This week in the BMJ
Volume 333, Number 7565, Issue of 26 Aug 2006Methods and reporting of systematic reviews of diagnostic tests need to improve
Methods and reporting of systematic reviews of diagnostic tests need to improve
Reliability and clinical relevance of published systematic reviews of diagnostic tests are compromised by poor review methods and poor reporting. Mallett and colleagues (p 413) assessed methods and reporting of 89 systematic reviews of diagnostic tests in cancer and found poor results. Of the 89 reviews, only 44 tabulated the characteristics of included studies, 36 reported details of study design, and 15 reported on the severity of disease in participants. Systematic reviews of diagnostic tests need better reporting of detailed information about the design, conduct, and results of the included primary studies, as well as review methods. These improvements will be required in the forthcoming Cochrane Reviews of Test Accuracy, conclude the authors.
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Appraising quality of patient decision aids
Developers, users, and purchasers of patient decision aids now have a checklist for appraising the quality of new technologies of patient decision support. Elwyn and colleagues (p 417) conducted a web based international Delphi consensus process to determine a framework for the development and evaluation of patient decision aids. Over 100 individuals, including researchers, practitioners, patients, and policy makers from 14 countries rated 83 quality criteria for patient decision aids. Criteria for which evidence existed were given the highest ratings, and these criteria were retained in the decision aids.
Furosemide is not effective in preventing and treating acute renal failure
Furosemide (frusemide) is not associated with any clinical benefits when used to prevent and treat acute renal failure in adults. In a meta-analysis of nine randomised trials, Ho and Sheridan (p 420) investigated the potential beneficial and adverse effects of furosemide to prevent or treat acute renal failure. They found that in-hospital mortality, risk of requiring renal replacement therapy or dialysis, number of dialysis sessions required, and proportion of patients with persistent oliguria were not significantly different after treatment with furosemide. However, high doses of furosemide may be associated with an increased risk of ototoxicity.
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How to manage obsessive-compulsive disorder
Obsessive-compulsive disorder is one of the more common serious mental illnesses. It can occur at any age but most often presents for the first time in adolescence. Long delays in diagnosis often occur, and the shame associated with the disorder may inhibit people from mentioning the symptoms. On page 424, Heyman and colleagues review the assessment of obsessive-compulsive disorder and discuss the current best treatment options, including guided self help, cognitive behaviour therapy, and drug treatment, as well as directions for the future.
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Whither professional regulation in the UK?
In the UK the notion of professional ethos, supported by intensive training and peer led inquiries into "fitness to practise," has long been the foundation for assuring quality in the NHS. Now, England's chief medical officer recommends the adoption of specialty certification—a well established process in the US—as one of several changes to strengthen professional regulation. In the light of positive findings of US observational studies on the associations between professional certification and quality of care, Sutherland and Leatherman (p 439) discuss if a system similar to that used in the US could work for the UK.
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