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Systematic reviews aim to minimize bias through the use of pre-specified research questions and methods that are documented in protocols, and by basing their findings on reliable research. Systematic reviews should be conducted by a team that...
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Good data management, project management and quality assurance mechanisms are essential for the completion of a successful systematic review. Chapter 1: Starting a review. Cochrane Handbook for Systematic Reviews of Interventions version 6....
1: Review And Assessment
This Handbook is about systematic reviews on the effects of interventions, and specifically about methods used by Cochrane to undertake them. Cochrane Reviews use primary research to generate new knowledge about the effects of an intervention or interventions used in clinical, public health or policy settings. They aim to provide users with a balanced summary of the potential benefits and harms of interventions and give an indication of how certain they can be of the findings.
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They can also compare the effectiveness of different interventions with one another and so help users to choose the most appropriate intervention in particular situations. The primary purpose of Cochrane Reviews is therefore to inform people making decisions about health or health care. Systematic reviews are important for other reasons. New research should be designed or commissioned only if it does not unnecessarily duplicate existing research Chalmers et al Therefore, a systematic review should typically be undertaken before embarking on new primary research. Such a review will identify current and ongoing studies, as well as indicate where specific gaps in knowledge exist, or evidence is lacking; for example, where existing studies have not used outcomes that are important to users of research Macleod et al A systematic review may also reveal limitations in the conduct of previous studies that might be addressed in the new study or studies.
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Systematic reviews are important, often rewarding and, at times, exciting research projects. They offer the opportunity for authors to make authoritative statements about the extent of human knowledge in important areas and to identify priorities for further research. They sometimes cover issues high on the political agenda and receive attention from the media. Conducting research with these impacts is not without its challenges, however, and completing a high-quality systematic review is often demanding and time-consuming. In this chapter we introduce some of the key considerations for potential review authors who are about to start a systematic review. Getting the research question right is critical for the success of a systematic review. Review authors should ensure that the review addresses an important question to those who are expected to use and act upon its conclusions.
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We discuss the formulation of questions in detail in Chapter 2. For a question about the effects of an intervention, the PICO approach is usually used, which is an acronym for Population, Intervention, Comparison s and Outcome. Reviews may have additional questions, for example about how interventions were implemented, economic issues, equity issues or patient experience. To ensure that the review addresses a relevant question in a way that benefits users, it is important to ensure wide input. In most cases, question formulation should therefore be informed by people with various relevant — but potentially different — perspectives see Chapter 2, Section 2. Systematic reviews should be undertaken by a team. Indeed, Cochrane will not publish a review that is proposed to be undertaken by a single person. Working as a team not only spreads the effort, but ensures that tasks such as the selection of studies for eligibility, data extraction and rating the certainty of the evidence will be performed by at least two people independently, minimizing the likelihood of errors.
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First-time review authors are encouraged to work with others who are experienced in the process of systematic reviews and to attend relevant training. Review teams must include expertise in the topic area under review. Topic expertise should not be overly narrow, to ensure that all relevant perspectives are considered. Perspectives from different disciplines can help to avoid assumptions or terminology stemming from an over-reliance on a single discipline. Review teams should also include expertise in systematic review methodology, including statistical expertise. However, it is important that both topic and methodological expertise is present to ensure a good mix of skills, knowledge and objectivity, because topic expertise provides important insight into the implementation of the intervention s , the nature of the condition being treated or prevented, the relationships between outcomes measured, and other factors that may have an impact on decision making.
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A Cochrane Review should represent an independent assessment of the evidence and avoiding financial and non-financial conflicts of interest often requires careful management. It will be important to consider if there are any relevant interests that may constitute a conflict of interest. There are situations where employment, holding of patents and other financial support should prevent people joining an author team. Funding of Cochrane Reviews by commercial organizations with an interest in the outcome of the review is not permitted. To ensure that any issues are identified early in the process, authors planning Cochrane Reviews should consult the Conflict of Interest Policy.
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Authors should make complete declarations of interest before registration of the review, and refresh these annually thereafter until publication and just prior to publication of the protocol and the review. For authors of review updates, this must be done at the time of the decision to update the review, annually thereafter until publication, and just prior to publication. Authors should also update declarations of interest at any point when their circumstances change. Systematic reviews are more likely to be relevant to a broad range of end users if they are informed by the involvement of people with a range of experiences, in terms of both the topic and the methodology Thomas et al , Rees and Oliver Engaging consumers and other stakeholders, such as policy makers, research funders and healthcare professionals, increases relevance, promotes mutual learning, improved uptake and decreases research waste. Mapping out all potential stakeholders specific to the review question is a helpful first step to considering who might be invited to be involved in a review.
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Stakeholders typically include: patients and consumers; consumer advocates; policy makers and other public officials; guideline developers; professional organizations; researchers; funders of health services and research; healthcare practitioners, and, on occasion, journalists and other media professionals. Balancing seniority, credibility within the given field, and diversity should be considered. Review authors should also take account of the needs of resource-poor countries and regions in the review process see Chapter 16 and invite appropriate input on the scope of the review and the questions it will address.
