Scoping systematic review on the extent, nature and quality of evidence underlying ophthalmic and paraophthalmic education
Conclusions
This review highlights the need for investigators, ethical committees and journals to insist on a better quality of RCT conduct than is presently apparent, but also that clinicians should not be blind to the strengths of non-RCT-based studies in the field of education. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Williams, M., Boohan, M., Thurston, A. Tags: Systematic review Source Type: research
Grading the quality of evidence in complex interventions: a guide for evidence-based practitioners
Evidence-based practitioners who want to apply evidence from complex interventions to the care of their patients are often challenged by the difficulty of grading the quality of this evidence. Using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and an illustrative example, we propose a framework for evaluating the quality of evidence that depends on obtaining feedback from the evidence user (eg, guideline panel) to inform: (1) proper framing of the question, (2) judgements about directness and consistency of evidence and (3) the need for additional contextual and qualitative eviden...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Murad, M. H., Almasri, J., Alsawas, M., Farah, W. Tags: Editor's choice EBM primer Source Type: research
Cholesterol paradox: a correlate does not a surrogate make
The global campaign to lower cholesterol by diet and drugs has failed to thwart the developing pandemic of coronary heart disease around the world. Some experts believe this failure is due to the explosive rise in obesity and diabetes, but it is equally plausible that the cholesterol hypothesis, which posits that lowering cholesterol prevents cardiovascular disease, is incorrect. The recently presented ACCELERATE trial dumbfounded many experts by failing to demonstrate any cardiovascular benefit of evacetrapib despite dramatically lowering low-density lipoprotein cholesterol and raising high-density lipoprotein cholesterol...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: DuBroff, R. Tags: Perspective Source Type: research
Informing treatment decisions through meta-analysis: to network or not?
Evidence from randomised trials and their meta-analyses is typically formed of head-to-head comparisons of a couple of treatments; multiarm trials are infrequent. However, in real-life healthcare, there are many more than two treatment options for a particular condition. To be relevant for the shop-floor of practice, evidence-based medicine requires the use a comprehensive approach to compile, compare and contrast evidence on all options in one synthesis. Network meta-analysis (NMA) offers exactly such a solution. It generates a rank order of the available treatments for practitioners and policymakers that has the merit of...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Al Wattar, B. H., Zamora, J., Khan, K. S. Tags: Perspective Source Type: research
Evidence-based medicine: a persisting desire under fire
We report on a curriculum that was delivered to 126 learners using an online remote delivery platform. This experience demonstrates the feasibility of this approach in disaster-stricken areas and underscores the importance of evidence-based medicine even under such conditions. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Alahdab, F., Alabed, S., Al-Moujahed, A., Al Sallakh, M. A., Alyousef, T., Alsharif, U., Fares, M., Murad, M. H. Tags: Editor's choice Perspective Source Type: research
Wrong guidelines: how to detect them and what to do in the case of flawed recommendations
Any evidence-based recommendation needs careful assessment of its methodological background as well as of its content trustworthiness, especially given that following it will not necessarily produce the intended clinical outcomes. There are no established instruments to evaluate guidelines for their content, while useful tools assessing the quality of methods followed are well recognised and adopted. We suggest a ‘safety bundle’ considering methodological aspects and content trustworthiness of guidelines, by adopting the GRADE method in a backward fashion. Sharing the critical analysis of the guidelines with pa...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Iannone, P., Costantino, G., Montano, N., Podda, G. M., Minardi, M., Doyle, J., Cartabellotta, A. Tags: Perspective Source Type: research
Wrong guidelines: why and how often they occur
Evidence-based guidelines are considered an essential tool in assisting physicians, policymakers and patients when choosing among alternative care options and are considered unbiased standards of care. Unfortunately, depending on how their reliability is measured, up to 50% of guidelines can be considered untrustworthy. This carries serious consequences for patients' safety, resource use and health economics burden. Although conflict of interests, panel composition and methodological flaws are traditionally thought to be the main reasons undermining their untrustworthiness, corruption and waste of biomedical research also ...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Iannone, P., Montano, N., Minardi, M., Doyle, J., Cavagnaro, P., Cartabellotta, A. Tags: Perspective Source Type: research
Where should preappraised evidence summaries and guidelines place in a pyramid?
