; 95% confidence interval (CI): 0.66 to 1.34]. Generally, COVID-19 SRs and COVID-19-unrelated SRs were both of low quality with only 10% of COVID-19 reviews and 11% of COVID-19-unrelated reviews rated as low RoB. However, SRs (regardless of topic) published during the pandemic were of lower quality than those published pre-pandemic (RR for low RoB for ‘during pandemic’ versus ‘pre-pandemic’: 0.30; 95% CI: 0.26 to 0.34) with 11% of pandemic and 36% of pre-pandemic SRs rated as low RoB.ConclusionThese results suggest COVID-19 and COVID-19-unrelated SRs published during the pandemic are equally of low quality. SRs published during the pandemic were generally lower quality compared with SRs published pre-pandemic irrespective of COVID-19 focus. Moreover, SR quality in general is seriously lacking, and considerable efforts need to be made to substantially improve the quality and rigour of the SR process.

Exploring barriers and facilitators, and their effectiveness in eye health promotion interventions: Protocol of a systematic review.

The rising global prevalence of visual impairment attributed to population growth and ageing heightens the risk of increased vision problems for many. However, there is a limited understanding of factors influencing intervention implementation, and the degree to which participation is achieved in interventions for eye health promotion by eye care professionals is currently limited. The purpose of this protocol is to review evidence on barriers and facilitators in eye health promotion, and their effectiveness on interventions employed in eye health promotion. The Center for Reviews and Dissemination (CRD) guidance for conducting systematic reviews in healthcare and reporting in accordance with the PRISMA statement will serve as the basis for the implementation of the proposed systematic review. Systematic literature searches will be performed by searching three databases, as well as hand-searching articles eligible for inclusion. The searches will include peer-reviewed articles presenting evidence on eye health promotion intervention from the inception of the Vision 2020 Campaign to the present day. RevMan 5.3 software will be used to gather quantitative data, such as (Effectiveness), meta-analysis of such data will be performed. Two reviewers will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) 2018 version. We expect to find relevant studies on health promotion interventions among health professionals at different levels of care. The synthesized evidence will help guide further implementation of research on health promotion interventions for eye health.

An introduction to carrying out and appraising systematic reviews in healthcare

Systematic literature reviews remain one of the most trusted sources of evidence used to inform policy and clinical decision-making. The proliferation of academic publications makes reviews increasingly essential to practitioners and policy makers as they enable them to rapidly access high-quality evidence synthesised from multiple sources. Knowledge and awareness of the structure and components of a systematic review can aid in the production of high-calibre reviews and improve the ability to appraise their quality. An overview of the main stages of carrying out a review is presented here along with frameworks and methodological considerations that will aid those producing or appraising systematic reviews.

The paranasal sinus localization of cholesteatoma: a systematic review

Paranasal sinus cholesteatoma is a rare occurrence for which only a few cases have been reported in the literature, particularly in the frontal and maxillary sinuses. The clinical features are non-specific, and thus a broad differential diagnosis should be considered. In most cases, diagnostic imaging is carried out through CT and/or MRI scans, and the treatment goal is complete eradication regardless of the approach. In our review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and Egger et al.’s approach for Systematic Reviews in Health Care. The papers included were in English or Italian, with an available and congruous full text. Out of the 140 selected articles, we included only 22 papers, ranging from 1958 to 2020 and accounting for 24 patients. Eleven had cholesteatoma in the frontal, 9 in the maxillary sinus, and 4 in other sites. Most patients underwent CT scans or combined CT and MRI, and an open approach was the most selected procedure. Only 2 patients showed postoperative complications, and 5 patients had a recurrence over an average follow-up period of 25 months. In this first systematic review on this subject, we provide an overview of the diagnostic procedures, the proper surgical approach and the postoperative follow-up found in the literature without precise and shared guidelines.

Risk factors for COVID-19 among healthcare workers. A protocol for a systematic review and meta-analysis.

