Dynamic intervention strategies await inclusion in clinical evidence synthesis
In the first half of this year, an article about the next generation of evidence-based medicine1 was published in Nature Medicine, emphasising the growing significance of real-world data in future evidence-based practice and research, providing an opportunity for the evidence accumulation of dynamic intervention (DI) strategies (spanning sequential designs to real-time feedback protocols) in various diseases, as is patient-centric, adaptable and pivotal for modern patient care. Most intervention meta-analyses address static interventions, diverging from dynamic clinical practices in multistage diseases such as the fac...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Pan, T., Zhang, P. Tags: Correspondence Source Type: research

Talk to me, but rather: talk to each other
During a yearly routine check-up for my alopecia in a hospital on the other side of the country, a small cancerous mass was discovered on my scalp. The dermatologist assured me it was not an immediate concern, but that it should be removed for investigation within a couple weeks nonetheless, along with an assessment of all the freckles and moles on my body. Since there was no rush, I asked her if it could be removed at my local clinic. This was no problem. She would send a referral to my general practitioner that same day. Within 2 weeks, I would be called to schedule an appointment. Three weeks later, I was still waiting ...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Keeris, M. Tags: Patient voices Source Type: research

When does the placebo effect have an impact on network meta-analysis results?
The placebo effect is the ‘effect of the simulation of treatment that occurs due to a participant’s belief or expectation that a treatment is effective’. Although the effect might be of little importance for some conditions, it can have a great role in others, mostly when the evaluated symptoms are subjective. Several characteristics that include informed consent, number of arms in a study, the occurrence of adverse events and quality of blinding may influence response to placebo and possibly bias the results of randomised controlled trials. Such a bias is inherited in systematic reviews of evidence and t...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Nikolakopoulou, A., Chaimani, A., Furukawa, T. A., Papakonstantinou, T., Rücker, G., Schwarzer, G. Tags: Open access Research methods and reporting Source Type: research

Reducing the residue of retractions in evidence synthesis: ways to minimise inappropriate citation and use of retracted data
The incorporation of publications that have been retracted is a risk in reliable evidence synthesis. Retraction is an important mechanism for correcting the literature and protecting its integrity. Within the medical literature, the continued citation of retracted publications occurs for a variety of reasons. Recent evidence suggests that systematic reviews and meta-analyses often unwittingly cite retracted publications which, at least in some cases, may significantly impact quantitative effect estimates in meta-analyses. There is strong evidence that authors of systematic reviews and meta-analyses may be unaware of the re...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Bakker, C., Boughton, S., Faggion, C. M., Fanelli, D., Kaiser, K., Schneider, J. Tags: Open access Research methods and reporting Source Type: research

Visualisation of evidence for shared decision making
Why does it matter? Consistent with the principles of evidence-based medicine, effectively communicating evidence (including risks) in medicine is an essential part of shared decision making (SDM). SDM has been defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’.1 This process relies on access and understanding of evidence-based information by both patients and healthcare professionals. This includes outcome probabilities, typically presented nu...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Durand, M.-A., Selby, K., Okan, Y. Tags: EBM learning Source Type: research

Catalogue of bias: racial bias
Background Racial bias is a distortion arising from systemic, institutional, interpersonal or individual forms of explicit (conscious) or implicit (unconscious) prejudice against individuals or groups based on social constructs of race or ethnicity that influences the planning, methods, results, interpretation, dissemination and application of health research. As a flaw in research design that undermines the validity of results, research-based racial bias should be distinguished from everyday racial bias—a phenomenon characterised by unfair or harmful treatment of specific members of society. Racial bias in research ...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Naicker, R., Nunan, D. Tags: EBM learning Source Type: research

Introduction of allergenic food to infants and allergic and autoimmune conditions: a systematic review and meta-analysis
Conclusions This systematic review and meta-analysis shows that early introduction of allergen-containing food from 4 to 12 months of age, was associated with lower risk of multiple food allergy and eczema. Further research on other allergenic foods, and their long-term impact on food allergy and autoimmune risk is essential for enhancing our understanding on development of these conditions and guiding future clinical recommendations. PROSPERO registration number CRD42022375679. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Tuballa, A., Connell, D., Smith, M., Dowsett, C., ONeill, H., Albarqouni, L. Tags: Original research Source Type: research

Does the format of result presentation and type of conclusion in Cochrane plain language summaries matter? A randomised controlled trial
Conclusions The format of Cochrane PLSs does not appear to significantly impact physiotherapy students’ perception of treatment benefit, understanding of evidence, persuasiveness or confidence in their decision. However, participants’ perception of treatment benefit does not align with the conclusion when the Cochrane PLS indicates strong evidence of non-benefit from the intervention. Trial registration number CTRI/2022/10/046476. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Prakash, V., Gore, K., Shukla, G., Tapiawala, P., Thakkar, S. Tags: Original research Source Type: research

Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial
Conclusions The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Scheibler, F., Geiger, F., Wehkamp, K., Danner, M., Debrouwere, M., Stolz-Klingenberg, C., Schuldt-Joswig, A., Sommer, C. G., Kopeleva, O., Bünzen, C., Wagner-Ullrich, C., Koch, G., Coors, M., Wehking, F., Clayman, M., Weymayr, C., Sundmacher, L., Tags: Open access Original research Source Type: research

Towards transparency: adoption of WHO best practices in clinical trial registration and reporting among top medical research funders in the USA
Conclusions There is a significant variation between the number of best practice policy items adopted by medical research funders in the USA. Many funders fell significantly short of WHO Joint Statement benchmarks. Each funder could benefit from policy revision and strengthening. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Gamertsfelder, E., Delgado Figueroa, N., Keestra, S., Silva, A. R., Borana, R., Siebert, M., Bruckner, T. Tags: Original research Source Type: research

The Six Steps of SDM: linking theory to practice, measurement and implementation
Introduction Shared decision-making (SDM) has gained acceptance as a preferred and ideal method for medical decision-making.1 2 As SDM concepts and assessments initially focused on the clinical encounter, efforts to improve decision-making for patients initially did so, as well.3 This resulted in a plethora of patient-focused interventions (eg, patient decision aids)4 while lacking concurrent development of a systems-oriented approach to change the structural and procedural requirements of medicine for optimal implementation of SDM practice.5 Rationale and context for developing The Six Steps of SDM We developed The Six St...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Clayman, M. L., Scheibler, F., Rüffer, J. U., Wehkamp, K., Geiger, F. Tags: Open access Analysis Source Type: research

Decision architecture randomisation: extremely efficient clinical trials that preserve clinician and patient choice?
Introduction Healthcare is full of choices between standard-of-care approaches where one might be better but we do not know which. Examples include ‘at what threshold should magnesium be supplemented for critically ill patients?’ and ‘which insulin formulation should be started in a hospitalised patient with diabetes?’1–3 Observational studies of such questions can be conducted relatively easily but are prone to biases, especially selection bias, that prevent them from reliably showing causal relationships between treatments and outcomes.4 Randomised controlled trials (RCTs) allow stronger cau...
Source: Evidence-Based Medicine - March 21, 2024 Category: Internal Medicine Authors: Flory, J., Ancker, J. S., Kim, S. Y. H., Kuperman, G., Vickers, A. Tags: Analysis Source Type: research

Enhancing title and abstract screening for systematic reviews with GPT-3.5 turbo
After conducting a database search, the subsequent phase in the execution of systematic reviews (SRs) involves title and abstract screening.1 This stage bears significant importance and necessitates the involvement of dedicated and experienced researchers who can exhibit precision and accuracy, particularly when the search yields a substantial number of studies. Besides the qualities of experience and dedication demonstrated by the screeners, several other factors influence the quality of the screening process, such as effective team management, the adoption of a double-screening approach and, notably, the implementation o...
Source: Evidence-Based Medicine - January 19, 2024 Category: Internal Medicine Authors: Kohandel Gargari, O., Mahmoudi, M. H., Hajisafarali, M., Samiee, R. Tags: Open access Letters Source Type: research

Enhanced access but increased testing with virtual care: insights from a multinational survey
The COVID-19 pandemic led to a dramatic increase in virtual (ie, telephone, video) care in many countries, particularly in the primary care setting.1 Yet, the impact of this increase on actual clinical practice remains unclear. Experts have hypothesised that the growth in virtual care could lead to more1 or less2 low-value care. Similarly, recent studies in single healthcare systems suggest that timeliness of care delivered virtually may be better3 or no different4 than in-person care. As this increased use of virtual care is enduring, it is critical to understand the positive and negative practice implications of virtual ...
Source: Evidence-Based Medicine - January 19, 2024 Category: Internal Medicine Authors: Metcalfe, R. K., Singer, A., LaBine, L., Francis, L., Levinson, W. Tags: COVID-19 Letters Source Type: research

Attitudes of people living with cancer towards trial non-publication and research participation
In medicine, the results of clinical trials are considered one of the most trustworthy forms of scientific evidence that can be generated. Consequently, the medical community relies on researchers running trials to publish timely summaries of their results to share new discoveries, identify areas for future research (as well as research ‘dead ends’) and ultimately to ensure patients receive the best and safest medical treatments available. However, previous research has shown that for approximately half of clinical trials, results are not reported in a timely manner or at all.1–4 For example, one of these...
Source: Evidence-Based Medicine - January 19, 2024 Category: Internal Medicine Authors: Hamilton, D. G., Everitt, S., Page, M. J., Vazire, S., Fidler, F. Tags: Letters Source Type: research