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The Article Alert for the week of November 17, 2014 (sample articles)
Gage NA, Lewis TJ. Hierarchical Linear Modeling Meta-Analysis of Single-Subject Design Research. J.Spec.Educ. 2014 May 1;48(1):3-16.
The identification of evidence-based practices continues to provoke issues of disagreement across multiple fields. One area of contention is the role of single-subject design (SSD) research in providing scientific evidence. The debate about SSD’s utility centers on three issues: sample size, effect size, and serial dependence. One potential method for addressing all three issues is hierarchical linear modeling (HLM) meta-analysis. This study explored the utility of HLM meta-analysis of SSD. A total of 206 functional behavior assessment–based intervention outcome graphs were aggregated to assess whether HLM meta-analysis could identify (a) an overall effect size and statistical significance for mean shift, slope, and variability; (b) how the results mapped to two additional effect size calculations; and (c) whether the procedure met SSD synthesis criteria outlined by Wolery, Busick, Reichow, and Barton.
Gargon E, Gurung B, Medley N, Altman DG, Blazeby JM, Clarke M, Williamson PR. Choosing important health outcomes for comparative effectiveness research: a systematic review. PLoS One. 2014 Jun 16;9(6):e99111. PMID: 24932522.
Background: A core outcome set (COS) is a standardised set of outcomes which should be measured and reported, as a minimum, in all effectiveness trials for a specific health area. This will allow results of studies to be compared, contrasted and combined as appropriate, as well as ensuring that all trials contribute usable information. The COMET (Core Outcome Measures for Effectiveness Trials) Initiative aims to support the development, reporting and adoption of COS. Central to this is a publically accessible online resource, populated with all available COS. The aim of the review we report here was to identify studies that sought to determine which outcomes or domains to measure in all clinical trials in a specific condition and to describe the methodological techniques used in these studies.
Methods: We developed a multi-faceted search strategy for electronic databases (MEDLINE, SCOPUS, and Cochrane Methodology Register). We included studies that sought to determine which outcomes/domains to measure in all clinical trials in a specific condition.
Results: A total of 250 reports relating to 198 studies were judged eligible for inclusion in the review. Studies covered various areas of health, most commonly cancer, rheumatology, neurology, heart and circulation, and dentistry and oral health. A variety of methods have been used to develop COS, including semi-structured discussion, unstructured group discussion, the Delphi Technique, Consensus Development Conference, surveys and Nominal Group Technique. The most common groups involved were clinical experts and non-clinical research experts. Thirty-one (16%) studies reported that the public had been involved in the process. The geographic locations of participants were predominantly North America (n=164; 83%) and Europe (n=150; 76%).
Conclusions: This systematic review identified many health areas where a COS has been developed, but also highlights important gaps. It is a further step towards a comprehensive, up-to-date database of COS. In addition, it shows the need for methodological guidance, including how to engage key stakeholder groups, particularly members of the public.
- FREE FULL TEXT: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059640/pdf/pone.0099111.pdf
- DOI: http://dx.doi.org/10.1371/journal.pone.0099111
- PubMed: http://www.ncbi.nlm.nih.gov/pubmed/24932522
- PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4059640/
Saldanha IJ, Dickersin K, Wang X, Li T. Outcomes in cochrane systematic reviews addressing four common eye conditions: an evaluation of completeness and comparability. PLoS One. 2014 Oct 16;9(10):e109400. PMID: 25329377.
Introduction: Choice of outcomes is critical for clinical trialists and systematic reviewers. It is currently unclear how systematic reviewers choose and pre-specify outcomes for systematic reviews. Our objective was to assess the completeness of pre-specification and comparability of outcomes in all Cochrane reviews addressing four common eye conditions.
Methods: We examined protocols for all Cochrane reviews as of June 2013 that addressed glaucoma, cataract, age-related macular degeneration (AMD), and diabetic retinopathy (DR). We assessed completeness and comparability for each outcome that was named in ≥25% of protocols on those topics. We defined a completely-specified outcome as including information about five elements: domain, specific measurement, specific metric, method of aggregation, and time-points. For each domain, we assessed comparability in how individual elements were specified across protocols.
Results: We identified 57 protocols addressing glaucoma (22), cataract (16), AMD (15), and DR (4). We assessed completeness and comparability for five outcome domains: quality-of-life, visual acuity, intraocular pressure, disease progression, and contrast sensitivity. Overall, these five outcome domains appeared 145 times (instances). Only 15/145 instances (10.3%) were completely specified (all five elements) (median=three elements per outcome). Primary outcomes were more completely specified than non-primary (median=four versus two elements). Quality-of-life was least completely specified (median=one element). Due to largely incomplete outcome pre-specification, conclusive assessment of comparability in outcome usage across the various protocols per condition was not possible.
Discussion: Outcome pre-specification was largely incomplete; we encourage systematic reviewers to consider all five elements. This will indicate the importance of complete specification to clinical trialists, on whose work systematic reviewers depend, and will indirectly encourage comparable outcome choice to reviewers undertaking related research questions. Complete pre-specification could improve efficiency and reduce bias in data abstraction and analysis during a systematic review. Ultimately, more completely specified and comparable outcomes could make systematic reviews more useful to decision-makers.