BackgroundEvidence on the spectrum of risk factors for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among front-line healthcare workers (HCWs) has not been well-described. While several studies evaluating the risk factors associated with SARS-CoV-2 infection among patient-facing and non-patient-facing front-line HCWs have been reported since the outbreak of the coronavirus disease in 2019 (COVID-19), and several more are still underway. There is, therefore, an immediate need for an ongoing, rigorous systematic review that continuously assesses the risk factors of SARS-CoV-2 infection among front-line HCWs.ObjectiveHere, we outline a protocol to serve as a guideline for conducting a living systematic review and meta-analysis to examine the burden of COVID-19 on front-line HCWs and identify risk factors for SARS-CoV-2 infection in patient-facing and non-patient-facing front-line HCWs.MethodsThe protocol was developed and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The conduct of the proposed living systematic review and meta-analysis will primarily follow the principles recommended in the Centre for Reviews and Dissemination (CRD) guidance for undertaking systematic reviews in healthcare, and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The systematic literature searches will be performed using the EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, Embase, PubMed, MEDLINE, Science Direct databases, Google Scholar, and; also a search in the China National Knowledge Infrastructure and the World Health Organization library databases for relevant studies will be performed. The searches will include peer-reviewed articles, published in English and Mandarin language irrespective of publication year, evaluating the risk for testing positive for C0VID-19, the risk of developing symptoms associated with SARS-CoV-2 infection, or both, among front-line HCWs. The initial review period will consider articles published since the onset of COVID-19 disease to the present and then updated monthly. Review Manager (RevMan 5.3) will be used to pool the odds ratios or mean differences for individual risk factors where possible. Results will be presented as relative risks and 95% confidence intervals for dichotomous outcomes and mean differences, or standardised mean differences along with 95% confidence intervals, for continuous outcomes. The Newcastle–Ottawa Scale will be used to rate study quality, and the certainty of the evidence will be assessed by using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). The results of the living systematic review and meta-analysis will be reported per the PRISMA guidelines.DiscussionThough addressing the needs of front-line HCWs during the COVID-19 pandemic is a high priority, data to inform such initiatives are inadequate, particularly data on the risk factor disparities between patient-facing and non-patient-facing front-line HCWs. The proposed living systematic review and meta-analysis anticipate finding relevant studies reporting risk factors driving the SARS-CoV-2 infection rates among patient-facing and non-patient-facing front-line HCWs, thus providing subsidies for public health interventions and occupational health policies. The study results will be disseminated electronically, in print and through conference presentation, and key stakeholder meetings in the form of policy briefs.Trail registrationPROSPERO registration number: CRD42020193508 available for public comments via the link below https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193508).

Association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases in sub-Saharan Africa: a systematic review and meta-analysis

In previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This systematic review and meta-analysis aimed to determine the associations between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs and estimate the prevalence of key metabolic risk factors among the food-insecure patients in sub-Saharan Africa. This study was guided by the Centre for Reviews and Dissemination (CRD) guidelines for undertaking systematic reviews in healthcare. The following databases were searched for relevant literature: PubMed, EBSCOhost (CINAHL with full text, Health Source - Nursing, MedLine). Epidemiological studies published between January 2015 and June 2019, assessing the associations between food insecurity and metabolic risk outcomes in sub-Saharan African populations, were selected for inclusion. Meta-analysis was performed with DerSimonian-Laird’s random-effect model at 95% confidence intervals (CIs). The I2 statistics reported the degree of heterogeneity between studies. Publication bias was assessed by visual inspection of the funnel plots for asymmetry, and sensitivity analyses were performed to assess the meta-analysis results’ stability. The Mixed Methods Appraisal Tool (MMAT) – Version 2018 was used to appraise included studies critically. The initial searches yielded 11,803 articles, 22 cross-sectional studies were eligible for inclusion, presenting data from 26,609 (46.8% males) food-insecure participants, with 11,545 (42.1% males) reported prevalence of metabolic risk factors. Of the 22 included studies, we identified strong evidence of an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs, based on 20 studies. The meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors among food-insecure participants at 41.8% (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00) derived from 14 studies. The most prevalent type of metabolic risk factors was dyslipidaemia 27.6% (95% CI: 6.5% to 54.9%), hypertension 24.7% (95% CI: 15.6% to 35.1%), and overweight 15.8% (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males. In this systematic review and meta-analysis, exposure to food insecurity was adversely associated with a wide spectrum of key metabolic risk factors, such as obesity, dyslipidaemia, hypertension, underweight, and overweight. These findings highlight the need to address food insecurity as an integral part of diet-sensitive NCDs prevention programmes. Further, these findings should guide recommendations on the initiation of food insecurity status screening and treatment in clinical settings as a basic, cost-effective tool in the practice of preventive medicine in sub-Saharan Africa.PROSPERO registration number: PROSPERO 2019 CRD42019136638.

