Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2012
Review[GRADE guidelines: 7. Rating the quality of evidence - inconsistency].
This article deals with inconsistency of relative, rather than absolute, treatment effects in binary/dichotomous outcomes. A body of evidence is not rated up in quality if studies yield consistent results, but may be rated down in quality if inconsistent. Criteria for evaluating consistency include similarity of point estimates, extent of overlap of confidence intervals, and statistical criteria including tests of heterogeneity and I(2). ⋯ When inconsistency is large and unexplained, rating down quality for inconsistency is appropriate, particularly if some studies suggest substantial benefit, and others no effect or harm (rather than only large versus small effects). Apparent subgroup effects may be spurious. Credibility is increased if subgroup effects are based on a small number of a priori hypotheses with a specified direction; subgroup comparisons come from within rather than between studies; tests of interaction generate low p-values; and have a biological rationale.
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Z Evid Fortbild Qual Gesundhwes · Jan 2012
The decisional conflict scale: moving from the individual to the dyad level.
Decisional conflict is a central determinant of decision making, particularly in the context of uncertainty. It is also one of the most frequently reported outcomes in studies on decision support interventions. Decisional conflict is defined as personal uncertainty about which option to choose. ⋯ In recent years, however, more and more researchers have found that evaluating the perspectives of the patient and the health professional as interdependent members of a dyad, rather than as two autonomous individuals, offers exciting avenues for developing interventions to improve decision making in the clinical setting. For that reason, the SDM community has increasingly turned its attention to a dyadic approach to SDM. In this paper, we briefly review the history of the Dyadic Decisional Conflict Scale (D-DCS), update its psychometrics based on published work, and propose a research agenda for refining it further.
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Z Evid Fortbild Qual Gesundhwes · Jan 2012
Guideline[GRADE guidelines: 5. Rating the quality of evidence: publication bias].
In the GRADE approach, randomized trials are classified as high quality evidence and observational studies as low quality evidence but both can be rated down if a body of evidence is associated with a high risk of publication bias. Even when individual studies included in best-evidence summaries have a low risk of bias, publication bias can result in substantial overestimates of effect. ⋯ The most popular of these is the funnel plot; all, however, have substantial limitations. Publication bias is likely frequent, and caution in the face of early results, particularly with small sample size and number of events, is warranted.
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Z Evid Fortbild Qual Gesundhwes · Jan 2012
['Optimal care for depression': Freiburg model of integrated care for depressive disorders].
Health care for persons with depressive disorders is not networked to an optimal degree in Germany. In order to improve outpatient care, an integrated care model for patients with depressive disorders was initiated in Freiburg in December 2008. The model aims at implementation of central recommendations of the "Conceptual Framework Integrated Care: Depression" of the German Association for Psychiatry and Psychotherapy. ⋯ In the Freiburg model the "Conceptual Framework Integrated Care: Depression" could be implemented under current routine conditions. The first evaluation results indicate the success of this model. The results are indicative of a high quality of health care of the Freiburg model.