Lisa Hartling, MSc; Finlay A. McAlister, MD, MSc; Brian H. Rowe, MD, MSc; Justin Ezekowitz, MB, BCh, MSc; Carol Friesen, MA, MLIS; Terry P. Klassen, MD, MSc
The authors discuss 3 challenges in conducting and interpreting any systematic review that are particularly relevant for systematic reviews of therapeutic devices or surgical procedures: 1) inclusion or exclusion of grey literature, 2) the role of nonrandomized studies, and 3) issues in applying the results to clinical care that are unique to the surgical and therapeutic device literature. The authors also discus s empirical evidence related to these topics and illustrate how reviewers in the Agency for Healthcare Research and Quality's Evidence-based Practice Center program have dealt with these challenges in developing evidence reports for decision makers and clinicians about therapeutic devices or surgical procedures.
The distribution of results indicates systematic bias (average odds ratios in the randomized, controlled trials and historical controlled studies were 1.23 and 1.06, respectively). Adapted with permission from reference 27: Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:iii-x, 1-173.
The distribution of results revealed that 9% of studies within each design had statistically significant findings. Adapted with permission from reference 27: Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7:iii-x, 1-173.
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Hartling L, McAlister FA, Rowe BH, Ezekowitz J, Friesen C, Klassen TP. Challenges in Systematic Reviews of Therapeutic Devices and Procedures. Ann Intern Med. 2005;142:1100–1111. doi: 10.7326/0003-4819-142-12_Part_2-200506211-00010
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Published: Ann Intern Med. 2005;142(12_Part_2):1100-1111.
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