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"risk of bias"

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Rating the Strength of Evidence From the CER

Presentation: Analgesics for Osteoarthritis—An Update
Keywords: comparative effectiveness | strength of evidence | systematic review | methods
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Rating the Strength of Evidence From the Comparative Effectiveness Review

Presentation: Antinuclear Antibody, Rheumatoid Factor, and Cyclic-Citrullinated Peptide Testing for the Evaluation of Musculoskeletal Complaints in Pediatric Populations
Keywords: comparative effectiveness review | strength of evidence | evidence grade | risk of bias | consistency | directness | precision | Quality Assessment of Diagnostic Accuracy Studies | QUADAS
What Is Quality Assessment? Definition of quality: “[T]he extent to which all aspects of a study’s design and conduct can be shown to protect against systematic bias, nonsystematic bias, and inferential error.” (Lohr & Carey, 1999). Considered to be synonymous with internal validity. Relevant for individual studies. Distinct from assessment of risk of bias for a body of evidence.
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What Is Quality Assessment?

Presentation: Assessing the Quality of Individual Studies
Keywords: quality assessment | internal validity
This slide includes a table with two columns and three rows. Column 1, row 1: high. Column 2, row 2: High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect. Column 1, row 2: moderate. Column 2, row 2: Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate. Column 1, row 3: low. Column 2, row 3: Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate. Column 1, row 4: insufficient. Column 2, row 4: Evidence is either unavailable or does not permit estimation of an effect. There is a footnote at the bottom that includes the following references: Guyatt GH, et al. BMJ 2008;336:924-6; Owens DK, et al. J Clin Epidemiol 2010;63:513-23; Samson DJ, et al. AHRQ Comparative Effectiveness Review No. 20. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=447.
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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

Presentation: Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
Keywords: evidence rating | comparative effectiveness review
To determine the strength of the evidence resulting from the systematic review, researchers used the methodology of the University of Connecticut/Hartford Hospital Evidence-Based Practice Center for grading, which is based on the GRADE (Grading of Recommendations, Assessment, DEvelopment) system of the Cochrane Collaboration. This system uses four required domains — risk of bias, consistency, directness, and precision — for assessments. All assessments were made by two investigators who resolved disagreements through discussion. The strength of evidence pertaining to each key question was classified into three broad categories or grades: 1. High means that there are consistent results from good quality clinical trials. Further research is very unlikely to change the conclusions. 2. Moderate means that findings are supported, but further research could change the conclusions. 3. Low means that there are very few clinical trials, or existing trials are flawed.
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Rating the Strength of Evidence From the CER: A Modification of the GRADE Methodology

Presentation: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and/or Angiotensin II Receptor Blockers Added to Standard Medical Therapy for Treating Patients With Stable Ischemic Heart Disease and Preserved Left Ventricular Systolic Function
Keywords: effective health care | GRADE | strength of evidence | comparative effectiveness
Four Domains Used To Assess Relevant Studies The following four major domains were examined: risk of bias (low, medium, high), consistency (no inconsistency, inconsistency present, unknown, or not applicable), directness (direct, indirect), and precision (precise, imprecise). Each key outcome on each comparison of interest was given an overall evidence grade based on the ratings for the individual domains.
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Four Domains Used To Assess Relevant Studies

Presentation: Comparative Effectiveness of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications vs. Usual Care
Keywords: comparative effectiveness | recombinant factor VIIa | off-label | risk of bias | consistency | directness | precision
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Rating the Strength of Evidence From the CER

Presentation: Comparative Effectiveness of Management Strategies for Adults With Gastroesophageal Reflux Disease: An Update
Keywords: comparative effectiveness | strength of evidence | systematic review | methods
Four Domains Used To Assess Relevant Studies The following four major domains were examined: risk of bias (low, medium, high), consistency (no inconsistency, inconsistency present, unknown, or not applicable), directness (direct, indirect), and precision (precise, imprecise). Four of the outcomes (health-related quality of life, shoulder function, cuff integrity and time to return to work) for each comparison of interest were given an overall evidence grade based on the ratings for the individual domains.
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Four Domains Used To Assess Relevant Studies

Presentation: Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears
Keywords: comparative effectiveness | nonoperative | operative | rotator cuff tear
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Strength of Evidence Ratings

Presentation: Comparative Effectiveness of Therapies for Children With Autism Spectrum Disorders
Keywords: comparative effectiveness review | CER | strength of evidence
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Strength of Evidence Ratings

Presentation: Comparisons of Medical, Laser, and Incisional Surgical Treatments for Open-Angle Glaucoma in Adults
Keywords: systematic review | strength of evidence | grading | risk of bias | consistency | directness | precision
On Data Extraction (II). Data extraction involves more than copying words and numbers from the publication to a form. Clinical domain, methodological, and statistical knowledge is needed to ensure the right information is captured. Interpretation of published data is often needed. What is reported is sometimes not what was carried out. Data extraction and evaluation of risk of bias and of applicability typically occur at the same time.
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On Data Extraction (II)

Presentation: Data Extraction
Keywords: data extraction | observational studies | risk of bias | applicability
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Rating the Strength of Evidence From the CER

Presentation: Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Keywords: comparative effectiveness | strength of evidence | systematic review | methods
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