Ten resources for understanding bias in health research: EBM live workshop 2022
Introduction Previous articles introduced resources for practising1 and teaching2 evidence-based medicine (EBM) and healthcare (EBHC). In an in-person workshop at the 2022 EBM live conference in Oxford, participants were invited to consider resources on bias in health research, contribute to a database of such studies and disseminate their learning. This paper shares insights from the workshop. Resource selection process The resource selection process is outlined in figure 1. Briefly, participants (n=25), in small groups, were given time to list and discuss resources they deemed useful for understanding bias in health rese...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Nunan, D., Bashir, K., Bilimoria, K., Birdi, J., Campbell, F., Dean, R., Downer, M. B., Costa, G. G., Golob, M. M., Heintzman, A., Howe, M. S., Karunananthan, S., Kurup, K. K., Leinberger-Jabari, A., Luo, Y., Mathe, N., Miguel, R. T. D., Morrow, R. L., Sc Tags: EBM learning Source Type: research
Implementing hierarchical network meta-analysis incorporating exchangeable dose effects compared to standard hierarchical network meta-analysis
Introduction Network meta-analysis (NMA) compares the efficacy or safety of more than two treatments or treatment doses that are directly or indirectly compared through a common comparator.1 2 Treatment doses are not routinely incorporated into NMAs, which potentially limits the applicability and validity of results.3 4 In this paper, we will introduce readers to NMA incorporating dose effects, specifically, how they can implement a hierarchical random effects NMA incorporating exchangeable dose effects. In particular, we share a motivating clinical example describing the comparative risk of vomiting associated with differ...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Watt, J., Hofmeister, M., Del Giovane, C., Turner, R., Tricco, A. C., Mavridis, D., Straus, S., Veroniki, A. A. Tags: EBM learning Source Type: research
Digitally enabled decentralised research: opportunities to improve the efficiency of clinical trials and observational studies
Background Clinical research is often site-centric, adhering to schedules largely driven by tradition and operational convenience rather than the natural history of diseases, and the diversity of target populations.1 It stands to reason therefore that the patients recruited to clinical trials do not always reflect real-world clinical presentations, which in turn can bias the findings and limit their applicability to real-world settings. However, in reality, few studies are totally site-centric with treatment often self-administered at home, between study-site visits; some data capture may also occur between site visits&mda...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Aiyegbusi, O. L., Davies, E. H., Myles, P., Williams, T., Frost, C., Haroon, S., Hughes, S. E., Wilson, R., McMullan, C., Subramanian, A., Nirantharakumar, K., Calvert, M. J. Tags: Open access EBM learning Source Type: research
Smartphone apps for point-of-care information summaries: systematic assessment of the quality and content
Conclusions
Future apps should report a more detailed evidence-based methodology, be accessible for offline use and support search in more than one language. There should be clearer information provided in future apps regarding the declaration of authorship and conflict of interest. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Lee, M., Lin, X., Chai, J. Z. Q., Lee, E. S., Smith, H., Tudor Car, L. Tags: Original research Source Type: research
Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study
Conclusion
Our results highlight the challenges and opportunities for those who wish to incorporate decision analysis to support shared decision-making for clinical decisions. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Humphries, B., Leon-Garcia, M., Bates, S. M., Guyatt, G., Eckman, M. H., D'Souza, R., Shehata, N., Jack, S. M., Alonso-Coello, P., Xie, F. Tags: Original research Source Type: research
Interpreting the results from the first randomised controlled trial of colonoscopy: does it save lives?
In screening for colorectal cancer (CRC), colonoscopy is generally referred to as the ‘gold standard’, as it examines both the right and left colon. Despite wide adoption, colonoscopy had not been studied in randomised fashion until the Northern-European Initiative on Colorectal Cancer (NordICC) trial. NordICC is a pragmatic, registry-based, randomised controlled trial (RCT) of colonoscopy versus no screening in adults between 55 and 64.1 In NordICC, 84 000 participants were randomised (1:2) to either an invitation to colonoscopy or usual care, which, at the time of the study, was no CRC screening. The trial fo...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Powell, K., Prasad, V. Tags: Open access EBM opinion and debate Source Type: research
Indias latest essential medicines list: gaps, strengths and opportunities in evidence-based decision-making
Essential medicines—defined by the WHO as ‘those that satisfy the priority health care needs of the population’—are meant to be always accessible within health systems, in sufficient quantities, in optimal dosage forms, of guaranteed quality and at affordable costs.1 The WHO Model Essential Medicines List (EML)1 serves as a reference for countries to design and update national EMLs to support medicine procurement, supply, manufacture, pricing and prescribing practices. In this commentary, we discuss the gaps, strengths and opportunities in evidence-based decision-making in India’s latest natio...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Satheesh, G., Unnikrishnan, M. K., Jha, V., Salam, A. Tags: EBM opinion and debate Source Type: research
Plain language summaries: enhancing patient-centred care and improving accessibility of health research
