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Screening Bias

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58941. Is this woman perimenopausal?

(MEDLINE) combined with screening references of included studies. No attempts were made to identify unpublished studies and the review was limited to English language studies. It is therefore possible that important studies might have been missed and that the review might be subject to publication bias. Some details of the review process were reported and all stages involved two reviewers. A formal quality assessment was undertaken; however, this involved stratifying studies into levels of evidence (...) the accuracy of self-assessment, symptoms, signs and laboratory tests in diagnosing women in perimenopause. Searching MEDLINE was searched from 1966 to 2001; the search terms were reported. The search was restricted to studies reported in the English language. The reference lists of included studies and other publications were screened for additional studies. Study selection Study designs of evaluations included in the review Studies that included a premenopausal control group were eligible for inclusion

2003 DARE.

58942. Interventions for violence against women: scientific review

a key research priority. CRD commentary This was a broad review question that was only loosely defined in terms of the interventions, participants and outcome measures. A number of sources were searched to identify potentially relevant studies, but it was unclear whether any language restrictions were applied. No efforts were made to search for unpublished material and, therefore, other relevant studies might have been missed. Screening the studies for inclusion in the review, and assessing (...) the quality of the included studies, was undertaken in duplicate, thus minimising reviewer errors and bias. The validity assessment tool used to assess the quality of the included studies appears to have been adequate. The reporting of the number of studies included in the review was confusing, with the inclusion of both a systematic review (that included primary studies that were also reported elsewhere) and a secondary analysis of data (that were also reported prospectively). In addition, the authors

2003 DARE.

58943. Microalbuminuria testing in diabetes: is a dipstick as effective as laboratory tests?

positive predictive value compared with laboratory detection. Thus, the test can be considered adequate for screening but not for diagnosis. The author's conclusions are likely to be reliable. Authors' objectives To compare the diagnostic performance of dipstick testing with a laboratory method for the detection of microalbuminuria in people with diabetes. Searching MEDLINE (from 1996 to 2003), CINAHL, EMBASE (from 1988 to 2003) and the Cochrane Library were searched. In addition, diabetic journals (...) , the receiver-operating characteristic (ROC) curve. How were decisions on the relevance of primary studies made? The author did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality Validity was assessed using the criteria described by Greenhalgh and Donald for screening or diagnostic tests (see Other Publications of Related Interest). The author did not state who performed the validity assessment. Data extraction The author did

2003 DARE.

58944. Characteristics of effective school-based substance abuse prevention

searched; additional electronic databases may have been searched, but this was unclear. The reference lists of recent reviews of prevention programmes were screened and studies already known to the authors were included. Unpublished studies were also included. Study selection Study designs of evaluations included in the review Studies with a comparison group, including studies with a nonequivalent comparison group, were eligible for inclusion. Studies that did not report sufficient data to allow (...) a control group, adjustment was made for statistical dependency. The meta-analyses were performed with and without estimated ESs. The results were similar and only those results using all data were presented. A funnel plot was used to explore the possibility of publication bias. How were differences between studies investigated? Separate mean ESs were calculated for cognitive-behaviour programmes delivered to high-risk students and the general population. The mean ES and 95% confidence interval (CI

2003 DARE.

58945. Inhaled corticosteroids reduce the progression of airflow limitation in chronic obstructive pulmonary disease: a meta-analysis

1982 to February 2003), International Pharmaceutical Abstracts (from 1970 to February 2003) and the Cochrane Controlled Trials Register (end of 2002) were searched. The reference lists in retrieved studies were also screened. Additional data and unpublished studies were sought through discussions with experts in the field who attended the 2002 American Thoracic Society international meeting. Studies reported only as abstracts were excluded. Study selection Study designs of evaluations included (...) in the review Studies that measured the change in FEV1 over time as the primary outcome were eligible for inclusion. The primary outcome in the review was the annual change in FEV1 decline rate. How were decisions on the relevance of primary studies made? All five authors independently screened the identified papers for inclusion and resolved any disagreements on study selection through discussion and consensus. Assessment of study quality The authors did not state that they assessed validity. Data

2003 DARE.

58946. Rehabilitation of ligamentous ankle injuries: a review of recent studies

of motion. The evidence, which came from small studies of unknown quality that assessed different treatments, was limited and was insufficient to support the authors' conclusions. Authors' objectives To assess the effects of treatments for ankle rehabilitation. Searching MEDLINE and EMBASE were searched from 1966 to April 2002 for studies published in English or German. The reference lists in identified studies were screened. Study selection Study designs of evaluations included in the review Randomised (...) in the omission of other relevant studies. Attempts were made to reduce language bias, but not to minimise publication bias. The methods used to select the studies, assess validity and extract the data were not described, so it is not known whether any efforts were made to reduce errors and bias. The validity assessment was inadequate since it was restricted to only some aspects of study design, and methodological limitation of the included studies were not discussed. Data on the number of participants

