Articles: outcome-assessment-health-care.
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Evid Based Child Health · Dec 2014
Meta Analysis Observational StudyA meta-epidemiological study to examine the association between bias and treatment effects in neonatal trials.
Randomized controlled trials are considered the gold standard for evidence on therapeutic interventions; however, they are susceptible to bias. The objectives of this observational study were to describe the methodological quality of neonatal randomized controlled trials and quantify the bias related to specific methodological and study-level characteristics. ⋯ This observational study of a sample of neonatal trials showed that most were at high risk of bias, indicating that there is room for improvement in the design, conduct and reporting of neonatal trials to ensure valid results for the most clinically important outcomes. We did not find an association between most risk of bias domains and effect estimates; however, we found that randomized controlled trials at high risk for selective outcome reporting were associated with overestimates of treatment benefits. These results need to be confirmed in larger samples.
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Review Meta Analysis
Associations between pain appraisals and pain outcomes: meta-analyses of laboratory pain and chronic pain literatures.
In this research, meta-analyses were performed to evaluate associations between primary appraisals of pain as a source of threat and/or challenge and responses to 1) noxious laboratory stimuli and 2) chronic noncancer pain. Twenty-two laboratory pain studies comprising 2,031 participants and 59 chronic pain studies based on 9,135 patients were identified for analysis. For laboratory pain, elevated threat appraisals were linked to overall increases in reported pain, reduced pain tolerance, and high levels of passive coping. Method of measuring appraisal as well as type and duration of noxious stimulation moderated some of these associations. Challenge appraisals were related to more pain tolerance and less passive coping but not pain intensity. For chronic pain studies, threat appraisals had positive overall correlations with pain intensity, impairment, affective distress, and passive coping but were negatively related to active coping. The pattern of associations between challenge appraisals and outcomes was largely complementary. Appraisal scale used and gender were consistent moderators of appraisal-outcome relations in chronic pain samples. In sum, appraisals of pain as a source of potential damage or opportunity have robust associations with responses to acute laboratory pain and ongoing chronic pain. ⋯ Meta-analyses evaluated associations between primary appraisals and responses to laboratory pain and chronic pain. Significant effect sizes for most outcomes suggest that appraisals of pain as a source of threat and challenge have important implications for functioning in response to pain.
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Journal of neurosurgery · Mar 2014
Review Meta AnalysisCaseload as a factor for outcome in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
Increasing evidence exists that treatment of complex medical conditions in high-volume centers is found to improve outcome. Patients with subarachnoid hemorrhage (SAH), a complex disease, probably also benefit from treatment at a high-volume center. The authors aimed to determine, based on published literature, whether a higher hospital caseload is associated with improved outcomes of patients undergoing treatment after aneurysmal subarachnoid hemorrhage. ⋯ Despite the shortcomings of this study, the mortality rate was lower in hospitals with a larger caseload. Limitations of the meta-analysis are the not uniform cutoff values and uncertainty about case mix.
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Review Meta Analysis
Systematic review of outcomes used to evaluate enhanced recovery after surgery.
Enhanced recovery pathways (ERPs) aim to improve patient recovery. However, validated outcome measures to evaluate this complex process are lacking. The objective of this review was to identify how recovery is measured in ERP studies and to provide recommendations for the design of future studies. ⋯ Patient-reported outcomes, particularly postdischarge functional status, were not commonly reported. Future studies of the effectiveness of ERPs should include validated, patient-reported outcomes to estimate better their impact on recovery, particularly after discharge from hospital.
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Review Meta Analysis
Regression methods for investigating risk factors of chronic kidney disease outcomes: the state of the art.
Chronic kidney disease (CKD) is a progressive and usually irreversible disease. Different types of outcomes are of interest in the course of CKD such as time-to-dialysis, transplantation or decline of the glomerular filtration rate (GFR). Statistical analyses aiming at investigating the association between these outcomes and risk factors raise a number of methodological issues. The objective of this study was to give an overview of these issues and to highlight some statistical methods that can address these topics. ⋯ This study provides a broad overview of the statistical methods used in the last ten years for investigating risk factors of CKD progression, as well as a discussion of their limitations. Some existing potential alternatives that have been proposed in the context of CKD or in other contexts are also highlighted.