As authors of the QFracture papers1-3, we read this article by Livingstone et al with interest. They stated that the had externally validated the QFracture-2016 algorithm using CPRD4. The authors report that whilst there was very good to excellent discrimination, calibration was poor. The authors attributed an apparent under-prediction to their outcome definition using the CPRD validation dataset since this included GP data linked to hospital data. However, we think this under-prediction is due to the authors using the wrong algorithm – the authors have confirmed that they had used a previous version (QFracture-2012) which is based on unlinked data. The QFracture-2016 algorithm is the version which is currently recommended and used in the NHS and is derived from the QResearch database including GP data linked to hospital and mortality data3. Therefore, the authors need to correct their paper and update their conclusions accordingly. We would also like to highlight that the code groups for QFracture are available here https://www.qresearch.org/data/qcode-group-library/
References
1. Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: Prospective derivation and validation of QFractureScores. BMJ (Online) 2009;339(7733):1291-95. doi: 10.1136/bmj.b4229
2. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorith...
As authors of the QFracture papers1-3, we read this article by Livingstone et al with interest. They stated that the had externally validated the QFracture-2016 algorithm using CPRD4. The authors report that whilst there was very good to excellent discrimination, calibration was poor. The authors attributed an apparent under-prediction to their outcome definition using the CPRD validation dataset since this included GP data linked to hospital data. However, we think this under-prediction is due to the authors using the wrong algorithm – the authors have confirmed that they had used a previous version (QFracture-2012) which is based on unlinked data. The QFracture-2016 algorithm is the version which is currently recommended and used in the NHS and is derived from the QResearch database including GP data linked to hospital and mortality data3. Therefore, the authors need to correct their paper and update their conclusions accordingly. We would also like to highlight that the code groups for QFracture are available here https://www.qresearch.org/data/qcode-group-library/
References
1. Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: Prospective derivation and validation of QFractureScores. BMJ (Online) 2009;339(7733):1291-95. doi: 10.1136/bmj.b4229
2. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: Prospective open cohort study. BMJ (Online) 2012;345(7864) doi: 10.1136/bmj.e3427
3. Hippisley-Cox J CC. QFracture-2016Annual update informaiton 2016 [Available from: https://www.qresearch.org/media/vh3hekdi/qfracture-2016-annual-update-in....
4. Livingstone SJ, Morales DR, McMinn M, et al. Effect of competing mortality risks on predictive performance of the QFracture risk prediction tool for major osteoporotic fracture and hip fracture: external validation cohort study in a UK primary care population. BMJ Medicine 2022;1(1) doi: 10.1136/bmjmed-2022-000316
We read with great interest the article on ‘Conducting umbrella reviews’. In our view, it is important to highlight that what is described as ‘umbrella reviews’ in this article is often referred to as ‘overviews (of reviews)’, and shares similar definitions and goals, namely to synthesise evidence at the systematic review-level. The term ‘overviews of reviews’ is employed by Cochrane, a leading international organization for evidence synthesis. The corresponding chapter in the Cochrane handbook (1) was revised a few years ago and provides a summary of methods research for this type of evidence synthesis along with recommendations for conducting overviews of reviews. Although this has been prepared for Cochrane, we think that the vast majority of the content can also be used outside Cochrane and for a range of research questions. It provides guidance for topics not mentioned in your article such as dealing with overlapping primary studies across reviews on the same topic, decision tools supporting the inclusion of reviews, and updating reviews by conducting supplemental searches for primary studies. Most importantly, in the article by Belbasis et al. there is no explicit mention of assessing the quality or risk of bias of the included reviews and there is no mention of the recently published reporting guideline for overviews of reviews of healthcare interventions (2).
A large body of research by many evidence synthesis groups over the past 10+ years exists to advan...
We read with great interest the article on ‘Conducting umbrella reviews’. In our view, it is important to highlight that what is described as ‘umbrella reviews’ in this article is often referred to as ‘overviews (of reviews)’, and shares similar definitions and goals, namely to synthesise evidence at the systematic review-level. The term ‘overviews of reviews’ is employed by Cochrane, a leading international organization for evidence synthesis. The corresponding chapter in the Cochrane handbook (1) was revised a few years ago and provides a summary of methods research for this type of evidence synthesis along with recommendations for conducting overviews of reviews. Although this has been prepared for Cochrane, we think that the vast majority of the content can also be used outside Cochrane and for a range of research questions. It provides guidance for topics not mentioned in your article such as dealing with overlapping primary studies across reviews on the same topic, decision tools supporting the inclusion of reviews, and updating reviews by conducting supplemental searches for primary studies. Most importantly, in the article by Belbasis et al. there is no explicit mention of assessing the quality or risk of bias of the included reviews and there is no mention of the recently published reporting guideline for overviews of reviews of healthcare interventions (2).
A large body of research by many evidence synthesis groups over the past 10+ years exists to advance the methods for umbrella/overview of reviews. We understand that it is not possible to cover all methodological details in a short article. However, we would like to highlight important literature that is not included in this article (e.g. on including systematic reviews (3, 4) or overlapping primary studies (5, 6, 7). Some articles provide a comprehensive view of available methods and literature specific for umbrella/overviews of reviews (8, 9, 10). Inconsistent nomenclature and lack of references to previous work may be misleading to researchers and policymakers new to umbrella reviews and can create confusion for readers and authors of evidence syntheses.
