Meta-analysis and decision analysis bridge research and practice

A Meta-Analysis of the Effect of Guided Imagery Practice on Outcomes

Guided imagery is an intervention used by nurses in a variety of settings. It has been suggested that better outcomes will occur with continued practice. No studies were found that examined the relationship between practice duration and strength of outcomes. The focus of this meta-analysis was the effect size of guided imagery intervention studies with different durations. Statistical findings of 10 studies of various durations were converted to d statistics and plotted against the duration of study. The results show an increase in effect size of guided imagery over the first 5 to 7 weeks; however, the effect was decreased at 18 weeks.

Curative Effects of Fuzheng Huayu on Liver Fibrosis and Cirrhosis: A Meta-Analysis

The Fuzheng Huayu (FZHY) formula is being used in antiliver fibrosis treatment in China. For systemic evaluation of the curative effects of FZHY on liver fibrosis and cirrhosis progress, a total of 1392 subjects (714 cases and 678 controls) were found to be eligible for meta-analysis in this study. Standard mean differences (SMDs) with 95% confidence interval (CI) were calculated for changes between FZHY groups and controls by employing fixed effects or random effects model. In the overall analysis, alanine transaminase (ALT) (P = 0.003, SMD = -0.87, 95% CI: -1.46 to -0.29), total bilirubin (TBil) (P = 0.001, SMD = -1.30, 95% CI: -2.10 to -0.50), hyaluronic acid (HA) (P = 0.000, SMD = -0.94, 95% CI: -1.30 to -0.58), laminin (LN) (P = 0.000, SMD = -0.80, 95% CI: -1.20 to -0.41), type III procollagen (PC-III) (P = 0.000, SMD = -1.27, 95% CI: -1.93 to -0.60), and type IV procollagen (IV-C) (P = 0.000, SMD = -0.78, 95% CI: -1.05 to -0.51) were decreased after FZHY treatment; however, albumin (ALB) was increased (P = 0.037, SMD = 1.10, 95% CI: 0.07 to 2.12) significantly. Furthermore, the Child-Pugh score was reduced significantly and the life quality was improved after FZHY treatment in cirrhosis patients. The results of this meta-analysis indicated that FZHY effectively improves the liver function, alleviates hepatic fibrosis, decreases Child-Pugh score, and relieves TCM symptoms caused by liver dysfunction, indicating that FZHY may contribute to the alleviation of liver fibrosis and cirrhosis.

Determining patient characteristics for decision analysis support systems using anonymized electronic patient records

While decision analysis has the potential to improve treatment decisions, the quality of patient specific data has hindered its development. Experience with the General Practice Research Database (GPRD) indicated the possibility of generating such data. The example developed concerns the probability of recurrent stroke and the risks and benefits of treatment with aspirin. Eight criteria were systematically applied to identify suitable patients from the 664,241 cohort of patients in the West Midlands GPRD. The risk of recurrent stroke was estimated using survival analysis, yielding multivariate hazard ratios for 960 patient profiles. These were used to populate a decision analysis model. The study highlights how decision analysis can introduce evidence-based information into the consultation. Data can be transformed into information for the increasingly complex world of general practice. This can clarify the risks and benefits of prescribing, assist GP-patient dialogue and promote shared decision-making.

Evidence-based Guidelines for the Utilization of Immunostains in Diagnostic Pathology: Pulmonary Adenocarcinoma Versus Mesothelioma

There are no firmly established guidelines for the use of antibodies in immunohistology as individual tests or panels. Practicing pathologists must rely on information available in individual publications, review articles, books, and internet-based databases to develop diagnostic immunohistochemical algorithms for their individual practices. In contrast, other medical specialties have crafted many evidence-based practice guidelines (EBG) that are widely used; these have helped to augment standardization and cost effectiveness. In particular, the use of several "epithelial" and "mesothelial" antibodies has been proposed to distinguish epithelioid malignant mesothelioma from metastatic pulmonary adenocarcinoma. Other authors have previously done systematic literature reviews of this subject up through 2004 and integrated the results of 88 publications into summarized test-performance values for 15 preselected immunohistochemical markers. The results suggested that 7 tests provide optimal sensitivity and specificity (MOC-31, BG8, CEA, TTF-1, CK5/6, WT-1, and HBME-1), but they provide no guidance for integration of such data into EBG. Odds ratios (ORs) were employed to compare the effectiveness of any single test, and chosen combinations thereof, in the differential diagnosis of malignant mesothelioma and metastatic pulmonary adenocarcinoma. Surprisingly, selected single immunostains or antibody pairs yielded ORs (varying from 96.34 to 1233.19) that were equal or better in efficacy when compared with more comprehensive panels. These results support the potential value of systematic reviews, meta-analysis, and OR calculations for development of EBG in diagnostic immunohistology.

Evidence-based medicine in pathology: an introduction

Evidence-based medicine (EBM) is a school of thought that has spread rapidly through medicine in the past 2 decades and is eliciting an increasing interest in Anatomic Pathology and Laboratory Medicine. It has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." The environmental factors that created a need for EBM and basic concepts of this discipline are reviewed. Methods for the accrual and critical appraisal of the validity of available evidence and its impact, applicability and usefulness in pathology practice are discussed. Basic concepts of bayesian data analysis with an emphasis on concepts such as prior and posterior probability and the use of "holdout" or "test" data are introduced. The future of EBM in pathology is discussed and potential applications of these concepts to pathology practice and research are proposed.