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Ahn S, McClure LA, Pinheiro PS, Hernandez D, Boga DJ, Ukani H, Chavez JV, Quintela Fernandez JA, Caban-Martinez AJ, Kobetz E, Lee DJ. Methodological and Practical Challenges in Synthesizing Occupational Cancer Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:742. [PMID: 38928988 PMCID: PMC11203818 DOI: 10.3390/ijerph21060742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/11/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
Studies examining occupational exposures and cancer risk frequently report mixed findings; it is thus imperative for researchers to synthesize study results and identify any potential sources that explain such variabilities in study findings. However, when synthesizing study results using meta-analytic techniques, researchers often encounter a number of practical and methodological challenges. These challenges include (1) an incomparability of effect size measures due to large variations in research methodology; (2) a violation of the independence assumption for meta-analysis; (3) a violation of the normality assumption of effect size measures; and (4) a variation in cancer definitions across studies and changes in coding standards over time. In this paper, we first demonstrate these challenges by providing examples from a real dataset collected for a large meta-analysis project that synthesizes cancer mortality and incidence rates among firefighters. We summarize how each of these challenges has been handled in our meta-analysis. We conclude this paper by providing practical guidelines for handling challenges when synthesizing study findings from occupational cancer literature.
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Affiliation(s)
- Soyeon Ahn
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, Coral Gables, FL 33146, USA
| | - Laura A. McClure
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
| | - Paulo S. Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - Diana Hernandez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
| | - Devina J. Boga
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
| | - Henna Ukani
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
| | - Jennifer V. Chavez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
| | | | - Alberto J. Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - Erin Kobetz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33101, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33101, USA; (L.A.M.); (P.S.P.); (D.H.); (D.J.B.); (H.U.); (J.V.C.); (A.J.C.-M.); (E.K.); (D.J.L.)
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33101, USA
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Faggion CM, Nagendrababu V, Dummer PMH. Should authors of overviews of systematic reviews invite the authors of the systematic reviews they analyzed to re-evaluate or validate their methodological analysis? J Clin Epidemiol 2023; 158:177-178. [PMID: 36990130 DOI: 10.1016/j.jclinepi.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany.
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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De Santis KK, Pieper D, Lorenz RC, Wegewitz U, Siemens W, Matthias K. User experience of applying AMSTAR 2 to appraise systematic reviews of healthcare interventions: a commentary. BMC Med Res Methodol 2023; 23:63. [PMID: 36927334 PMCID: PMC10018966 DOI: 10.1186/s12874-023-01879-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND 'A Measurement Tool to Assess Systematic Reviews, version 2' (AMSTAR 2) is a validated 16-item scale designed to appraise systematic reviews (SRs) of healthcare interventions and to rate the overall confidence in their results. This commentary aims to describe the challenges with rating of the individual items and the application of AMSTAR 2 from the user perspective. DISCUSSION A group of six experienced users (methodologists working in different clinical fields for at least 10 years) identified and discussed the challenges in rating of each item and the general use of AMSTAR 2 to appraise SRs. A group discussion was used to develop recommendations on how users could deal with the identified challenges. We identified various challenges with the content of items 2-16 and with the derivation of the overall confidence ratings on AMSTAR 2. These challenges include the need (1) to provide additional definitions (e.g., what constitutes major deviations from SR protocol on item 2), (2) to choose a rating strategy for multiple conditions on single items (e.g., how to rate item 5 if studies were selected in duplicate, but consensus between two authors was not reported), and (3) to determine rules for deriving the confidence ratings (e.g., what items are critical for such ratings). Based on these challenges we formulated specific recommendations for items 2-16 that AMSTAR 2 users could consider before applying the tool. Our commentary adds to the existing literature by providing the first in-depth examination of the AMSTAR 2 tool from the user perspective. The identified challenges could be addressed by additional decision rules including definitions for ambiguous items and guidance for rating of complex items and derivation of confidence ratings. We recommend that a team consensus regarding such decision rules is required before appraisal procedure begins. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Dawid Pieper
- Brandenburg Medical School Theodor Fontane (MHB), Center for Health Services Research (ZVF-BB), Brandenburg an der Havel, Germany
| | - Robert C Lorenz
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Uta Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA), Division 3 Work and Health, Berlin, Germany
| | - Waldemar Siemens
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Sciences Stralsund, Stralsund, Germany.
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Hock J, Willinger L, Pozza RD, Ewert P, Hager A. Abnormalities in pulmonary function and volumes in patients with CHD: a systematic review. Cardiol Young 2023; 33:169-181. [PMID: 36601957 DOI: 10.1017/s1047951122004103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lung function and cardiac function are naturally correlated by sharing the thoracic cage and handling the whole cardiac output sequentially. However, lung function studies are rare in patients with CHD, although results worthy of investigation could be expected. This review summarises existing studies with the lung function parameters (spirometry and body plethysmography) in CHD patients during the last decade. METHODS A systematic review was performed in the relevant database (PubMed, Cochrane, and Scopus) in studies including paediatric and adult patients with CHD where lung parameters (spirometry, body plethysmography) were investigated from January 2010 to December 2020. Two independent reviewers evaluated the studies according to the Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. RESULTS Eight studies investigated patients with Fontan palliation including 704 patients (306 female). Four studies included patients after repaired tetralogy of Fallot examining 219 patients (103 female), with one study using double. Further six studies included 3208 (1324 female) children and adults with various CHDs. Overall, four studies were categorised as "good", ten as "fair", and four as "poor". While the measurements were consistently standardised, references to calculate %predicted differed substantially across all studies. All evaluated studies showed reduced forced vital capacity in the majority of CHD patients. CONCLUSIONS Many CHD patients have a reduced forced vital capacity independent of their underlying defect. Spirometry should not only follow a standardised measure according to ATS (update 2019) but also stick to the 2012 GLI reference values.