Directing scientists away from potentially biased publications: the role of systematic reviews in health care

Despite increasing concerns about the validity of published research, the issue of how the scientific community can maintain a high-quality body of research is not well understood. We consider the case of systematic reviews in health care, and explore whether risk of bias ratings communicated within these reviews may help shift scientists’ attention towards published research that is at a low risk of bias. We focus on publications deemed at risk of bias due to selective reporting; that is, scientific articles with high chances of systematic errors in the published research findings due to flaws in the reporting. Using a matched-sample control group we find that, after potential bias is signalled in systematic reviews, publications at high risk of bias attract less attention – as indicated by fewer follow-on citations – when compared to a control group of low risk of bias publications. We extend our analysis by considering those cases where risk of bias is unclear, and by examining how different features of the rating system may affect the magnitude of the main effect. The findings provide evidence about whether systematic reviews can play a role in signalling biases in the scientific literature, over and above their established role of synthesising prior research.

Assessing the Quality of Systematic Reviews in Healthcare Using AMSTAR and AMSTAR2

Abstract. The current study assessed the consistency between A Measurement Tool to Assess Systematic Reviews (AMSTAR) and its updated version (AMSTAR2) applied to the same systematic reviews in healthcare. Data from k = 10 systematic reviews were coded by two raters using AMSTAR and AMSTAR2. AMSTAR and AMSTAR2 perfectly agreed on a subset of nine individual items and strongly correlated based on the total scores (percentage scores: ρ = .84, p = .002, k = 10; absolute scores: Spearman ρ = .83, p = .003, k = 10). The overall review quality was medium to high on AMSTAR, while the overall confidence in the results was low to critically low on AMSTAR2 for the same systematic reviews. AMSTAR2 can identify the sources of strengths, weaknesses, and biases in systematic reviews. However, the interpretation of the overall confidence in results of systematic reviews requires additional guidelines for users.

Software tools to support title and abstract screening for systematic reviews in healthcare: an evaluation

BackgroundSystematic reviews are vital to the pursuit of evidence-based medicine within healthcare. Screening titles and abstracts (T&Ab) for inclusion in a systematic review is an intensive, and often collaborative, step. The use of appropriate tools is therefore important. In this study, we identified and evaluated the usability of software tools that support T&Ab screening for systematic reviews within healthcare research.MethodsWe identified software tools using three search methods: a web-based search; a search of the online “systematic review toolbox”; and screening of references in existing literature. We included tools that were accessible and available for testing at the time of the study (December 2018), do not require specific computing infrastructure and provide basic screening functionality for systematic reviews. Key properties of each software tool were identified using a feature analysis adapted for this purpose. This analysis included a weighting developed by a group of medical researchers, therefore prioritising the most relevant features. The highest scoring tools from the feature analysis were then included in a user survey, in which we further investigated the suitability of the tools for supporting T&Ab screening amongst systematic reviewers working in medical research.ResultsFifteen tools met our inclusion criteria. They vary significantly in relation to cost, scope and intended user community. Six of the identified tools (Abstrackr, Colandr, Covidence, DRAGON, EPPI-Reviewer and Rayyan) scored higher than 75% in the feature analysis and were included in the user survey. Of these, Covidence and Rayyan were the most popular with the survey respondents. Their usability scored highly across a range of metrics, with all surveyed researchers (n = 6) stating that they would be likely (or very likely) to use these tools in the future.ConclusionsBased on this study, we would recommend Covidence and Rayyan to systematic reviewers looking for suitable and easy to use tools to support T&Ab screening within healthcare research. These two tools consistently demonstrated good alignment with user requirements. We acknowledge, however, the role of some of the other tools we considered in providing more specialist features that may be of great importance to many researchers.

