Objective: There is increasing empirical evidence for the existence of bias in the publication of primary clinical research, with statistically significant results being published more readily, more quickly, and in higher impact journals. Meta-analysis of individual patient data (IPD) may represent a gold standard of “secondary” clinical research, giving the best possible summary of current evidence for a particular question, but publication of these may also be subject to bias. This study aimed to explore which factors might be associated with publication of IPD meta-analyses and to identify potential sources of bias.

Methods: For all known IPD meta-analysis projects in cancer, the responsible investigator was surveyed by means of a questionnaire to determine descriptive characteristics of the meta-analysis, the nature of the results, and details of the publication history.

Results: There is no good evidence that overall publication status of meta-analyses in cancer is dependent on the statistical or clinical significance of the results. However, those meta-analyses with nonsignificant results did seem to take longer to publish and were published in lower impact journals compared with those with more striking results.

Conclusions: Based on the current data, there seems to be no strong association between the results of IPD meta-analyses in cancer and publication.

Objectives: To determine if published figures on the proportion of articles included in systematic reviews and identified in electronic databases are applicable to an example from medical imaging.

Methods: A systematic review was performed. Additionally, sensitivity and precision of a MEDLINE search were compared with values from three published searches, each customized for a specific field.

Results: All articles included in the systematic review were in electronic databases. The MEDLINE search had low precision compared with searches in other fields.

Conclusions: In a specific area of medical imaging, electronic databases, including MEDLINE, are reliable sources of articles.

Objectives: To collect and summarize information published by INAHTA agencies on the indications, habitual attitudes and practices, and economic and legal implications of preoperative evaluation in elective surgeries.

Method: The authors appraised the information contained in six papers published between 1989 and 1999 in Sweden, France, Basque Country, the Netherlands, United Kingdom, and Catalonia. The section on indications in preoperative evaluation does not present global conclusions. The sections addressing habitual attitudes and practices among physicians and those addressing economic and legal considerations cover only the similarities among the reports and the main ideas relating to these issues.

Results: The conclusions found in the reports about indications in preoperative evaluation are similar or differ slightly, e.g., as regards age limits in patients for whom the tests are recommended. However, more important differences are shown in other areas, especially in reports where consensus methods were used. In some instances, the opinions, attitudes, and customary practices of professionals during the preoperative stage do not concur with the recommendations extracted from the assessment reports and the customary practice of doctors. In relation to economic considerations, a substantial quantity of resources could be liberated if the recommended general clinical practices were followed. From the point of view of civil law, the evidence-based recommendations could be considered as a kind of coded lex artis.

Objectives: This study compared the relative cost-effectiveness of stroke care provided in London and Copenhagen.

Methods: Hospitalized stroke patients at centers in London (1995–96) and Copenhagen (1994–95) were included. Each patient's use of hospital and community health services was recorded for 1 year after stroke. Center-specific unit costs were collected and converted into dollars using the Purchasing Power Parity Index. An incremental cost-effectiveness ratio (ICER) was calculated comparing a Copenhagen model of stroke care to a London model, using regression analysis to adjust for case-mix differences.

Results: A total of 625 patients (297 in Copenhagen, 328 in London) were included in the analysis. Most patients in London (85%) wereadmitted to general medical wards, with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients were directly admitted to a stroke or neurology unit, with 23% then transferred to a separate rehabilitation hospital. The average length of total hospital stay was 11 days longer in Copenhagen. Patients in Copenhagen were less likely to die than those in London; for patients with cerebral infarction the hazard ratio after case-mix adjustment was 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion of patients with hemorrhagic stroke died in London. The ICER of using the Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebral infarctions.

Conclusions: The ICERs of the Copenhagen compared with the London model of care were within a range generally regarded as cost-effective.

Objectives: Several instruments for measuring health-related quality of life (HRQOL) have been developed, and others are under construction. The problem is whether the different HRQOL measures show comparable results. We first compared the functional relationship of the Nottingham Health Profile (NHP) and the 15-dimensional measure of HRQOL (15D) in hip and knee replacement patients. The hypothesis was that condition or intervention does not affect the functional relationship between NHP and 15D changes.

Methods: We assessed the agreement of the instruments by comparing observed changes in the 15D and its fitted values derived by regressing the 15D by the NHP dimensions. Patients (n = 452) were recruited consecutively from seven Finnish orthopedic departments during April 1991–May 1992. HRQOL was measured prior to surgery and 6, 12, and 24 months postoperatively.

Results: There was a different functional relationship between the HRQOL instruments in hip and knee patients; they agreed upon the direction of changes in HRQOL in 84% and showed opposite signs in 12%. The NHP showed significantly more improvement in quality of life than the 15D.

Conclusions: The two instruments were in slight but significant disagreement. Estimates of effectiveness can vary according to the instrument used. Comparisons of effectiveness in healthcare programs measured by differing instruments need information on the functional discrepancies between the instruments in the conditions and interventions in which they are applied.

This paper presents the results of a contingent valuation study measuring willingness to pay (WTP) for treatment of patients with von Willebrand's disease. Median WTP for treatment of this disorder was $1,500 or $3,500, depending on how the initial bid was structured. Regression analysis shows that income, education, and a category rating scale for health status were significant in predicting WTP. The adjusted annual WTP was $2,178. WTP surveys may increasingly be useful for health technology assessment. Starting point bias in how the bids are structured must be recognized.

Objectives: To determine whether unpublished dissertations are an important source of trials for systematic reviews.

Methods: In a review of infant massage, we identified 17 dissertations. We recorded whether each dissertation was included in the review and, if so, whether it contributed data to any analyses.

Results: Thirteen dissertations were excluded, 11 because of poor reporting of methodology. Three dissertations were also published as journal papers. The data from the remaining dissertation were not included in any analysis. Reviewing data on the Cochrane Library, only one of 878 reviews included data from a dissertation that might have changed a review's conclusions.

Conclusions: Searching for and retrieving unpublished dissertations involves considerable time and effort and appears to influence the conclusions of a review only rarely.

This document focuses on the scientific evidence presently available on the patient–doctor relationship. As the patient seeks care, the physician represents only one of many relationships that the patient forms, and relationships with physicians and other professional caregivers have a mutual influence on each other. This critical, systematic review is based on approximately 800 studies that were selected according to predetermined quality criteria. Most of the studies were performed in the United States, but several are from Canada, the Netherlands, Great Britain, and Sweden. Most studies involve patients treated in ambulatory care settings.