The methods of systematic reviews Setting the question

Clinical questions regarding the effects of treatments have three parts: the participants (who are the people of interest to the questioner?), the interventions (what are the specific treatments that are to be the focus of the review?), and the outcomes (what are the outcomes of interest to the reviewers?) ( Fig, !). Although the reviewers may have knowledge of existing trials and their limitations, it is important that the questions set are relevant to the review's readership. If the review is to service clinicians then clinically relevant outcomes must be a priority and not those anticipated by foreknowledge of the trials. If all studies then provide data on mean change in the Brief Psychiatric Rating Scale and fail to mention the outcome of 'clinically important improvement', the review can highlight this important gap in knowledge.

Fig. 1 Developing an answerable question.

The next stage for formulating the question is to decide on the type of study that is best suited to answering the question. For questions related to the efficacy of treatments this is usually the randomized trial. At first glance, this may seem straightforward, but it is important to state a priori whether studies that implied, but did not state, randomization should be included. No other methodological parameter is so consistently linked with exaggerated estimations of effect than poor description of randomization/5,25) Studies that describe themselves as 'prospective, double-blind, evaluative controlled trials' would be excluded from a review if the entry criteria demanded and explicit description of randomization.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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