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It is established good practice to ensure that consumers are involved and engaged in health research, including systematic reviews. In , a Statement of Principles for consumer involvement in Cochrane was agreed. This seeks to change the culture of research practice to one where both consumers and other stakeholders are joint partners in research from planning, conduct, and reporting to dissemination. Systematic reviews that have had consumer involvement should be more directly applicable to decision makers than those that have not see online Chapter II. Decisions about what methods to use will typically be based on resource availability, but review teams should be aware of the merits and limitations of such methods. Authors will need to decide who to involve and how to provide adequate support for their involvement. This can include financial reimbursement, the provision of training, and stating clearly expectations of involvement, possibly in the form of terms of reference.
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While a small number of consumers or other stakeholders may be part of the review team and become co-authors of the subsequent review, it is sometimes important to bring in a wider range of perspectives and to recognize that not everyone has the capacity or interest in becoming an author. Advisory groups offer a convenient approach to involving consumers and other relevant stakeholders, especially for topics in which opinions differ. Important points to ensure successful involvement include the following. The review team should co-ordinate the input of the advisory group to inform key review decisions. Advisory group membership should reflect the breadth of the review question, and consideration should be given to involving vulnerable and marginalized people Steel to ensure that conclusions on the value of the interventions are well-informed and applicable to all groups in society see Chapter Templates such as terms of reference, job descriptions, or person specifications for an advisory group help to ensure clarity about the task s required and are available from INVOLVE.
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The website also gives further information on setting and organizing advisory groups. See also the Cochrane training website for further resources to support consumer involvement. As understanding improves, the review can be updated. Nevertheless, it is important that the review itself is accurate at the time of publication. There are two main reasons for this imperative for accuracy. Current knowledge may be imperfect, but decisions will be better informed when taken in the light of the best of current knowledge. Second, systematic reviews form a critical component of legal and regulatory frameworks; for example, drug licensing or insurance coverage. Here, systematic reviews also need to hold up as auditable processes for legal examination. As systematic reviews need to be both correct, and be seen to be correct, detailed evidence-based methods have been developed to guide review authors as to the most appropriate procedures to follow, and what information to include in their reports to aid auditability.
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Developed collaboratively by methodologists and Cochrane editors, they are intended to describe the desirable attributes of a Cochrane Review. The expectations are not all relevant at the same stage of review conduct, so care should be taken to identify those that are relevant at specific points during the review. Different methods should be used at different stages of the review in terms of the planning, conduct, reporting and updating of the review. Each expectation has a title, a rationale and an elaboration. Items described as mandatory are expected to be applied, and if they are not then an appropriate justification should be provided; failure to implement such items may be used as a basis for deciding not to publish a review in the Cochrane Database of Systematic Reviews CDSR.
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Items described as highly desirable should generally be implemented, but there are reasonable exceptions and justifications are not required. The recommendations provided in the Preferred Reporting Items for Systematic reviews and Meta-Analyses PRISMA Statement have been incorporated into the Cochrane reporting expectations, ensuring compliance with the PRISMA recommendations and summarizing attributes of reporting that should allow a full assessment of the methods and findings of the review Moher et al To minimize the potential for bias in the review process, these judgements should be made as far as possible in ways that do not depend on the findings of the studies included in the review. All chapters in the Handbook should be consulted when drafting the protocol.
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Since systematic reviews are by their nature retrospective, an element of knowledge of the evidence is often inevitable. This is one reason why non-content experts such as methodologists should be part of the review team see Section 1. Two exceptions to the retrospective nature of a systematic review are a meta-analysis of a prospectively planned series of trials and some living systematic reviews, as described in Chapter The review question should determine the methods used in the review, and not vice versa. The question may concern a relatively straightforward comparison of one treatment with another; or it may necessitate plans to compare different treatments as part of a network meta-analysis, or assess differential effects of an intervention in different populations or delivered in different ways.
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The protocol sets out the context in which the review is being conducted. It presents an opportunity to develop ideas that are foundational for the review.
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Health Chapter 1 Review Quizlet
Prehistoric medicine and ancient medicine were characterized by an interest in the arts and sciences. True b. The focus of health care consumers is on primary and preventative care. Preadmission testing on an outpatient basis is more frequently performed than is admitting patients a day or two early to perform such tests. Antyllos, a Roman physician appointed to treat gladiators, gained anatomical insight by tending to their fractures and wounds. Avicenna, a Persian physician, summarized the knowledge of medieval medicine in the Canon of Medicine. The Health Care Quality Improvement Act of requires that consumers to be provided with informed consent guidance,and with information about state laws that impact health care decisions. Powered by Cognero. Hospital administrators are responsible for appointing medical staff members.