What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments.

International clinical practice guidelines for low back pain (LBP) contain consistent recommendations including universal provision of information and advice to remain active, discouraging routine referral for imaging, and limited prescription of opioids. This systematic review describes usual care provided by first-contact physicians to patients with LBP. Studies that reported the assessments and care provided to people with LBP in family practice and emergency departments (EDs) from January 2000 to May 2019 were identified by searches of PubMed, EMBASE, and CINAHL. Study quality was assessed with reference to representativeness of samples, potential misclassification of patients, potential misclassification of outcomes, inconsistent data and precision of the estimate, and the findings of high-quality studies were prioritized in the data synthesis. We included 26 studies that reported data from almost 195,000 patients: 18 from family practice, and 8 from EDs. Less than 20% of patients with LBP received evidence-based information and advice from their family practitioner. Around 1 in 4 patients with LBP received referral for imaging in family practice and 1 in 3 in EDs. Up to 30% of patients with LBP were prescribed opioids in family practice and up to 60% in EDs. Large numbers of patients who saw a physician for LBP received care that is inconsistent with evidence-based clinical practice guidelines. Usual care included overuse of imaging and opioid prescription and underuse of advice and information. Suboptimal care may contribute to the massive burden of the condition worldwide.

Delays related to maternal mortality in the department of Santander from 2012 to 2015

To characterize maternal deaths in the department of Santander, Colombia, and the delays that contributed to these deaths during the period 2012-2015, through a systematic review of health care, in order to offer an input that allows proposing actions that contribute to reduce these fatal outcomes. Descriptive, retrospective, cross-sectional study that determines the characteristics of maternal mortality in pregnant or postpartum women who were administered complete analysis units and whose death was not caused by external or violent causes. The most frequent delay in the 49 cases of maternal deaths was type IV, which refers to the delay in receiving adequate and timely medical treatment (87.8%), mainly due to deficiencies in promotion and prevention strategies (63.2%). The majority of the deaths were avoidable (61.2%) in the puerperium (84%), and in users of the subsidized insurance scheme (57.1%). Although 98% of mothers were affiliated to the health system (subsidized, contributory, special or exceptional schemes), it was possible to demonstrate that women who were affiliated to the subsidized regime showed a greater frequency of the event, which reflects that there are important opportunities for improvement in the care provided to pregnant women in this type of scheme.

An International Educational Training Course for Conducting Systematic Reviews in Health Care: The Joanna Briggs Institute's Comprehensive Systematic Review Training Program.

The cornerstone of evidence-based health care is the systematic review of international evidence. Systematic reviews follow a rigorous, standardized approach in their conduct and reporting, and as such, education and training are essential prior to commencement. This study reports on the evolution of the Joanna Briggs Institute Comprehensive Systematic Review Training Program (JBICSRTP) as an exemplar approach for teaching systematic review methods. The Joanna Briggs Institute (JBI) is an international research and development center at the University of Adelaide, South Australia. Its mission is to promote and facilitate evidence-based best practice globally, largely through the provision of education and training. JBI was one of the first to consider all forms of evidence in systematic reviews, and as such, implementation of standardized training was essential. Since 1999, JBI has offered a systematic review training program. The JBICSRTP is now delivered face to face over 5days, with an optional online component; the content aligns to that proposed in the Sicily statement. Over the last 3years, JBI and its Collaboration have trained over 3,300 people from over 30 countries. A "train-the-trainer" (TtT) style program was established to cope with demand, and to date, hundreds of trainers have been licensed across the globe to deliver the JBICSRTP. Providing standardized training materials, ensuring open and ongoing communication, and adopting a TtT style program while still allowing for local adaptability are strategies that have led to the establishment of a highly skilled global training network and ensured the success and longevity of the JBICSRTP.

