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Meta-analytic comparison of randomized and nonrandomized studies of breast cancer surgeryBackground: Randomized controlled trials (RCTs) are thought to provide the most accurate estimation of "true" treatment effect. The relative quality of effect estimates derived from nonrandomized studies (nRCTs) remains unclear, particularly in surgery, where the obstacles to performing high-quality RCTs are compounded. We performed a meta-analysis of effect estimates of RCTs comparing surgical procedures for breast cancer relative to those of corresponding nRCTs.Methods: English-language RCTs of breast cancer treatment in human patients published from 2003 to 2008 were identified in MEDLINE, EMBASE and Cochrane databases. We identified nRCTs using the National Library of Medicine's "related articles" function and reference lists. Two reviewers conducted all steps of study selection. We included studies comparing 2 surgical arms for the treatment of breast cancer. Information on treatment efficacy estimates, expressed as relative risk (RR) for outcomes of interest in both the RCTs and nRCTs was extracted. Results:We identified 12 RCTs representing 10 topic/outcome combinations with comparable nRCTs. On visual inspection, 4 of 10 outcomes showed substantial differences in summary RR. The pooled RR estimates for RCTs versus nRCTs differed more than 2-fold in 2 of 10 outcomes and failed to demonstrate consistency of statistical differences in 3 of 10 cases. A statistically significant difference, as assessed by the z score, was not detected for any of the outcomes. Conclusion:Randomized controlled trials comparing surgical procedures for breast cancer may demonstrate clinically relevant differences in effect estimates in 20%-40% of cases relative to those generated by nRCTs, depending on which metric is used. Contexte :On estime que les essais randomisés et contrôlés (ERC) offrent l'estimation la plus juste de l'effet « réel » des traitements. La qualité relative de l'estimation de l'effet dérivée des études non randomisées (EnRC) reste indéterminée, particulièrement en ce qui concerne la chirurgie, où les obstacles à la réalisation d'ERC optimaux sont nombreux. Nous avons procédé à une méta-analyse des estimations de l'effet dérivées d'ERC qui comparaient des interventions chirurgicales pour le cancer du sein, aux estimations dérivées d'EnRC assortis. Méthodes :Nous avons relevé les ERC sur le traitement du cancer du sein chez l'humain publiés en langue anglaise entre 2003 et 2008 à partir des bases de données MEDLINE, EMBASE et Cochrane. Nous avons relevé les EnRC à l'aide des listes bibliographiques et de la fonction « articles connexes » de la National Library of Medicine. Deux examinateurs se sont chargés de toutes les étapes de la sélection des études. Nous avons inclus les études qui comparaient 2 groupes soumis à une chirurgie pour le traitement du cancer du sein. Nous avons extrait l'information sur les estimations de l'efficacité des traitements, exprimées sous forme de risque relatif (RR) de survenue des paramètres r...

ObjectiveThis study explored the effectiveness of search filters in identifying sex- and gender-specific data in health promotion studies that are indexed in MEDLINE.MethodsLiterature searches were conducted to identify studies on patient or consumer attitudes and behaviors toward colorectal cancer screening, nutritional labeling, and influenza vaccination. Publications reporting sex- or gender-specific outcome data constituted the gold standards for this study. The sensitivity and precision of previously published gender-specific filters, as well as individual filter component terms, were calculated and compared with values identified in prior studies.ResultsThe sensitivity and precision of published sex or gender filters varied across topics. Sensitivity values ranged from 14.3% to 92.5%, while precision varied from 17.9% to 51.4%. These filters were less sensitive and less precise in their identification of relevant studies than has been reported in previous studies. Further, while the MEDLINE Medical Subject Headings (MeSH) term “Sex Factors” achieved the greatest average precision (59.3%) of any individual filter term, the MEDLINE check tag “Female” returned the highest average sensitivity (90.1%), with an average precision of 25.0% across topics.ConclusionsAlthough search filters can facilitate the identification of research evidence to enable decision making, variability in study abstracting and indexing can limit the generalizability and usability of these filters. This potential for variability should be considered when deciding to incorporate a search filter into any literature search. This research highlights the importance of this awareness when developing strategies for searching the published literature and the potential value of supplementing database searching with other methods of study identification.

Background:With emphasis on evidence-based medical care, ‘evidence’ is often the result of literature reviews. Hence, the critical question, “are literature reviews comprehensive?”Aim:This study compares the literature generated by a researcher and a health sciences librarian (HSL).Methods:The Research Associate and the HSL conducted a parallel, segregated literature search on ‘patient-centered care’.Results:The Research Associate identified 215 manuscripts, and the HSL 129 manuscripts. Overlap was only 55 manuscripts. Differences in process and blind spots are discussed.Conclusion:To improve the quality of research outcomes, it seems prudent and ethical to have a synergistic collaboration between researchers and HSLs. Given that this is just one case study that has looked into the issue, further research is strongly encouraged.