Melissa L McPheeters

Integration of existing systematic reviews into new reviews: identification of guidance needs

BackgroundAn exponential increase in the number of systematic reviews published, and constrained resources for new reviews, means that there is an urgent need for guidance on explicitly and transparently integrating existing reviews into new systematic reviews. The objectives of this paper are: 1) to identify areas where existing guidance may be adopted or adapted, and 2) to suggest areas for future guidance development.MethodsWe searched documents and websites from healthcare focused systematic review organizations to identify and, where available, to summarize relevant guidance on the use of existing systematic reviews. We conducted informational interviews with members of Evidence-based Practice Centers (EPCs) to gather experiences in integrating existing systematic reviews, including common issues and challenges, as well as potential solutions.ResultsThere was consensus among systematic review organizations and the EPCs about some aspects of incorporating existing systematic reviews into new reviews. Current guidance may be used in assessing the relevance of prior reviews and in scanning references of prior reviews to identify studies for a new review. However, areas of challenge remain. Areas in need of guidance include how to synthesize, grade the strength of, and present bodies of evidence composed of primary studies and existing systematic reviews. For instance, empiric evidence is needed regarding how to quality check data abstraction and when and how to use study-level risk of bias assessments from prior reviews.ConclusionsThere remain areas of uncertainty for how to integrate existing systematic reviews into new reviews. Methods research and consensus processes among systematic review organizations are needed to develop guidance to address these challenges.

Home uterine activity monitoring in the care of preterm labor: a review of the evidence

Abstract Objective: Preterm labor (PTL) that results in cervical change and spontaneous preterm birth requires organized forceful uterine contractions. Home uterine activity monitoring (HUAM) detects increases in activity and facilitates intervention. We sought to summarize randomized trials comparing pregnancy outcomes of women who did and did not receive HUAM. Methods: We worked as part of the AHCPR Evidence Report on the Management of Preterm Labor and restricted our search to randomized trials of HUAM among women who had experienced PTL in the pregnancy for which they were receiving monitoring. With ACOG and an advisory group, we developed search criteria. We did an exhaustive literature search, including the gray literature, for articles in English from 1980 to 1998. The initial search identified 37 studies; after review (masked to author and journal), 4 studies met inclusion criteria. Results: This is a systematic review of HUAM for the care of women with a history of PTL in the current pregnancy. We will report the results examining the outcomes of gestational age at delivery, infant birth weight, and term birth. Conclusions: We will present the conclusions and recommendations of the project team.