Synthesizing medical evidence: systematic reviews and metaanalyses

Barker, Fred G.; Carter, Bob S.

doi:10.3171/foc.2005.19.4.6

Cited by 33 publications

(37 citation statements)

References 344 publications

(362 reference statements)

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“…There are some inherent limitations with systematic reviews and analysis [85]. One obvious limitation is that any aggregation of data is only as good as its composite studies.…”

Section: Discussionmentioning

confidence: 99%

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

et al. 2009

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Objective Facial nerve preservation is a critical measure of clinical outcome after vestibular schwannoma treatment. Gamma Knife radiosurgery has evolved into a practical treatment modality for vestibular schwannoma patients, with several reported series from a variety of centers. In this study, we report the results of an objective analysis of reported facial nerve outcomes after the treatment of vestibular schwannomas with Gamma Knife radiosurgery. Materials and methods A Boolean Pub Med search of the English language literature revealed a total of 23 published studies reporting assessable and quantifiable outcome data regarding facial nerve function in 2,204 patients who were treated with Gamma Knife radiosurgery for vestibular schwannoma. Inclusion criteria for articles were: (1) Facial nerve preservation rates were reported specifically for vestibular schwannoma, (2) Facial nerve functional outcome was reported using the House-Brackmann classification (HBC) for facial nerve function, (3) Tumor size was documented, and (4) Gamma Knife radiosurgery was the only radiosurgical modality used in the report. The data were then aggregated and analyzed based on radiation doses delivered, tumor volume, and patient age. Results An overall facial nerve preservation rate of 96.2% was found after Gamma Knife radiosurgery for vestibular schwannoma in our analysis. Patients receiving less than or equal to 13 Gy of radiation at the marginal dose had a better facial nerve preservation rate than those who received higher doses (B13 Gy = 98.5% vs. [13 Gy = 94.7%, P \ 0.0001). Patients with a tumor volume less than or equal to 1.5 cm 3 also had a greater facial nerve preservation rate than patients with tumors greater than 1.5 cm 3 (B1.5 cm 3 99.5% vs. [1.5 cm 3 95.5%, P \ 0.0001). Superior facial nerve preservation was also noted in patients younger than or equal to 60 years of age (96.8 vs. 89.4%, P \ 0.0001). The average reported follow up duration in this systematic review was 54.1 ± 31.3 months. Conclusion Our analysis of case series data aggregated from multiple centers suggests that a facial nerve preservation rate of 96.2% can be expected after Gamma knife radiosurgery for vestibular schwannoma. Younger patients with smaller tumors less than 1.5 cm 3 and treated with lower doses of radiation less than 13 Gy will likely have better facial nerve preservation rates after Gamma Knife radiosurgery for vestibular schwannoma.

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“…There are some inherent limitations with systematic reviews and analysis [85]. One obvious limitation is that any aggregation of data is only as good as its composite studies.…”

Section: Discussionmentioning

confidence: 99%

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

et al. 2009

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“…4,46 The inconsistent criteria used to define disease remission make it difficult to appreciate the actual efficacy of SRS in normalizing GH and IGF-I levels in acromegaly patients with hyperfunctional pituitary adenomas. Moreover, other prognostic and outcome measures, such as side effects, baseline endocrine function, and posttreatment hormone levels, are inconsistently reported.…”

Section: Discussionmentioning

confidence: 99%

A systematic analysis of disease control in acromegaly treated with radiosurgery

Yang

Kim²,

Salles³

et al. 2010

FOC

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Object Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone–secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly. Methods A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication. Results The overall disease control rate without medication was 48%–53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 ± 25.8 months. The mean overall tumor volume in this analysis was 2.11 ± 1.16 cm3. The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546). Conclusions Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly.

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“…Over 10 million articles have been indexed in MED-LINE, and 2 million new biomedical articles are published each year in 20,000 journals (Barker & Carter, 2005). At the same time, the amount of time stakeholders have to learn about evidence is short due to factors such as the desire to act quickly to reduce suffering, pressures for productivity, and competing demands for people's time (Caminiti, Scoditti, Diodati, & Passalacqua, 2005;Chilvers & Shelton 2001;Strauss et al, 2005).…”

Section: Concisenessmentioning

confidence: 98%

“…If studies differ in areas such as specific measures, time periods, intervention details, designs, and findings, then coding, combining, and collapsing variables should be employed to make synthesis possible. Syntheses should weight factors like study size, variability, and design (Lipsey, 2003;Barker & Carter, 2005).…”

Section: Completenessmentioning

confidence: 99%

“…Narrative reviews can be valuable while a body of evidence is in nascent stages and lacks the depth and sophistication necessary for systematic reviews, as well as in later stages where ''methods for incorporating qualitative research and other evidence in systematic reviews are relatively under-developed'' (Mays, Pope, & Poppay, 2005). Narrative reviews of behavioral health interventions are usually found in journal articles and text books (Barker & Carter, 2005).…”

Section: Definition and Historymentioning

confidence: 99%

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Desired Attributes of Evidence Assessments for Evidence-based Practices

Leff

Conley

2006

Adm Policy Ment Health

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In this paper we describe three approaches to assessing evidence for stakeholders interested in evidence-based practices: narrative reviews, systematic reviews (including meta-analyses), and registries. We then compare the approaches in terms of the degree to which they posses desired attributes of evidence assessments. Our review suggests that hybrid approaches that combined the best features of all three should be pursued to further the use of evidence-based practices, and that such hybrids are possible given the capacity of the World Wide Web. We conclude by stressing the need for empirical research on evidence assessments.

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Synthesizing medical evidence: systematic reviews and metaanalyses

Cited by 33 publications

References 344 publications

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

Facial nerve preservation after vestibular schwannoma Gamma Knife radiosurgery

A systematic analysis of disease control in acromegaly treated with radiosurgery

Desired Attributes of Evidence Assessments for Evidence-based Practices

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