Gabriela Lewin

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

BackgroundBreast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare.MethodsTen databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicators scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development.ResultsSixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care.ConclusionWhile some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCOs current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.

The evidence for efficacy of omega-3 fatty acids in preventing or slowing the progression of retinitis pigmentosa: a systematic review

BACKGROUND Studies in preterm and term human infants have suggested that a dietary supply of omega-3 fatty acids is essential for optimal visual development. Several basic science studies support the hypothesis that omega-3 fatty acids may be useful therapeutic agents for pathologies of the retina and lens. As part of a systematic review of the effect of omega-3 fatty acids on eye health, the purpose of this study was to conduct a systematic review of the scientific-medical literature to appraise and synthesize the evidence for the effects of omega-3 fatty acids in preventing the development or progression of retinitis pigmentosa. METHODS A comprehensive search was undertaken in MEDLINE, PREMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Global Health, and Dissertation Abstracts. Unpublished literature was sought through manual searches of reference lists of included studies and key review articles and from the files of content experts. Searches were not restricted by language of publication, publication type, or study design. Eligibility criteria were applied to screen eligible studies on two levels. Data extraction and quality assessment were performed. RESULTS Six studies published between 1995 and 2004 met eligibility criteria in investigating the question of the possible value of omega-3 fatty acids in slowing the progression of retinitis pigmentosa. Meta-analysis was not performed because there was not enough available information for formal quantitative analysis. INTERPRETATION There are trends in improvement of some retinitis pigmentosa outcomes with omega-3 fatty acids in the higher quality studies. Clinical research is preliminary in this field, however. Accordingly, definitive answers will require significantly more observational and interventional clinical research.

Evidence for the effect of omega-3 fatty acids on progression of age-related macular degeneration: a systematic review.

Background: As part of a larger systematic review on the effect of &ohgr;-3 fatty acids on eye health, the aim of this report was to appraise and synthesize the evidence for the effects of &ohgr;-3 fatty acids in slowing down the progression of age-related macular degeneration (AMD) and/or decreasing the rate of progression to advanced forms of AMD. Methods: A comprehensive search was undertaken in six databases (MEDLINE, PreMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CAB Health, and Dissertation Abstracts). Results: Two unique studies, one randomized clinical trial (RCT) and one prospective cohort study, satisfied the eligibility criteria and were included in the review. The RCT reported evidence on the effect of &ohgr;-3 fatty acids in slowing down the progression of AMD. The prospective cohort study addressed the question: what is the evidence that &ohgr;-3 fatty acids decrease the rate of progression to advanced forms of AMD? Conclusions: Clinical research on this topic is scarce. Only two studies were eligible to be included in this review. Although one study result indicated efficacy of preventing AMD progression to its advanced form, this result needs to be duplicated and supported by future research.