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Qualitative Review (qualitative + review)
Selected Abstracts(631) Chronic Pain Treatment Meta-Analyses: A Mathematical and Qualitative ReviewPAIN MEDICINE, Issue 2 2000Article first published online: 25 DEC 200 Authors: Fishbain DA, University of Miami Comprehensive Pain Center; Rosomoff H, University of Miami Comprehensive Pain Center; Cutler RB, University of Miami Comprehensive Pain Center; Steele-Rosomoff R, University of Miami Comprehensive Pain Center Aim of Investigation: To critically review chronic pain treatment meta-analyses according to defined criteria. Methods: An extensive literature search yielded 22 meta-analyses dealing with pain. The following inclusion criteria were applied to these studies: (1) nonsurgical pain treatment outcome only, including nerve blocks; (2) chronic pain treatment outcome only; (3) nonmalignant pain only and; (4) study data presenting an effect size which enabled the calculation of a confidence interval (CI). These inclusion criteria selected 16 studies from the original group. These remaining meta-analyses were then divided into 3 categories: (1) General pain facility treatment (n = 4); (2) Headache treatment (n = 5) and; (3) Specific treatment types, eg, manipulation, psychoeducational, antidepressant, etc. (n = 7). Within each meta-analysis the data was subdivided according to type of pain, treatment type and outcome variable. The CI was then calculated for each of these subdivisions within each meta-analysis. The quality of the 16 meta-analyses was also investigated according to 20 meta-analysis criteria previously presented in the literature. Results: (1) Overall, the pain facility treatment meta-analyses were remarkably consistent in demonstrating that pain facility treatment is effective for most treatment outcome variables. (2) Within pain facility treatments, biofeedback, cognitive therapy, operant conditioning, and package treatment were demonstrated to be efficacious. (3) Within the headache treatment meta-analyses, both relaxation/biofeedback and various medications were demonstrated to be efficacious. (4) Within the specific isolated treatments group, psychoeducation, antidepressants, capsaicin and spinal manipulation were found to have efficacy, for a number of treatment outcome variables. (5) The quality of the meta-analyses was variable but acceptable, according to the meta-analysis criteria utilized. Conclusions: Overall the results of the reviewed meta-analyses indicate that most treatments are effective for most pain patients but that some treatments appear to be more effective than others. [source] Long-term outcome of pediatric obsessive,compulsive disorder: a meta-analysis and qualitative review of the literatureACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2004S. E. Stewart Objective:, To review the extant literature on the long-term outcome of child/adolescent-onset obsessive,compulsive disorder (OCD). Method:, Medline and Psychlit databases were systematically searched for articles regarding long-term outcomes of child/adolescent-onset OCD. Meta-analysis regression was applied to evaluate predictors and persistence of OCD. Results:, Sixteen study samples (n = 6,132; total = 521 participants) in 22 studies had follow-up periods ranging between 1 and 15.6 years. Pooled mean persistence rates were 41% for full OCD and 60% for full or subthreshold OCD. Earlier age of OCD onset (z = ,3.26, P = 0.001), increased OCD duration (z = 2.22, P = 0.027) and in-patient vs. out-patient status (z = 2.94, P = 0.003) predicted greater persistence. Comorbid psychiatric illness and poor initial treatment response were poor prognostic factors. Although psychosocial function was frequently compromised, most studies lacked comprehensive outcome measures. Conclusion:, Long-term persistence of pediatric OCD may be lower than believed. Future studies should include broader measures of outcome including symptomatic persistence and functional impairment in multiple domains. [source] Targeted group antenatal prevention of postnatal depression: a reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003M.-P. Austin Objective:, To review the efficacy of antenatal group interventions aimed at reducing postnatal depression (PND) in ,at risk' women. Method:, Medline, Psyclit, HEALTHSTAR, EMBASE, Cochrane library, UK National Research Register and CINHAL searches were performed from 1960 to December 2001 focussing on randomized controlled trials (RCTs). Results:, As statistical synthesis of the studies was not feasible, a qualitative review is provided. All five studies reviewed suffer from substantial limitations including small numbers; unrealistic effect sizes; large attrition rates; lack of a systematic approach in identifying those ,at risk' and thus clinically heterogenous samples. Three of the studies used unvalidated interventions that were educational or supportive in approach. While one such study reported a benefit of intervention, the largest study using a structured intervention, reported no effect. A very small study using interpersonal therapy, was promising but needs replication with an adequate sample size. Conclusion:, There is currently little evidence from RCTs to support the implementation of antenatal group interventions to reduce PND in ,at risk' women. Further studies addressing the significant methodological limitations are recommended before concluding that antenatal targeted interventions have no place in maternity care. [source] Testosterone Supplementation Therapy for Older Men: Potential Benefits and RisksJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2003David A. Gruenewald MD Serum testosterone levels decline gradually and progressively with aging in men. Many manifestations associated with aging in men, including muscle atrophy and weakness, osteoporosis, reduced sexual functioning, and increased fat mass, are similar to changes associated with testosterone deficiency in young men. These similarities suggest that testosterone supplementation may prevent or reverse the effects of aging. A MEDLINE search was performed to identify studies of testosterone supplementation therapy in older men. A structured, qualitative review was performed of placebo-controlled trials that included men aged 60 and older and evaluated one or more physical, cognitive, affective, functional, or quality-of-life outcomes. Studies focusing on patients with severe systemic diseases and hormone deficiencies related to specific diseases were excluded. In healthy older men with low-normal to mildly decreased testosterone levels, testosterone supplementation increased lean body mass and decreased fat mass. Upper and lower body strength, functional performance, sexual functioning, and mood were improved or unchanged with testosterone replacement. Variable effects on cognitive function were reported, with improvements in some cognitive domains (e.g., spatial, working, and verbal memory). Testosterone supplementation