Background:
Qualitative synthesis has become more commonplace in recent years. Meta-ethnography is one of several methods for synthesising qualitative research and is being used increasingly within health care research. However, many aspects of the steps in the process remain ill-defined.DiscussionWe utilized the seven stages of the synthesis process to synthesise qualitative research on adherence to tuberculosis treatment. In this paper we discuss the methodological and practical challenges faced; of particular note are the methods used in our synthesis, the additional steps that we found useful in clarifying the process, and the key methodological challenges encountered in implementing the meta-ethnographic approach.The challenges included shaping an appropriate question for the synthesis; identifying relevant studies; assessing the quality of the studies; and synthesising findings across a very large number of primary studies from different contexts and research traditions. We offer suggestions that may assist in undertaking meta-ethnographies in the future.SummaryMeta-ethnography is a useful method for synthesising qualitative research and for developing models that interpret findings across multiple studies. Despite its growing use in health research, further research is needed to address the wide range of methodological and epistemological questions raised by the approach.

source

• Share:
• Bookmark on Delicious
• Digg this
• Share on Reddit
• Share with Stumblers
• Tweet this

Background:
Assessing the risk of bias in individual studies in a systematic review can be done using individual components or by summarizing the study quality in an overall score.
Methods:
We examined the instructions to authors of the 50 Cochrane Review Groups that focus on clinical interventions for recommendations on methodological quality assessment of studies.
Results:
Forty-one of the review groups (82%) recommended quality assessment using components and nine using a scale. All groups recommending components recommended to assess concealment of allocation, compared to only two of the groups recommending scales (P < 0.0001). Thirty-five groups (70%) recommended assessment of sequence generation and 21 groups (42%) recommended assessment of intention-to-treat analysis. Only 28 groups (56%) had specific recommendations for using the quality assessment of studies analytically in reviews, with sensitivity analysis, quality as an inclusion threshold and subgroup analysis being the most commonly recommended methods. The scales recommended had problems in the individual items and some of the groups recommending components recommended items not related to bias in their quality assessment.
Conclusion:
We found that recommendations by some groups were not based on empirical evidence and many groups had no recommendations on how to use the quality assessment in reviews. We suggest that all Cochrane Review Groups refer to the Cochrane Handbook for Systematic Reviews of Interventions, which is evidence-based, in their instructions to authors and that their own guidelines are kept to a minimum and describe only how methodological topics that are specific to their fields should be handled.

source

• Share:
• Bookmark on Delicious
• Digg this
• Share on Reddit
• Share with Stumblers
• Tweet this

Background:
There is a growing trend towards the production of hospital report-cards in which hospitals with higher than acceptable mortality rates are identified. Several commentators have advocated for the use of Bayesian hierarchical models in provider profiling. Several researchers have shown that some degree of misclassification will result when hospital report cards are produced. The impact of misclassifying hospital performance can be quantified using different loss functions.
Methods:
We propose several families of loss functions for hospital report cards and then develop Bayes rules for these families of loss functions. The resultant Bayes rules minimize the expected loss arising from misclassifying hospital performance. We develop Bayes rules for generalized 1-0 loss functions, generalized absolute error loss functions, and for generalized squared error loss functions. We then illustrate the application of these decision rules on a sample of 19,757 patients hospitalized with an acute myocardial infarction at 163 hospitals.
Results:
We found that the number of hospitals classified as having higher than acceptable mortality is affected by the relative penalty assigned to false negatives compared to false positives. However, the choice of loss function family had a lesser impact upon which hospitals were identified as having higher than acceptable mortality.
Conclusions:
The design of hospital report cards can be placed in a decision-theoretic framework. This allows researchers to minimize costs arising from the misclassification of hospitals. The choice of loss function can affect the classification of a small number of hospitals.

source

• Share:
• Bookmark on Delicious
• Digg this
• Share on Reddit
• Share with Stumblers
• Tweet this

Background:
To assess the intra- and inter-rater agreement of chart abstractors from multiple sites involved in the evaluation of an Asthma Care Program (ACP).
Methods:
For intra-rater agreement, 110 charts randomly selected from 1,433 patients enrolled in the ACP across eight Ontario communities were re-abstracted by 10 abstractors. For inter-rater agreement, data abstractors reviewed a set of eight fictitious charts. Data abstraction involved information pertaining to six categories: physical assessment, asthma control, spirometry, asthma education, referral visits, and medication side effects. Percentage agreement and the kappa statistic were used to measure agreement. Sensitivity and specificity estimates were calculated comparing results from all raters against the gold standard.
Results:
Intra-rater re-abstraction yielded an overall kappa of 0.81. Kappa values for the chart abstraction categories were: physical assessment (kappa 0.84), asthma control (kappa 0.83), spirometry (kappa 0.84), asthma education (kappa 0.72), referral visits (kappa 0.59) and medication side effects (kappa 0.51). Inter-rater abstraction of the fictitious charts produced an overall kappa of 0.75, sensitivity of 0.91 and specificity of 0.89. Abstractors demonstrated agreement for physical assessment (kappa 0.88, sensitivity and specificity 0.95), asthma control (kappa 0.68, sensitivity 0.89, specificity 0.85), referral visits (kappa 0.77, sensitivity 0.88, specificity 0.95), and asthma education (kappa 0.49, sensitivity 0.87, specificity 0.77).
Conclusions:
Though collected by multiple abstractors, the results show high sensitivity and specificity and substantial to excellent inter- and intra-rater agreement, assuring confidence in the use of chart abstraction for evaluating the ACP.

source

• Share:
• Bookmark on Delicious
• Digg this
• Share on Reddit
• Share with Stumblers
• Tweet this