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Affiliation(s)
- Julia Hock
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Laura Willinger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
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Using existing systematic reviews for developing vaccination recommendations: Results of an international expert workshop. Vaccine 2021; 39:3103-3110. [PMID: 33965256 DOI: 10.1016/j.vaccine.2021.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022]
Abstract
National immunization technical advisory groups (NITAGs) develop immunization-related recommendations. Systematic reviews are recommended to be used in this process, but conducting them requires significant resources, which many NITAGs lack. Using existing systematic reviews could help address this problem. The Robert Koch Institute and collaborators set up the SYSVAC2 project to facilitate the retrieval of existing systematic reviews and offer guidance on using them. This will include an online registry of systematic reviews relevant to immunization policy and an online course on how to use existing reviews. This report describes an international expert workshop held in December 2019 to develop consensus on methods for using existing reviews and other relevant factors for the registry and course. Members from NITAGs representing different regions of the world presented their experiences of using systematic reviews and reflected on challenges inhibiting use. Three methodologists considered different aspects of using systematic reviews. Interactive sessions followed, where implications for SYSVAC2 were discussed. Participants supported having critical appraisal ratings, plain language summaries, keyword search, and data visualization functions in the registry. They suggested tailoring course content to different audiences and including overviews of reviews as a topic and examples of how NITAGs have used or could use existing reviews. Participants agreed that whether a review is out-of-date should be decided by those using the review rather than registry staff. The registry could help by highlighting the date of literature search or included primary studies. Participants recommended a visualization function to highlight overlap across reviews and guidance on handling challenges to using reviews, ideally, involving a practical element. No consensus was reached on which critical appraisal tool to use for reviews in the registry, but a majority of participants wanted registry staff to perform appraisals. Formative research is planned before the registry and online course are launched in 2020.
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Abstract
There exists an ever-increasing number of systematic reviews, with or without meta-analysis, in the field of nutrition. Concomitant with this increase is the increased use of such to guide future research as well as both practice and policy-based decisions. Given this increased production and consumption, a need exists to educate both producers and consumers of systematic reviews, with or without meta-analysis, on how to conduct and evaluate high-quality reviews of this nature in nutrition. The purpose of this paper is to try and address this gap. In the present manuscript, the different types of systematic reviews, with or without meta-analyses, are described as well as the description of the major elements, including methodology and interpretation, with a focus on nutrition. It is hoped that this non-technical information will be helpful to producers, reviewers and consumers of systematic reviews, with or without meta-analysis, in the field of nutrition.
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Bühn S, Holstiege J, Pieper D. Are patients willing to accept longer travel times to decrease their risk associated with surgical procedures? A systematic review. BMC Public Health 2020; 20:253. [PMID: 32075615 PMCID: PMC7031936 DOI: 10.1186/s12889-020-8333-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Distance to a hospital is an influencing factor for patients´ decision making when choosing a hospital for surgery. It is unclear whether patients prefer to travel further to regional instead of local hospitals if the risk associated with elective surgery is lower in the farther hospital. The aim of our systematic review was to investigate patient preferences for the location of care, taking into consideration surgical outcomes and hospital distance. Methods MEDLINE (PubMed), EconLit, PsycInfo and EMBASE were searched until November 2019. We included experimental choice studies in which participants were asked to make a hypothetical decision where to go for elective surgery when surgical risk and/or distance to the hospitals vary. There was no restriction on the type of intervention or study. Reviewers independently extracted data using a standardized form. The number and proportion of participants willing to accept additional risk to obtain surgery in the local hospital was recorded. We also extracted factors associated with the decision. Results Five studies exploring participants´ preferences for local care were included. In all studies, there were participants who, independently of a decreased mortality risk or a higher survival benefit in the regional hospital, adhered to the local hospital. The majority of the patients were willing to travel longer to lower their surgical risk. Older age and fewer years of formal education were associated with a higher risk tolerance in the local hospital. Conclusions Whether patients were willing to travel for a lower surgery-associated risk could not be answered in a straightforward manner. The studies we identified showed that decision making also relies on factors other than on rational information on risk or distance to hospital. Trial registration International prospective register of ongoing systematic reviews (PROSPERO): CRD42016033655. Registered 1 January 2016.
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Affiliation(s)
- Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, Building 38, D-51109, Cologne, Germany.
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Salzufer 8, D-10587, Berlin, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, Building 38, D-51109, Cologne, Germany
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