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Moving from Evidence to Action

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Umbrella Reviews

Abstract

Decision making should always be based on the best evidence while also taking into account stakeholder values and resources. The traditional hierarchy of evidence puts at the uppermost level a large randomized trial or a meta-analysis of homogeneous randomized trials. This approach is atomically correct but fails to capture the complexity and comprehensiveness of evidence sources. Umbrella reviews, overviews of reviews, and meta-epidemiologic studies offer a novel tool to summarize and appraise clinical evidence at a level which is even more general than that of meta-analyses. Knowledge is an essential prerequisite of effective action, but if such exercises in evidence synthesis are to be truly meaningful, their impact on decision making must actually translate into specific actions. To enable this, while empowering all stakeholders, it is crucial to search appropriately for umbrella reviews, to correctly appraise them, and to correctly grade them in terms of pragmatic impact.

Come, let us go down and there confuse their language, so that they may not understand one another’s speech.

Genesis 11, 1–9 (Holy Bible)

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References

  1. ACE inhibitors may increase risk of recurrence in breast cancer survivors. Available at: http://www.eurekalert.org/pub_releases/2011-04/uoc--aim041911.php. Last accessed on 31 July 2015.

  2. Soranna D, Scotti L, Zambon A, et al. Cancer risk associated with use of metformin and sulfonylurea in type 2 diabetes: a meta-analysis. Oncologist. 2012;17:813–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Taylor ML, Wells BJ, Smolak MJ. Statins and cancer: a meta-analysis of case control studies. Eur J Cancer Prev. 2008;17:259–68.

    Article  PubMed  Google Scholar 

  4. Corrao G, Scotti L, Bagnardi V, et al. Hypertension, antihypertensive therapy and renal-cell cancer: a meta-analysis. Curr Drug Saf. 2007;2:125–33.

    Article  PubMed  Google Scholar 

  5. Yoon C, Yang HS, Jeon I, et al. Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies. CMAJ. 2011;183:E1073–84.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Tressler CS, Wiseman RL, Dombi TM, et al. Lack of evidence for a link between latanoprost use and malignant melanoma: an analysis of safety databases and a review of the literature. Br J Ophthalmol. 2011;95:1490–5.

    Article  PubMed  Google Scholar 

  7. Ioannidis JP, Zhou Y, Chang CQ, Schully SD, Khoury MJ, Freedman AN. Potential increased risk of cancer from commonly used medications: an umbrella review of meta-analyses. Ann Oncol. 2014;25(1):16–23.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Biondi-Zoccai GG, Lotrionte M, Abbate A, Testa L, Remigi E, Burzotta F, Valgimigli M, Romagnoli E, Crea F, Agostoni P. Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study. BMJ. 2006;332(7535):202–9.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Vlaar PJ, Mahmoud KD, Holmes Jr DR, van Valkenhoef G, Hillege HL, van der Horst IC, Zijlstra F, de Smet BJ. Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. J Am Coll Cardiol. 2011;58(7):692–703.

    Article  PubMed  Google Scholar 

  10. Biondi-Zoccai G, Agostoni P, Abbate A, D’Ascenzo F, Modena MG. Potential pitfalls of meta-analyses of observational studies in cardiovascular research. J Am Coll Cardiol. 2012;59(3):292–3.

    Article  PubMed  Google Scholar 

  11. Moretti C, D’Ascenzo F, Quadri G, Omedè P, Montefusco A, Taha S, Cerrato E, Colaci C, Chen SL, Biondi-Zoccai G, Gaita F. Management of multivessel coronary disease in STEMI patients: a systematic review and meta-analysis. Int J Cardiol. 2015;179:552–7.

    Article  PubMed  Google Scholar 

  12. http://www.prisma-statement.org/.

  13. Wu W, Tong Y, Zhao Q, Yu G, Wei X, Lu Q. Coffee consumption and bladder cancer: a meta-analysis of observational studies. Sci Rep. 2015;5:9051.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Yaphe J, Edman R, Knishkowy B, Herman J. The association between funding by commercial interests and study outcome in randomized controlled drug trials. Fam Pract. 2001;18(6):565–8.

    Article  CAS  PubMed  Google Scholar 

  15. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Gartlehner G, Chapman A, Strobelberger M, Thaler K. Differences in efficacy and safety of pharmaceutical treatments between men and women: an umbrella review. PLoS One. 2010;5(7):e11895.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Eco U. Semeiotica e filosofia del linguaggio. 1994.

    Google Scholar 

  18. Incorporating heterogeneity into random-effects models. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available at: http://handbook.cochrane.org/chapter_9/9_5_4_incorporating_heterogeneity_into_random_effects_models.htm. Last accessed on 31 July 2015.

  19. Melsen WG, Bootsma MC, Rovers MM, Bonten MJ. The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses. Clin Microbiol Infect. 2014;20(2):123–9.

    Article  CAS  PubMed  Google Scholar 

  20. Keene ON. The log transformation is special. Stat Med. 1995;14(8):811–9.

    Article  CAS  PubMed  Google Scholar 

  21. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org. Last accessed on 31 July 2015.

  22. Biondi-Zoccai G, Romagnoli E, Agostoni P, Capodanno D, Castagno D, D’Ascenzo F, Sangiorgi G, Modena MG. Are propensity scores really superior to standard multivariable analysis? Contemp Clin Trials. 2011;32(5):731–40.

    Article  PubMed  Google Scholar 

  23. D’Ascenzo F, Cavallero E, Biondi-Zoccai G, Moretti C, Omedè P, Bollati M, Castagno D, Modena MG, Gaita F, Sheiban I. Use and misuse of multivariable approaches in interventional cardiology studies on drug-eluting stents: a systematic review. J Interv Cardiol. 2012;25(6):611–21.

    Article  PubMed  Google Scholar 

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Correspondence to Fabrizio D’Ascenzo MD .

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D’Ascenzo, F., Moretti, C., Templin, C., Gaita, F. (2016). Moving from Evidence to Action. In: Biondi-Zoccai, G. (eds) Umbrella Reviews. Springer, Cham. https://doi.org/10.1007/978-3-319-25655-9_21

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  • DOI: https://doi.org/10.1007/978-3-319-25655-9_21

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-25655-9

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