References:
1. Pollock M, Fernandes RM, Becker LA, Pieper D, Hartling L. Chapter V: Overviews of Reviews. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022. Available from www.training.cochrane.org/handbook
2. Gates M, Gates A, Pieper D, Fernandes R M, Tricco A C, Moher D et al. Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement. BMJ 2022; 378 :e070849 doi:10.1136/bmj-2022-070849
3. Pollock M, Fernandes RM, Newton AS, Scott SD, Hartling L. A decision tool to help researchers make decisions about including systematic reviews in overviews of reviews of healthcare interventions. Systematic Reviews2019; 8: 29.
4. Pollock M, Fernandes RM, Newton AS, Scott SD, Hartling L. The impact of different inclusion decisions on the comprehensiveness and complexity of overviews of reviews of healthcare interventions. Syst Rev. 2019 Jan 11;8(1):18. doi: 10.1186/s13643-018-0914-3.
5. Lunny C, Pieper D, Thabet P, Kanji S. Managing overlap of primary study results across systematic reviews: practical considerations for authors of overviews of reviews. BMC Med Res Methodol. 2021 Jul 7;21(1):140.
doi: 10.1186/s12874-021-01269-y.
6. Hennessy EA, Johnson BT. Examining overlap of included studies in meta-reviews: Guidance for using the corrected covered area index. Res Synth Methods. 2020 Jan;11(1):134-145. doi: 10.1002/jrsm.1390. Epub 2019 Dec 10.
7. Bougioukas KI, Diakonidis T, Mavromanoli AC, Haidich AB. ccaR: A package for assessing primary study overlap across systematic reviews in overviews. Res Synth Methods. 2022 Nov 12. doi: 10.1002/jrsm.1610. Online ahead of print.
8. Gates M, Gates A, Guitard S, Pollock M, Hartling L. Guidance for overviews of reviews continues to accumulate, but important challenges remain: a scoping review. Syst Rev2020;9:254. doi:10.1186/s13643-020-01509-0
9. Lunny, C., Brennan, S.E., McDonald, S. and McKenzie, J.E., 2018. Toward a comprehensive evidence map of overview of systematic review methods: paper 2—risk of bias assessment; synthesis, presentation and summary of the findings; and assessment of the certainty of the evidence. Systematic reviews, 7(1), pp.1-31.
10. Lunny C, Brennan SE, McDonald S, McKenzie JE. Toward a comprehensive evidence map of overview of systematic review methods: paper 1—purpose, eligibility, search and data extraction. Systematic reviews. 2017 Dec;6(1):1-27.
As authors of the QFracture papers1-3, we read this article by Livingstone et al with interest. They stated that the had externally validated the QFracture-2016 algorithm using CPRD4. The authors report that whilst there was very good to excellent discrimination, calibration was poor. The authors attributed an apparent under-prediction to their outcome definition using the CPRD validation dataset since this included GP data linked to hospital data. However, we think this under-prediction is due to the authors using the wrong algorithm – the authors have confirmed that they had used a previous version (QFracture-2012) which is based on unlinked data. The QFracture-2016 algorithm is the version which is currently recommended and used in the NHS and is derived from the QResearch database including GP data linked to hospital and mortality data3. Therefore, the authors need to correct their paper and update their conclusions accordingly. We would also like to highlight that the code groups for QFracture are available here https://www.qresearch.org/data/qcode-group-library/
Show MoreReferences
1. Hippisley-Cox J, Coupland C. Predicting risk of osteoporotic fracture in men and women in England and Wales: Prospective derivation and validation of QFractureScores. BMJ (Online) 2009;339(7733):1291-95. doi: 10.1136/bmj.b4229
2. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorith...
We read with great interest the article on ‘Conducting umbrella reviews’. In our view, it is important to highlight that what is described as ‘umbrella reviews’ in this article is often referred to as ‘overviews (of reviews)’, and shares similar definitions and goals, namely to synthesise evidence at the systematic review-level. The term ‘overviews of reviews’ is employed by Cochrane, a leading international organization for evidence synthesis. The corresponding chapter in the Cochrane handbook (1) was revised a few years ago and provides a summary of methods research for this type of evidence synthesis along with recommendations for conducting overviews of reviews. Although this has been prepared for Cochrane, we think that the vast majority of the content can also be used outside Cochrane and for a range of research questions. It provides guidance for topics not mentioned in your article such as dealing with overlapping primary studies across reviews on the same topic, decision tools supporting the inclusion of reviews, and updating reviews by conducting supplemental searches for primary studies. Most importantly, in the article by Belbasis et al. there is no explicit mention of assessing the quality or risk of bias of the included reviews and there is no mention of the recently published reporting guideline for overviews of reviews of healthcare interventions (2).
A large body of research by many evidence synthesis groups over the past 10+ years exists to advan...
Show More