improved exercise-induced coronary ischemia in men with coronary heart disease, whereas angina pectoris was improved or unchanged. In a few studies, men with low testosterone levels were more likely to experience improvements in lumbar bone mineral density, self-perceived functional status, libido, erectile function, and exercise-induced coronary ischemia with testosterone replacement than men with less marked testosterone deficiency. No major unfavorable effects on lipids were reported, but hematocrit and prostate specific antigen levels often increased. Based on these results, testosterone supplementation cannot be recommended at this time for older men with normal or low-normal testosterone levels and no clinical manifestations of hypogonadism. However, testosterone replacement may be warranted in older men with markedly decreased testosterone levels, regardless of symptoms, and in men with mildly decreased testosterone levels and symptoms or signs suggesting hypogonadism. The long-term safety and efficacy of testosterone supplementation remain uncertain. Establishment of evidence-based indications will depend on further demonstrations of favorable clinical outcomes and symptomatic, functional, and quality-of-life benefits in carefully performed, long-term, randomized, placebo-controlled clinical trials. J Am Geriatr Soc 51:101,115, 2003. [source] Primacy of Affect Over Cognition in Determining Adult Men's Condom,Use Behavior: A Review,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 12 2005Tina R. Norton Prior research suggests that failure to use condoms can be understood within the context of condom-related attitudes. We reviewed quantitative and qualitative literature on adult men's condom-use attitudes; condom-related attitudinal beliefs were classified as cognitive (e.g., effectiveness) or affective (e.g., pleasure-related), and their relationships to behavior were examined. To determine differences in the effects of cognitive and affective beliefs, we conducted a critical qualitative review, a meta-analysis, and a "vote-count." In support of the primacy of affect hypothesis (Zajonc, 1984), cognitive beliefs were weaker predictors of condom use than were affective beliefs. Results suggest that HIV-prevention interventions will have greater success by addressing negative affective reactions to condom use in addition to promoting the protective value of condoms. [source] Economic analysis for clinical practice , the case of 31 national consensus guidelines in the NetherlandsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Louis W. Niessen MD Abstract Rationale, aims and objective, Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods, ,Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results, The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between ,20 000 and ,30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions, Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined. [source] Multilateral development banks, transparency and corporate clients: ,public,private partnerships' and public access to informationPUBLIC ADMINISTRATION & DEVELOPMENT, Issue 3 2003Paul J. Nelson The multilateral development banks (MDB) recognise and promote transparency as a principle of good governance. Public release of information about policies and projects is a central aspect of this transparency, and the five MDBs studied here each adopted new policies during the 1990s to increase the accessibility of such information. The flow of information to local communities is important to the effectiveness of MDBs' social and environmental safeguards and to securing public support. But MDBs also embrace a second strategy, which sometimes conflicts with transparency: each MDB (or an affiliate) lends to private corporations as well as to member states and each bank modifies its information disclosure rules, giving corporate clients greater discretion than member governments. Environmental and social safeguards apply to corporate borrowers as well as to governments and there is a relatively high level of controversy over corporate projects' environmental and social impact. When subjected to a qualitative review of their disclosure standards, emphasising fullness of disclosure, accessibility of information, timeliness of information and availability of recourse, the disclosure policies of all five MDBs are clearly found to accommodate corporate confidentiality while compromising public demands for information. Copyright © 2003 John Wiley & Sons, Ltd. [source] Does Team Training Work?ACADEMIC EMERGENCY MEDICINE, Issue 11 2008Principles for Health Care Abstract Teamwork is integral to a working environment conducive to patient safety and care. Team training is one methodology designed to equip team members with the competencies necessary for optimizing teamwork. There is evidence of team training's effectiveness in highly complex and dynamic work environments, such as aviation and health care. However, most quantitative evaluations of training do not offer any insight into the actual reasons why, how, and when team training is effective. To address this gap in understanding, and to provide guidance for members of the health care community interested in implementing team training programs, this article presents both quantitative results and a specific qualitative review and content analysis of team training implemented in health care. Based on this review, we offer eight evidence-based principles for effective planning, implementation, and evaluation of team training programs specific to health care. [source] The integrative review: updated methodologyJOURNAL OF ADVANCED NURSING, Issue 5 2005Robin Whittemore PhD APRN Aim., The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process. Background., Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated. Discussion., A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review. Conclusion., An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives. [source] What determines the value of life? a meta-analysisJOURNAL OF POLICY ANALYSIS AND MANAGEMENT, Issue 2 2002Janusz R. Mrozek A large literature has developed in which labor market contracts are used to estimate the value of a statistical life (VSL). Reported estimates of the VSL vary substantially, from less than $100,000 to more than $25 million. This research uses meta-analysis to quantitatively assess the VSL literature. Results from existing studies are pooled to identify the systematic relationships between VSL estimates and each study's particular features, such as the sample composition and research methods. This meta-analysis suggests that a VSL range of approximately $1.5 million to $2.5 million (in 1998 dollars) is what can be reasonably inferred from past labor-market studies when "best practice" assumptions are invoked. This range is considerably below many previous qualitative reviews of this literature. © 2002 by the Association for Public Policy Analysis and Management. [source] | ||||||||||