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Finding What Works in Health Care: Standards for Systematic Reviews B Glossary Acceptability. Cultivates stakeholder understanding and acceptance of findings. Also referred to as credibility. Applicability. Consistent with the aim of comparative effectiveness research, that is, to help consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels. Also referred to as external validity or generalizability. Benefit. A positive or valued outcome of an action or event. Bias (intellectual). Views stated or positions taken that are largely intellectually motivated or that arise from the close identification or association of an individual with a particular point of view or the positions or perspectives of a particular group. Bias (study quality). The tendency for a study to produce results that depart systematically from the truth. Clinical practice guidelines. Statements that include recommendations intended to optimize patient care that are informed by a systematic review (SR) of evidence and assessment of the benefits and harms of clinical interventions in particular circumstances.
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Finding What Works in Health Care: Standards for Systematic Reviews Comparative effectiveness research (CER). The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to help consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels. Also referred to as clinical effectiveness research, evidence-based medicine, or health technology assessment. Conflict of interest. A set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. Consistency. The degree to which estimates of effect for specific outcomes are similar across included studies. Directness. The extent to which studies in the body of evidence were designed to address the link between the healthcare intervention and a specific health outcome. Dose–response association. A consistent association across similar studies of a larger effect with greater exposure to the intervention. Efficiency of conducting review. Avoids unnecessary burden and cost of the process of conducting the review, and allows completion of the review in a timely manner. Evidence. Information on which a decision or guidance is based. Evidence is obtained from a range of sources, including randomized controlled trials, observational studies, and expert opinion of clinical professionals and/or patients. Harm. A hurtful or adverse outcome of an action or event, whether temporary or permanent. Meta-analysis. The process of using statistical methods to combine quantitatively the results of similar studies in an attempt to allow inferences to be made from the sample of studies and be applied to the population of interest. Patient-centeredness. Respect for and responsiveness to individual patient preferences, needs, and values; helps ensure that patient values and circumstances guide clinical decisions.
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Finding What Works in Health Care: Standards for Systematic Reviews Precision. A measure of the likelihood of random errors in the estimates of effect; the degree of certainty about the estimates for specific outcomes. Quality of evidence. The extent to which one can be confident that the estimate of an intervention’s effectiveness is correct. Reporting bias. A group of related biases that lead to overrepresentation of significant or positive studies in systematic reviews. Reporting bias includes publication bias, outcome reporting bias, time-lag bias, location bias, language bias, citation bias, and multiple- (duplicate-) publication bias. Risk of bias. The extent to which flaws in the design and execution of a collection of studies could bias the estimate of effect for each outcome under study. Scientific rigor. Improves objectivity, minimizes bias, provides reproducible results, and fosters more complete reporting. Standard. A process, action, or procedure that is deemed essential to producing scientifically valid, transparent, and reproducible results. May be supported by scientific evidence, by a reasonable expectation that the standard helps achieve the anticipated level of quality, or by the broad acceptance of its practice. Strength of association. The likelihood that a large observed effect in an observational study is not due to bias from potential confounding factors. Study quality. For an individual study, study quality refers to all aspects of a study’s design and execution and the extent to which bias is avoided or minimized. A related concept is internal validity, that is, the degree to which the results of a study are likely to be true and free of bias. Systematic review. A scientific investigation that focuses on a specific question and that uses explicit, planned scientific methods to identify, select, assess, and summarize the findings of similar but separate studies. It may or may not include a quantitative synthesis of the results from separate studies (meta-analysis). Timeliness. Currency of the review.
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Finding What Works in Health Care: Standards for Systematic Reviews Transparency. Methods are explicitly defined, consistently applied, and available for public review so that observers can readily link judgments, decisions, or actions to the data on which they are based. Allows users to assess the strengths and weaknesses of the systematic review or clinical practice guideline. Users and stakeholders. Refers to individuals who are likely to consult a specific SR to guide decision making or who have a particular interest in the outcome of an SR. This includes consumers, including patients, families, and informal (or unpaid) caregivers; clinicians, including physicians, nurses, and other healthcare professionals; payers; and policy makers, including guideline developers and other SR sponsors.