ROSES RepOrting standards for Systematic Evidence Syntheses: pro forma, flow-diagram and descriptive summary of the plan and conduct of environmental systematic reviews and systematic maps

Reliable synthesis of the various rapidly expanding bodies of evidence is vital for the process of evidence-informed decision-making in environmental policy, practice and research. With the rise of evidence-base medicine and increasing numbers of published systematic reviews, criteria for assessing the quality of reporting have been developed. First QUOROM (Lancet 354:1896–1900, 1999) and then PRISMA (Ann Intern Med 151:264, 2009) were developed as reporting guidelines and standards to ensure medical meta-analyses and systematic reviews are reported to a high level of detail. PRISMA is now widely used by a range of journals as a pre-submission checklist. However, due to its development for systematic reviews in healthcare, PRISMA has limited applicability for reviews in conservation and environmental management. We highlight 12 key problems with the application of PRISMA to this field, including an overemphasis on meta-analysis and no consideration for other synthesis methods. We introduce ROSES (RepOrting standards for Systematic Evidence Syntheses), a pro forma and flow diagram designed specifically for systematic reviews and systematic maps in the field of conservation and environmental management. We describe how ROSES solves the problems with PRISMA. We outline the key benefits of our approach to designing ROSES, in particular the level of detail and inclusion of rich guidance statements. We also introduce the extraction of meta-data that describe key aspects of the conduct of the review. Collated together, this summary record can help to facilitate rapid review and appraisal of the conduct of a systematic review or map, potentially speeding up the peer-review process. We present the results of initial road testing of ROSES with systematic review experts, and propose a plan for future development of ROSES.

Cost of Type 2 Diabetes Management And Associated Complications In The United Kingdom

The objective of this study was two-fold. Firstly, to systematically collect up-to-date published cost data for management (pharmacotherapy) and associated complications (cardiovascular, renal, eye disease and diabetic foot) of type 2 diabetes mellitus in the United Kingdom (UK) for use in the CORE Diabetes Model (CDM). Secondly, where data was scarce, calculations were carried out to estimate the cost inputs for CDM. A systematic literature review (SLR) for published direct medical costs from the UK’s National Health Service and societal perspective was performed in peer-reviewed journals and on government websites in years 2011-2017 in English. The SLR was conducted according to the general principles for undertaking systematic reviews in health care. These methods adhere to the UK’s National Institute for Health and Care Excellence standards for evidence generation. Where the papers did not present primary data the references were explored. A quality assessment of included studies was performed using either the checklist for assessing costing studies or the checklist for assessing cost-effectiveness studies. When conducting calculations, pack sizes, dosages, treatment duration and number of hospital visits were taken into account. All parameters were converted to British Pound and updated to 2016 prices by an inflation factor. The SLR identified 2,472 records of which 52 met the final eligibility criteria. Non-fatal stroke cost was the highest among cardiovascular complications (£7 154), followed by myocardial infarction (£6,706) and congestive heart failure (£3,355). Overall, renal complications were the most costly with renal transplant being the highest (£42,060). Eye disease costs spanned between £109 and £2,557 for retinopathy laser treatment and cataract operation respectively. Diabetic foot amputation cost was £13,926 followed by gangrene treatment at £3,583. Costs are annual. This study presents an updated set of costs for diabetes complications and management for use in the UK setting.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence.

Global burden of eye and vision disease as reflected in the Cochrane Database of Systematic Reviews.

Eye and vision disease burden should help guide ophthalmologic research prioritization. The Global Burden of Disease (GBD) Study 2010 compiled data from 1990 to 2010 on 291 diseases and injuries, 1160 disease and injury sequelae, and 67 risk factors in 187 countries. The Cochrane Database of Systematic Reviews (CDSR) is a resource for systematic reviews in health care, with peer-reviewed systematic reviews that are published by Cochrane Review Groups. To determine whether systematic review and protocol topics in the CDSR reflect disease burden, measured by disability-adjusted life-years (DALYs), from the GBD 2010 project. This is one of a series of projects mapping GBD 2010 medical field disease burdens to corresponding systematic reviews in the CDSR. Two investigators independently assessed 8 ophthalmologic conditions in the CDSR for systematic review and protocol representation according to subject content. The 8 diseases were matched to their respective DALYs from the GBD 2010 project. Cochrane Database of Systematic Reviews systematic review and protocol representation and percentage of total 2010 DALYs. All 8 ophthalmologic conditions were represented by at least 1 systematic review in the CDSR. A total of 91.4% of systematic reviews and protocols focused on these conditions were from the Cochrane Eyes and Vision Group. Comparing the number of reviews and protocols with disability, only cataract was well matched; glaucoma, macular degeneration, and other vision loss were overrepresented. In comparison, trachoma, onchocerciasis, vitamin A deficiency, and refraction and accommodation disorders were underrepresented. These results prompt further investigation into why certain diseases are overrepresented or underrepresented in the CDSR relative to their DALY. With regard to ophthalmologic conditions, this study encourages that certain conditions get more focus to create a better representation of what is causing the most disability and mortality within this research database. These results provide high-quality and transparent data to inform future prioritization decisions.

