Panning for the gold in health research: Incorporating studies’ methodological quality in meta-analysis

Background: Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators.

Objective and methods: We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality.

Results: Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice.

Conclusions: In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.     

If We Build It … Will They Come? – Establishing a Cancer Genetics Services Clinic for an Underserved Predominantly Latina Cohort

Background: Cancer genetic counseling and testing is a standard of care option for appropriate families and can identify individuals at increased risk prior to diagnosis, when prevention or detection strategies are most effective. Despite documented efficacy of cancer risk reduction in high-risk individuals, underserved and minority individuals have a disproportionate cancer burden and limited access to genetic counseling. Methods: A needs assessment survey documented gaps in knowledge and interest in prevention. Satellite clinics were established at two indigent healthcare systems. Cancer genetics CME lectures were conducted and referral guidelines disseminated to clinicians who referred patients for counseling. Results: An increase in clinician knowledge was demonstrated post-CME and reflected by quality referrals. Eighty-eight percent of patients kept their appointments. In the predominantly Latina⁶ (n=77) clinic population, 71.4% were affected with cancer, and 17 mutation positive families were identified. Preliminary data shows a positive impact on patients' motivation and behavior. The majority has expressed satisfaction and reduction in anxiety. Conclusions: This study demonstrates feasibility and acceptability of cancer genetics services in this population, suggesting the potential to reduce cancer morbidity in underserved, high-risk families.“Latino” is the most common census term for individuals of Spanish, Mexican, Central and South American, Cuban, or Puerto Rican descent, referring to ethnicity, and is generally considered a more ethnically/culturally based term for individuals of the aforementioned groups. As this cohort is female the feminine noun “Latina” is used     

Psychological management and body image issues in facial transplantation

Facial transplantation, although controversial, is proposed as a major advance in facial reconstructive surgery, with the first partial transplant having taken place in France in November 2005. Although the psychological impact of facial transplantation will not be understood until several procedures have been carried out, this article examines the psychological issues likely to arise with particular reference to body image. A detailed framework for anticipation and management of psychological change is proposed. Pre-operative preparation must include thorough psychological preparation for the patient and their family. The immediate post-operative period is likely to be challenging, and a detailed management plan is proposed emphasising early return to function; subsequent psychological issues including altered body image, anxiety, shame, depression, communication and behavioural avoidance are discussed and a management strategy based on cognitive behavioural principles is proposed for the first post-operative year. Previous discussion frames psychological outcome in terms of complication and risk, tending to downplay the potential advantages of a successful procedure; the focus of this paper is on ensuring psychological adjustment as an inevitable consequence of change.     

Book reviews

John Christian Laursen (ed.). Religious Toleration: ‘The Variety of Rites’ from Cyrus to Defoe. New York, St Martin's Press, 1999. xx + 252 pp. $45.00. ISBN 0–312–22233–5.

Daniel Garber. Descartes Embodied: Reading Cartesian Philosophy through Cartesian Science Cambridge, Cambridge University Press, 2001, £40.00 hb; £14.95 pb. xii + 337 pp. ISBN 0–521–00337–7 pb. 0–521–80279–2 hb.

Olli Koistinen and John Biro (eds). Spinoza: Metaphysical Themes, Oxford, Oxford University Press, 2002. x + 255 pp. £40.00. ISBN 0–19–512815‐X.

Paul Abela. Kant's Empirical Realism. Oxford and New York, Clarendon Press, 2002. vii + 303 pp. £40.00. ISBN 0–19–924274–7.

Bruce L. Kinzer. England's Disgrace? J. S. Mill and the Irish Question. Toronto, Buffalo, and London, University of Toronto Press, 2001. 292 pp. $60. ISBN 0–8020–4862–5.

Maria Dimova‐Cookson. T. H. Green's Moral and Political Philosophy: A Phenomenological Perspective. Basingstoke, Palgrave, 2001. £40.00. xiii + 175 pp. ISBN 0–333–9144–7.

Stephen Mulhall. Inheritance &; Originality. Wittgenstein, Heidegger, Kierkegaard. Oxford, Clarendon Press, 2001. £40.00. xii + 448 pp. ISBN 0–19–924390–5.

Paul Gorner. Twentieth‐Century German Philosophy. Oxford, Oxford University Press, 2000. iii + 225 pp. £12.99. ISBN 0–19–289309–2.

Karen Green. Dummett: Philosophy of Language. Cambridge, Polity Press, 2001. xi + 236 pp. £55.00 (hb), £14.99 (pb). ISBN 0–7456–2294–1 (hb) 0–7456–2295‐X (pb).     

Current Approaches to Phenomenology

Tennessen and Naess both assume that we can make meaningful judgments about the value of life but disagree with one another about whether it is obvious, as Tennessen believes, that the more men know the less reason they have to affirm life. It is their common assumption which Nietzsche would question and these notes try to bring out why.     

The Straight Path to Healing: Using Motivational Interviewing to Address Spiritual Bypass

Spiritual bypass is the avoidance of underlying emotional issues by focusing solely on spiritual beliefs, practices, and experiences. Motivational interviewing (MI) is a client‐centered, compassionate approach to effectively addressing resistance among those who present with spiritual bypass. In this article, the authors provide background information on spiritual bypass and a rationale for adopting an MI approach to working with these clients. A case presentation illustrates 1 example of using MI with spiritual bypass.