The interpretation of systematic reviews with meta-analyses: an objective or subjective process?

<p>Abstract</p> <p>Background</p> <p>Discrepancies between the conclusions of different meta-analyses (quantitative syntheses of systematic reviews) are often ascribed to methodological differences. The objective of this study was to determine the discordance in interpretations when meta-analysts are presented with identical data.</p> <p>Methods</p> <p>We searched the literature for all randomized clinical trials (RCT) and review articles on the efficacy of intravenous magnesium in the early post-myocardial infarction period. We organized the articles chronologically and grouped them in packages. The first package included the first RCT, and a summary of the review articles published prior to first RCT. The second package contained the second and third RCT, a meta-analysis based on the data, and a summary of all review articles published prior to the third RCT. Similar packages were created for the 5^thRCT, 10^thRCT, 20^thRCT and 23^rdRCT (all articles). We presented the packages one at a time to eight different reviewers and asked them to answer three clinical questions after each package based solely on the information provided. The clinical questions included whether 1) they believed magnesium is now proven beneficial, 2) they believed magnesium will eventually be proven to be beneficial, and 3) they would recommend its use at this time.</p> <p>Results</p> <p>There was considerable disagreement among the reviewers for each package, and for each question. The discrepancies increased when the heterogeneity of the data increased. In addition, some reviewers became more sceptical of the effectiveness of magnesium over time, and some reviewers became less sceptical.</p> <p>Conclusion</p> <p>The interpretation of the results of systematic reviews with meta-analyses includes a subjective component that can lead to discordant conclusions that are independent of the methodology used to obtain or analyse the data.</p

Who are the enforcers? The motives and methods of muscle for hire in West Scotland and the West Midlands

Enforcement, ranging from threats to intimidation to assault to homicide, has long been an established practice within criminal networks. However, comparatively little academic research exists about the nature and role of enforcers within and beyond the context of contract killings. Drawing on qualitative interviews with criminal enforcers from two contrasting sites within the UK—the West Scotland and the West Midlands—the current study examines the articulated, identifiable pathways into criminal enforcement. Also it examines the nuanced nature of enforcement and the roles those men commonly adopt within the context of organised crime, as well as the relationship between these men’s activity, the wider context of organised crime, and presence of social and cultural capital within it. This article provides insights into how one becomes an enforcer; how contact is made between all parties involved; the degree of planning involved; and costing arrangements, with important implications for research and practice

Is Pharmacy a Knowledge-Based Profession?

An increasingly important question for the pharmacy educator is the relationship between pharmacy knowledge and professionalism. There is a substantial body of literature on the theory of knowledge and it is useful to apply this to the profession of pharmacy. This review examines the types of knowledge and skill used by the pharmacist, with particular reference to tacit knowledge which cannot be codified. This leads into a discussion of practice-based pharmacy knowledge and the link between pharmaceutical science and practice. The final section of the paper considers the challenge of making knowledge work in practice. This includes a discussion of the production of knowledge within the context of application. The theoretical question posed by this review, “Is pharmacy a knowledge-based profession?” highlights challenging areas of debate for the pharmacy educator