In Support of EHP ’s Proposal to Adopt the ARRIVE Guidelines

In Support of <i>EHP</i> ’s Proposal to Adopt the ARRIVE Guidelines

Can a core outcome set improve the quality of systematic reviews? – a survey of the Co-ordinating Editors of Cochrane review groups

BackgroundMissing outcome data or the inconsistent reporting of outcome data in clinical research can affect the quality of evidence within a systematic review. A potential solution is an agreed standardized set of outcomes known as a core outcome set (COS) to be measured in all studies for a specific condition. We investigated the amount of missing patient data for primary outcomes in Cochrane systematic reviews, and surveyed the Co-ordinating Editors of Cochrane Review Groups (CRGs) on issues related to the standardization of outcomes in their CRG’s reviews. These groups are responsible for the more than 7,000 protocols and full versions of Cochrane Reviews that are currently available, and the several hundred new reviews published each year, presenting the world’s largest collection of standardized systematic reviews in health care.MethodsUsing an unselected cohort of Cochrane Reviews, we calculated and presented the percentage of missing patient data for the primary outcome measure chosen for each review published by each CRG. We also surveyed the CRG Co-ordinating Editors to see what their policies are with regards to outcome selection and outcomes to include in the Summary of Finding (SoF) tables in their Cochrane Reviews. They were also asked to list the main advantages and challenges of standardizing outcomes across all reviews within their CRG.ResultsIn one fifth of the 283 reviews in the sample, more than 50% of the patient data for the primary outcome was missing. Responses to the survey were received from 90% of Co-ordinating Editors. Thirty-six percent of CRGs have a centralized policy regarding which outcomes to include in the SoF table and 73% of Co-ordinating Editors thought that a COS for effectiveness trials should be used routinely for a SoF table.ConclusionsThe reliability of systematic reviews, in particular meta-analyses they contain, can be improved if more attention is paid to missing outcome data. The availability of COSs for specific health conditions might help with this and the concept has support from the majority of Co-ordinating Editors in CRGs.

Steps in the undertaking of a systematic review in orthopaedic surgery.

In the last decades of the twentieth century it became obvious that modern medical care is replete with data and information, but in need of reliable evidence. This has led to an increased effort to systematically synthesise medical research and make it more useful for practitioners. Systematic reviews use an approach to research synthesis that minimises the risk of misinterpreting a body of evidence due to incomprehensive search or subjective opinion. Carrying out a systematic review is a rigorous procedure which corresponds to standard methodological steps in primary research studies. It involves posing a well-defined question, developing a robust search strategy, screening for relevant primary studies, critical appraisal of included studies, data extraction and processing, analysis and interpretation of results. In some, but not all systematic reviews it is appropriate to conduct a meta-analysis, which is a statistical procedure that integrates the results of several independent studies. Results of meta-analysis are graphically presented in forest plots, with pooled point estimate and its confidence interval represented as a rhombus, usually called a "diamond". Methodological quality of systematic reviews should not be judged by the quality of primary studies included, but by a distinct set of criteria specified in assessment tools such as AMSTAR. Systematic reviews and meta-analyses should be reported according to the PRISMA checklist. A major contribution to the development of methodological standards has been given by The Cochrane Collaboration, whose Handbook of Systematic Reviews of Interventions is the primary reference for all authors and referees of systematic reviews in health care.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement