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    ABSTRACT: To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.
    Stroke 03/2014; DOI:10.1161/STROKEAHA.114.004519 · 6.02 Impact Factor
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    ABSTRACT: Assessment of the quality of studies is a critical component of evidence syntheses such as systematic reviews (SRs) that are used to inform policy decisions. To reduce the potential for reviewer bias, and to ensure that the findings of SRs are transparent and reproducible, organisations such as the Cochrane Collaboration, the Campbell Collaboration, and the Collaboration for Environmental Evidence, recommend the use of formal quality assessment tools as opposed to informal expert judgment. However, there is a bewildering array of around 300 formal quality assessment tools that have been identified in the literature, and it has been demonstrated that the use of different tools for the assessment of the same studies can result in different estimates of quality, which can potentially reverse the conclusions of a SR. It is therefore important to consider carefully, the choice of quality assessment tool. We argue that quality assessment tools should: (1) have proven construct validity (i.e. the assessment criteria have demonstrable link with what they purport to measure), (2) facilitate inter-reviewer agreement, (3) be applicable across study designs, and (4) be quick and easy to use. Our aim was to examine current best practice for quality assessment in healthcare and investigate the extent to which these best practices could be useful for assessing the quality of environmental science studies. The feasibility of this transfer is demonstrated in a number of existing SRs on environmental topics. We propose that environmental practitioners should revise, test and adopt the best practice quality assessment tools used in healthcare as a recommended approach for application to environmental science. We provide pilot versions of quality assessment tools, modified from the best practice tools used in healthcare, for application on studies from environmental science.
    09/2014; DOI:10.1186/2047-2382-3-14
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    Archivos latinoamericanos de nutrición 06/2010; 60(2):113-118. · 0.24 Impact Factor

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