Introduction As part of the Open Science movement, plain language summaries (PLSs) could make scientific research more understandable and accessible to all audiences. They aim to clearly communicate research results without using technical language.1 Regulatory bodies increasingly require these summaries to disseminate clinical studies’ results as part of the efforts to make them more transparent to the public.2 For example, the European Union Clinical Trials Regulation and the Dutch Ethics Committee require clinical trials to provide public summaries adapted for non-medical audiences within 6–12 months after c...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Riganti, P., McKinnon, A. M. Tags: Analysis Source Type: research
Challenges to delivering evidence-based management for long COVID
Early on in the COVID-19 pandemic, scientists forewarned of a potential medium to long-term post-acute sequelae in patients infected with SARS-CoV-2, similar to that documented in bacterial,1 protozoan and viral infections including Epstein-Barr virus,2 Ebola virus,3 dengue virus,4 Chikunguña virus,5 going far back to the influenza pandemic in 1918.6 These varied symptoms following acute SARS-CoV-2 infection is now termed as long COVID and is also known as long-haulers syndrome, post COVID-19 condition (PCC),7 ‘post-acute sequelae of SARS-CoV-2 infection (PASC)’,7 ‘chronic COVID’ and many oth...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Peiris, S., Izcovich, A., Ordunez, P., Luciani, S., Martinez, C., Aldighieri, S., Reveiz, L. Tags: Open access, COVID-19 Analysis Source Type: research
Metro Mapping: development of an innovative methodology to co-design care paths to support shared decision making in oncology
Shared decision making and service design Treatment decision-making can be complex, notably when there are multiple treatments available, with different (probabilities of) benefits and harms, for example, survival and side effects.1 It is precisely in these complex situations that the preferences of the patient are of utmost importance, as the trade-offs of benefits and harms are subjective and concern patients’ lives.2 In such trade-offs, shared decision making (SDM) has gained momentum as a strategy to include both the best available evidence and the patient’s preferences.3 Healthcare professionals generally ...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Stiggelbout, A., Griffioen, I., Brands, J., Melles, M., Rietjens, J., Kunneman, M., van der Kolk, M., van Eijck, C., Snelders, D. Tags: Open access Analysis Source Type: research
What is the place in therapy for nirmatrelvir/ritonavir?
The COVID-19 pandemic presents substantial challenges for governments and providers keen to provide effective treatments. The tensions between supply, uncertainty of which patient populations optimally benefit, time-limited effectiveness (due to need for rapid initiation of treatment on an individual level, and viral evolution and potential development of resistance on a population level), and action bias (ie, most providers to want to ‘do something’ for an ailing patient) have incentivised rapid authorisation of therapeutic agents with relatively broad use criteria.1 Nirmatrelvir/ritonavir (Paxlovid, Pfizer) i...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Lee, T. C., Pogue, J. M., McCreary, E. K., Morris, A. M. Tags: EBM analysis Source Type: research
Exploring advanced methods for network meta-analysis
High-quality systematic reviews (SRs) of both new and existing health technologies are vital to inform clinical practices and healthcare decision-making. This has been recognised by global entities such as the World Health Organization and national healthcare policy agencies like the Canadian Agency for Drugs and Technologies in Health, the National Institute for Health and Care Excellence in the United Kingdom, and the National Health and Medical Research Council in Australia. These SRs serve as the foundation for evidence-based practices and policies, which is reflected in the increasing number of publications in recent ...
Source: Evidence-Based Medicine - September 21, 2023 Category: Internal Medicine Authors: Veroniki, A. A., Franco, J. V. A. Tags: Editorials Source Type: research
Replacing PICO in non-interventional studies
Dr Luijendijk1 has identified an elephant in the evidence-based medicine (EBM) classroom: patient, intervention, comparison, outcome (PICO acronym) for the formulation of clinical questions, teaching EBM and searching the literature is extremely useful for interventional studies but confusing for other types of studies. Instead of forcing words into the acronym, we suggest adding two acronyms. The acronym PECO (E for exposure) can replace PICO in observational studies. This acronym is already used for environmental exposures2 but can be used for any exposure, including genetic factors, toxins or medical conditions. For exa...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Mintzker, Y., Blum, D., Adler, L. Tags: Letters Source Type: research
Correspondence on 'The limits of shared decision making by Elwyn et al: We call for a more nuanced approach
We read with interest the recent article by Elwyn and colleagues that addressed ‘The limits of shared decision making’ (Elwyn et al, p.1).1 Like the article’s authors, we identify as ‘strong advocates of shared decision-making (SDM)’ while recognizing some limits to its application (Elwyn et al, p.1).1 However, we find the article’s interpretation of SDM principles to be lacking in nuance on multiple fronts. SDM is an essential component of evidence-based medicine, which requires a ‘recognition that values and preferences are as important as evidence in determining optimal clinical...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Ijaz, N., Wieland, L. S., Gallego-Perez, D. F. Tags: Letters Source Type: research
Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews
Conclusions
Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed.
PROSPERO registration number
CRD42020206535. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Meza, N., Rojas, V., Escobar Liquitay, C. M., Perez, I., Aguilera Johnson, F., Amarales Osorio, C., Irarrazaval, M., Madrid, E., Franco, J. V. A. Tags: Evidence synthesis Source Type: research