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Associate medical staff members include former members who are honored with emeritus status. Hospital-originated infections are also known as nosocomial infections. Hippocrates was the first physician to consider medicine a science. During ancient times, Antyllos performed and described new procedures, and he became an authority on aneurysms. Rhazes produced the Canon of Medicine, which summarized medical knowledge and accurately described many diseases. The American College of Surgeons ACS improved the quality of care for surgical patients by establishing standards for surgical. In , just 89 of hospitals surveyed as part of the Hospital Standardization Program met requirements of the Minimum Standard for Hospitals. The primary purpose of the Joint Commission is the mandatory accreditation of health care facilities.
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The utilization review process was strengthened through formation of professional standards review organizations PSROs to monitor the appropriateness, quality, and outcome of services provided to beneficiaries of Medicare, Medicaid, and Maternal and Child Health programs. Sally Slip fell and broke her arm. Her fracture would most likely be treated by an orthopedic specialist. Individual state laws require health care facilities to obtain licenses to operate from state departments of health.
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The preparation of a final meeting agenda is the joint responsibility of the committee chairperson and secretary. When taking minutes, the committee secretary should record only the final decisions made by the committee. The drug utilization review committee is responsible for maintaining the hospital formulary. Abstracted patient information is used to generate diagnosis and procedure indexes. The purpose of contracting out health information services is to improve quality and contain costs.
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Which Persian physician produced the Canon of Medicine? Papyrus b. Avicenna c. Rhazes d. Which surgeon and surgical writer educated by the army after being rejected by medical schools saved thousands of lives by the use of ligatures in amputations? Fracastoro c. Vesalius d. To advance the health of individuals and communities, hospitals and health care networks are represented by the a.
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American Medical Association b. American College of Surgeons. National Medical Association. American Hospital Association. Which medical staff committee is responsible for the review of preoperative and pathologic diagnosis to determine the necessity of surgery? The first physician to document accurate descriptions of measles and smallpox was a. Hippocrates b. Rhazes c. Avicenna d. The anatomist who revolutionized anatomy by writing De Humani Corporis Fabrica was a. Edwin Smith Papyrus b. Girolamo Fracastoro c. Andreas Vesalius d. Which organization was founded to improve the quality of care for surgical patients by establishing standards for surgical education and practice? American Hospital Association c. American College of Surgeons d. Hospital Standardization Program b. Health Insurance Portability and Accountability Act c.
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Health Care Quality Improvement Act d. McKinney b. Migrant Health c. Patient Self-Determination d. Medical staff members are granted clinical privileges by the a. Which acts on reports and recommendations from medical staff committees? Which hospital department directs the facilitywide program that monitors standards of conduct, implements sanctions for noncompliance, and maintains a confidential integrity hot line? Which coding system is used in the United States to collect information about diseases and injuries and to classify diagnoses and procedures? HCPCS c. CPT d. Since , the organization that has developed professionally based standards to evaluate the compliance of health care organizations is the: a.
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CARF b. The Joint Commission c. AAAHC d. Which committee ensures patient safety by analyzing trends of incidents and establishing priorities for dealing with high-risk areas? Pasteur b. Leeuwenhoek c. Koch d. Which organization currently provides voluntary accreditation of health care organizations? ACS b. AMA c. World Health Organization d.
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Which joint state and federal program s assist s with medical costs for those with low incomes and limited resources? Medicaid b. Medicare c. Medicaid and Medicare d. Jones examines Sally Sick in the office and completes a history and physical exam for the treatment of an upper respiratory infection. Jones writes a prescription for antibiotics and instructs her to return to his office in 10 to 14 days. Organized has developed a draft strategic plan for Sunny Valley Hospital and will present the plan at the hospital board of trustees meeting next month. Jones refers Tom to an eye specialist in the field of: a. The quality assurance committee has completed a study that reviewed preoperative and pathologic diagnosis. Upon review of the statistical findings, it appears that three surgeons may be performing surgeries that cannot be justified. Pam Paper reviews inpatient admissions to assess patients who may require posthospital services on discharge.
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She works for the: a. Mark Smith, a victim of a motor vehicle accident, has instructed his physician that, if he stops breathing or his heartbeat stops, he does not want to be revived. The physician should complete which of the following for the patient? The assembly and analysis of discharged patient records is called a. The Medicaid Integrity Program, a fraud and abuse detection program, was established by the: a. Hill-Burton Act b. Genetic Information Nondiscrimination Act c. American Recovery and Reinvestment Act d. Which of the following encourages the reporting of health care mistakes to patient safety organizations by making the reports confidential and providing a shield from their use in civil and criminal proceedings?
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Patient Safety and Quality Improvement b. Deficit Reduction Act c. Tax Relief and Health Care Act of d. Which of the following authorized the implementation of a PQRI that established a financial incentive for eligible professionals who participate in a voluntary quality reporting program? Deficit Reduction Act of b.
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Anger: feeling powerless or unfairly deprived 4. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Laboratory Safety. Glencoe Virtual Density Lab. Identify how tanning can affect your health. I had to move Benchmarking up a week, so we'll start our presentations on Thursday. Where else can you find valid health information? Real-life application of health skills helps students apply what they learn in health class toward practicing good health. Cross-contamination - The spreading of bacteria or other pathogens from one food to another.
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