The letter by Kaufmann1 is quite reassuring as it demonstrates that policy researchers have intuitively and astutely questioned simple evidence hierarchies and were sceptical about using study design or study label as a surrogate for validity. This was the impetus for proposing our revised pyramid. The letter also reminds us that there are higher order scientific publications (guidelines and clinical synopses) that can also have variable levels of credibility. How can we place such highly synthesised and preappraised summaries in a pyramid? The pyramid suggested by Alper and Haynes2 includes such summaries but that pyramid...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Alahdab, F., Alsawas, M., Murad, M. H. Tags: Letters Source Type: research
Letter in reply to 'Evidence pyramids' from Dr Kaufmann
Dr Kaufmann makes an important point that quality varies in primary studies and that one should be sceptical when reading the medical literature. Systematic review of poor quality evidence does not make that evidence more valid. Dr Kaufmann suggests that by reviewing the primary literature for themselves, readers would detect potential biases, conflicts of interest and better understand the implications of the findings. I am not so sure. I am concerned that the busy clinician with minimal EBM training would not detect design flaws (nor understand their impact on the results) nor review author affiliations to recognise pote...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Shaneyfelt, T. Tags: Letters Source Type: research
Letter in reply to 'Evidence pyramids from Dr Kaufmann
Dr Kaufmann1 suggests that readers should use the ‘New Evidence Pyramid’ which conveys a hierarchy of quality across primary studies2 rather than the ‘EBHC Pyramid 5.0’ which conveys a hierarchy of comprehensiveness across types of information resources (primary studies, systematic reviews, guidelines and synthesised summaries for clinical reference).3 However, these pyramids are complementary and address very different issues. The hierarchy of validity of primary studies (and the recognition that quality varies so the hierarchy should not be interpreted strictly) reported by Murad et al in the &lsq...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Alper, B. S., Haynes, B. R. Tags: Letters Source Type: research
Evidence pyramids
I read with great interest the Perspective pieces and accompanying editorial on evidence pyramids in your August 2016 journal.1–3 In my prior work as a medical policy researcher for two health insurance plans, it was disheartening to find that industries and clinicians alike not uncommonly relied on synthesised summaries and guidelines as a sole source of information, and systematic reviews and meta-analysis as a source of ‘truth’. With this in mind, I found the ‘New Evidence Pyramid’ proposed by Murad et al3 to be ingenious. It is graphically simple while conveying that quality varies in prim...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Kaufmann, J. Tags: Letters Source Type: research
Determination of a single, universal threshold for caesarean section rate is not the way forward
This study was a cross-sectional analysis of nationally representative data evaluating... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Betran, A. P., Zhang, J., Torloni, M. R., Gülmezoglu, A. M. Tags: Epidemiologic studies, Open access, Childhood nutrition, Injury Practice guideline Source Type: research
Traditionally taught clinical variables and risk factors perform poorly in the prediction of acute coronary syndromes in the emergency department
Commentary on: Fanaroff AC, Rymer JA, Goldstein SA, et al. Does this patient with chest pain have acute coronary syndrome? The rational clinical examination systematic review. JAMA 2015;314:1955–65 . Context Up to 5–10% of annual presentations to emergency departments (EDs) and 25% of hospital admissions are patients with symptoms suggestive of acute coronary syndromes (ACS). Estimating the pretest probability of ACS is important. Traditionally, this has been determined using clinical acumen, primarily involving historical variables and risk factors learnt during early training and reinforced in clinical practi...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Than, M. Tags: EBM Diagnosis, Drugs: cardiovascular system, Pain (neurology), Ischaemic heart disease Source Type: research
Cognitive adverse effects and brain deterioration associated with use of anticholinergic activity medicines in older adults
This study examined whether medicines with anticholinergic activity alter brain glucose metabolism, and the impact this has on brain structure, function and cognitive decline. Methods This retrospective cohort study involved 402 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) centre and 49 participants from the Indiana Memory and Aging Study (IMAS). Data on cognitive and neuroimaging findings... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Nishtala, P. S., Salahudeen, M. S. Tags: Geriatric medicine, Epidemiologic studies, Dementia, Drugs: CNS (not psychiatric), Sleep disorders (neurology), Stroke, Memory disorders (psychiatry), Psychiatry of old age, Sleep disorders, Sleep disorders (respiratory medicine) Aetiology/Harm Source Type: research
Morphine exposure in preterm infants correlates with impaired cerebellar growth and poorer neurodevelopmental outcome
This study included 136 infants born at 24–32 weeks gestational age who underwent magnetic resonance imaging of the brain near birth and... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: McPherson, C. Tags: Clinical trials (epidemiology), Epidemiologic studies, Pain (neurology), Stroke, Pain (palliative care), Radiology, Drugs: musculoskeletal and joint diseases, Clinical diagnostic tests, Radiology (diagnostics) Aetiology/Harm Source Type: research