2003 DARE.

58947. Complementary and alternative medicine in fibromyalgia and related syndromes

were decisions on the relevance of primary studies made? One reviewer screened the abstracts of identified studies with respect to the inclusion criteria. Assessment of study quality Validity was assessed and scored using the Consolidated Standards of Reporting Trials (CONSORT) rating system. This evaluates the inclusion and exclusion criteria, description of the intervention, definition of the outcome, methods used for randomisation, sample size, the reporting of adverse events (...) . The inclusion criteria were broadly defined in terms of outcomes. Several relevant sources were searched and the search terms were stated, but by limiting the included studies to those in English some relevant studies might have been omitted. No attempt was made to locate unpublished studies, thus raising the possibility of publication bias. Only one reviewer selected the studies for inclusion and this lack of duplication might have led to errors and bias. The methods used to assess validity and extract

2003 DARE.

58948. Internal fixation versus arthroplasty of comminuted fractures of the distal humerus

the Cochrane Library and using the OVID search engine, covering the period 1969 to 2003; the search terms were not reported. In addition, the bibliographies of selected articles were screened. Study selection Study designs of evaluations included in the review The authors stated that they were seeking the 'best available evidence', but did not specify any inclusion criteria pertaining to the study design. The studies reported in the review were all small case series. The duration of follow-up ranged from (...) the specific databases searched nor the search terms used. It is therefore possible that relevant studies might have been missed, though without crucial information about the search this is impossible to verify. Although the identified studies as a whole were considered 'weak evidence', no attempts were made to assess the validity of relevant studies compared with one another. It was unclear how many reviewers were involved in the study selection and data extraction, so there remains the potential for bias

2003 DARE.

58949. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review

for cancer pain, for chronic noncancer pain. Searching MEDLINE and the Cochrane Controlled Trials Register were searched for relevant studies reported in the English language. This was supplemented by screening reference lists for additional studies in any language. The search terms were reported, though the dates of the searches were not. Trials reported in foreign languages were included if they were identified via the reference list search. Study selection Study designs of evaluations included (...) in the selection, assessment or data extraction of the studies, thus there is the potential for errors and possible bias to exist within these processes. The use of a narrative synthesis was appropriate given the methodological and clinical heterogeneity of the included studies. The authors' conclusions regarding the need for higher quality research appear justified on the basis of the evidence reported in the review, though it is possible that relevant evidence may have been available that was not included

2003 DARE.

58950. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review

of life; tumour response; and survival. How were decisions on the relevance of primary studies made? Two reviewers screened both abstracts and full papers to select studies for inclusion in the review. It was not stated whether the reviewers performed the selection independently. Assessment of study quality The validity of the primary studies was assessed using the Jadad scale, which assesses randomisation, blinding and handling of withdrawals (see Other Publications of Related Interest no.1). Level (...) treated with RT for cancer of the head and neck. The overall impact of mucositis on treatment outcomes has not been adequately investigated. CRD commentary The review question and the inclusion criteria were clear. The search was adequate, although the restriction to studies published in English might have led to the introduction of language and publication biases. No tests for publication bias were conducted. The authors reported using procedures to minimise bias and error in the study selection

2003 DARE.

58951. Immunonutrition in the intensive care unit: a systematic review and consensus statement

of enteral nutrition with pharmaconutrient-enriched diets in critically ill patients. The authors concluded that enriched diets offer beneficial effects to patients requiring enteral feeding, although further research is required to identify the population who could benefit the most. The lack of individual study results, the inclusion of only published studies, and funding from the manufacturer of such diets may potentially bias the authors' conclusion. Authors' objectives To determine the effectiveness (...) of primary studies made? Clinicians screened all citations and selected those that met the inclusion criteria. The authors did not state how the papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality The authors assigned a quality score to each study (1 being the lowest and 5 the highest), using the Jadad instrument to assess randomisation, blinding and withdrawals. The authors did not state how the papers were assessed for quality, or how many

2003 DARE.

58952. A systematic review of diabetes self-care interventions for older, African American, or Latino adults

relevant studies, and could have led to publication bias. Two reviewers independently selected the studies from full publications, but the methods used to initially screen titles and abstracts were unclear. The methods used to assess validity and extract data were not described; hence, efforts made to reduce errors and bias cannot be judged. The authors did not formally assess validity but they did discuss some aspects of it in the text: study design, attrition rates, the use of intention-to-treat

2003 DARE.

58953. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women

it was not possible to judge whether bias might have occurred at this stage, although more than one reviewer independently screened studies for inclusion, which minimises bias. The validity of the included studies was assessed using a checklist derived from the published literature and used in a sensitivity analysis. A meta-analysis was performed and studies were only pooled where no significant heterogeneity existed, which seems appropriate. The authors' conclusions did not mention patient discomfort, which

2003 DARE.

58954. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials

screened the identified papers for inclusion and selected studies. Any disagreements were resolved through discussion. Assessment of study quality Validity was assessed using the Jadad scale, which considers randomisation, blinding and withdrawals. Two reviewers independently assessed validity and resolved any disagreements through discussion. Data extraction Two reviewers independently extracted the data and resolved any disagreements through discussion. The mean difference and 95% confidence interval (...) using a random-effects model. Where studies did not report sufficient information to calculate the variance of the change from baseline, the variance was input (the methods for this were described in the review). The possibility of publication bias was explored using a funnel plot. How were differences between studies investigated? For the meta-analysis of maximal workload, statistical heterogeneity was tested using the chi-squared statistic and a forest plot was presented. A sensitivity analysis

