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A pragmatic strategy for the review of clinical evidence
Author(s) -
Sagliocca Luciano,
De Masi Salvatore,
Ferrigno Luigina,
Mele Alfonso,
Traversa Giuseppe
Publication year - 2013
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12020
Subject(s) - medicine , medline , intensive care medicine , psychology , political science , law
Background Systematic reviews ( SR ) of clinical evidence are rightfully considered the basis for developing recommendations to support decisions in current practice. To avoid bias, SR s are expected to be systematic in their research strategy and are exhaustive. The drawback of the latter criteria relies in the substantial work needed to conduct and keep SR s updated. The objective of this paper is to compare a research strategy based on the review of a selected number of core journals, which we consider a ‘pragmatic review’ ( PR ), with that derived by an SR in estimating the efficacy of treatments. Methods Five clinical areas were considered for the comparison between the two strategies: chronic obstructive pulmonary disease, dermatology, heart failure, renal diseases and stroke. We extracted a systematic sample from all the Cochrane SRs pertaining to each area and were published before A pril 2010. Two groups of journals were considered in the PR : six general journals that commonly published research for the five clinical areas, and five specialist journals with the highest impact factor in each area. To assess the agreement in the findings of SR s and PR s, we considered both the direction of the estimates and P ‐values. Results A sample of 27 SR s included 171 overall analyses and 259 subgroup analyses related to primary outcomes. The PR captured one or more clinical trials in 24 of the 27 SR s (89%), and 118 of the 171 overall analyses (69%) were replicated. The PR supported the recommendations to use (or not) the study treatment in 11 of the 13 SR s (85%), which ended with a clinical recommendation. Conclusions We verified in a sample of SR s that the conclusion of a research strategy based on a pre‐defined set of general and specialist medical journals is able to replicate almost all the clinical recommendations of a formal SR .