2003 DARE.

58955. A review of intravenous versus oral vitamin D hormone therapy in hemodialysis patients

to reach a conclusion about the comparative safety and efficacy of oral and intravenous regimens. These conclusions are likely to be reliable. Authors' objectives To compare intravenous (i.v.) and oral vitamin D administration for the treatment of secondary hyperparathyroidism in haemodialysis patients. Searching PubMed was searched using the keywords were stated. The reference lists in identified studies were also screened. Studies published either as abstracts or full publications were included (...) of the inclusion criteria were explicitly defined. Only one database was searched and this might have resulted in the omission of other relevant studies. No details of the dates searched, or any language restrictions applied, were reported. The methods used to select the studies, assess validity and extract the data were not described; hence, any efforts made to reduce errors and bias cannot be judged. The validity of the included studies was not formally assessed, but some aspects of validity were discussed

2003 DARE.

58956. Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review

in the review. The authors appear to have searched the databases from their date of inception until October 2002. The reference lists of eligible studies were screened for relevant literature. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible for inclusion. Specific interventions included in the review Studies with either TE or MT administered or supervised by a physiotherapist were eligible if TE or MT was reported as the main intervention (...) -training programme carried out at home (n=43). Authors' conclusions There were insufficient data from well-conducted trials to support the use of therapeutic exercise or manual therapy in the treatment of SIS. CRD commentary The review provided a structured question, specifying the intervention and patient population of interest. Several databases were searched to identify published literature. No attempt was made to identify unpublished literature, which might have introduced publication bias

2003 DARE.

58957. Effectiveness of interventions to increase Papanicolaou smear use

and physicians, or health care systems. The majority of the studies examined the rates of screening in women in the 40- to 49-year and 50- to 59-year age groups; women aged less than 40 years and over 60 years were also assessed. Outcomes assessed in the review Studies detailing the receipt or recommendation of a Pap smear were eligible for inclusion. The included studies assessed the uptake or recommendation of screening by self-report, chart audit, claims or electronic record. How were decisions (...) in uptake between treatment groups for randomised studies, and as the difference in uptake pre and post intervention between treatment groups for concurrently controlled studies. Compliance with recommended screening frequency was determined by the proportion of women screened. Information on the intervention strategy, target and content, outcome measurement, and patient population was also recorded. Methods of synthesis How were the studies combined? The primary studies were combined narratively

2003 DARE.

58958. Calcium antagonists reduce cardiovascular complications after cardiac surgery: a meta-analysis

syndrome, inotropic support (need for inotropes or intra-aortic balloon pump support), post-operative pacing and post-operative blood loss. How were decisions on the relevance of primary studies made? The authors stated that the titles and abstracts were screened to exclude ineligible studies, but did not state who performed this screening. Two reviewers independently read the remaining (potentially eligible) studies. Any disagreements were resolved by consensus. Assessment of study quality Validity (...) were calculated for the individual studies. Methods of synthesis How were the studies combined? The studies were combined using a random-effects model to estimate the pooled treatment effects: OR with 95% CI for dichotomous outcomes and weighted mean differences for continuous outcomes. Funnel plots were used to investigate publication bias. A fixed-effect model was used to compare adverse events and prior medication use. Primary analyses were the effects of CAs on the outcomes listed above

2003 DARE.

58959. Epidural ropivacaine versus bupivacaine for labor: a meta-analysis

of retrieved articles and reviews on the subject were handsearched, as were several journals: International Journal of Obstetric Anesthesia, British Journal of Anaesthesia, Anesthesiology, and Anethesia and Analgesia. The abstracts from the Society for Obstetric Anethesia and Perinatology meetings (1995 and 2001) were screened and the authors of clinical trials were contacted for additional data. Only English language papers were eligible for inclusion. Study selection Study designs of evaluations included (...) a clear research question with explicit inclusion criteria and was well reported. The authors searched explicitly for unpublished studies and for additional data from existing studies, which will help to reduce publication bias. However, since the review was restricted to English language papers, potentially relevant studies could have been excluded. At least two independent reviewers selected the studies for inclusion, assessed the quality of the studies, and extracted the data, thus reducing

2003 DARE.

58960. Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis

screened, only two electronic databases were searched and there was no attempt to search for unpublished studies, thus some studies might have been missed and the potential for publication bias remains. The assessment of the quality of the primary studies was very limited and the results were not reported. It is therefore not possible to assess the potential impact of methodological flaws in the primary studies on the results of the review. Adequate details of the individual studies were reported (...) Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis Diagnostic performance of intracardiac echogenic foci for Down syndrome: a meta-analysis Sotiriadis A, Makrydimas G, Ioannidis J P CRD summary This review assessed the diagnostic performance of intracardiac echogenic foci, and evaluated whether they could be used in prenatal screening for trisomy 21. The authors

2003 DARE.

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