Pragmatic and open science-based solution to a current problem in the reporting of living systematic reviews
We describe a new method to transparently report the living evidence surveillance process that occurs between published LSR versions. We use the example of the living Cochrane Review on nirmatrelvir combined with ritonavir (Paxlovid) for preventing and treating COVID-19 to illustrate how this can work in practice. We created a publicly accessible spreadsheet on the Open Science Framework platform, linking to the living Cochrane Review, that details the search and study selection process, enabling readers to track the progress of eligible ongoing or completed studies. Further automation of the evidence surveillance process ...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Metzendorf, M.-I., Weibel, S., Reis, S., McDonald, S. Tags: Open access Research methods and reporting Source Type: research
Using Risk of Bias 2 to assess results from randomised controlled trials: guidance from Cochrane
A systematic review identifies, appraises and synthesises all the empirical evidence from studies that meet prespecified eligibility criteria to answer a specific research question. As part of the appraisal, researchers use explicit methods to assess risk of bias in the results’ from included studies that contribute to the review’s findings, to improve our confidence in the review’s conclusions. Randomised controlled trials included in Cochrane Reviews have used a specific risk of bias tool to assess these included studies since 2008. In 2019, a new version of this tool, Risk of Bias 2 (RoB 2), was launch...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Flemyng, E., Moore, T. H., Boutron, I., Higgins, J. P., Hrobjartsson, A., Nejstgaard, C. H., Dwan, K. Tags: Research methods and reporting Source Type: research
Sharing study materials in health and medical research
Making study materials available allows for a more comprehensive understanding of the scientific literature. Sharing can take many forms and include a wide variety of outputs including code and data. Biomedical research can benefit from increased transparency but faces unique challenges for sharing, for instance, confidentiality concerns around participants’ medical data. Both general and specialised repositories exist to aid in sharing most study materials. Sharing may also require skills and resources to ensure that it is done safely and effectively. Educating researchers on how to best share their materials, and p...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: DeVito, N. J., Morton, C., Cashin, A. G., Richards, G. C., Lee, H. Tags: Research methods and reporting Source Type: research
How to interpret studies using Mendelian randomisation
Introduction to Mendelian randomisation The importance of causal inference in biomedical science cannot be overstated. It can help determine the direction of effect, the mechanisms behind observed associations and potential interventions.1 Although observational studies are the most common type in the biomedical field, they primarily suggest an association, and less likely infer causation, because of the potential for confounding and bias associated with this type of study. Recent advances in genetic epidemiology, such as new statistical techniques, large genotyped datasets and advanced computational methods for data analy...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Kim, M. S., Song, M., Shin, J. I., Won, H.-H. Tags: EBM learning Source Type: research
All health is not equal: the use of modifiers in NICE technology appraisal
This article describes NICE’s current modifiers and briefly considers the implications of their use. NICE’s methods: an overview NICE’s approach to technology... (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Charlton, V. Tags: EBM learning Source Type: research
Proof of concept: all-virtual guideline development workshops using GRADE during the COVID-19 pandemic
Introduction The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework is an approach to assessing the certainty of evidence and developing clinical practice recommendations based on a systematic review of the relevant literature.1 Since 2014, the US GRADE Network (USGN) has held a total of 16 semiannual guideline development workshops for attendees ranging from healthcare organisation staff to patients to guideline panel members. Using an in-person format in different cities of the continental USA, experienced educators with extensive methodological background have taught participants how to ...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Siedler, M. R., Murad, M. H., Morgan, R. L., Falck-Ytter, Y., Mustafa, R. A., Sultan, S., Dahm, P. Tags: COVID-19 EBM learning Source Type: research
Likelihood ratio interpretation of the relative risk
Key messages What is already known on this topic The risk ratio (relative risk) is a ratio of two risks that is interpreted as connecting the intervention conditional risks in a clinical trial. What this study adds It is demonstrated that the conventional interpretation of the risk ratio is in conflict with Bayes’ theorem. The interpretation of the risk ratio as a likelihood ratio connecting prior (unconditional) intervention risk to outcome conditional intervention risk is required to avoid conflict with Bayes’ theorem. How this study might affect research, practice or policy The interpretation of the risk rat...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Doi, S. A. R., Kostoulas, P., Glasziou, P. Tags: EBM learning Source Type: research
Acupuncture for acute migraine attacks in adults: a systematic review and meta-analysis
Conclusion
The body of evidence suggests that acupuncture may be more effective than sham acupuncture in the treatment of migraine. Acupuncture may also be as effective as pharmacological therapy. However, the certainty evidence across outcomes was low to very low and new high-quality studies can provide more clarity.
PROSPERO registration number
CRD42014013352. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Wang, Y., Du, R., Cui, H., Zhang, L., Yuan, H., Zheng, S. Tags: Original research Source Type: research
Caring without boundaries: delimiting shared decision-making
In shared decision-making (SDM), patients and clinicians work together to determine the best next steps in health and care. Elwyn et al’s recent paper1 makes an important contribution to the literature about the applicability and limits of SDM.2 Their argument requires adherence to the traditional definition of SDM. The definition of SDM the authors use—that is, the preference-based selection of an alternative based on its relative merits3—has enabled progress. It has fuelled work on standards for patient decision aids, measurement instruments, efficacy and implementation studies, and policy initiatives. ...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Montori, V., Kunneman, M. Tags: EBM opinion and debate Source Type: research
Promise and peril of claims-based dementia ascertainment in causal inference
Festa and colleagues highlight under-recognised factors that may bias research, policy and population health strategies predicated on claims-based ascertainment of Alzheimer’s disease and related dementias within the USA Absent effective disease-modifying therapies for Alzheimer’s disease and related dementias (ADRD), measures to prevent incident disease, delay symptom onset and prolong functional independence are paramount. Identifying effective preventive measures and care delivery models, in turn, requires improved information regarding modifiable risk factors and corresponding population-level interventions...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Festa, N., Moura, L. M., Blacker, D., Newhouse, J. P., Hsu, J. Tags: EBM analysis Source Type: research
The limits of shared decision making
The foundation of shared decision making (SDM) is the view that people should be aware of relevant choices, and that their personal views, priorities and preferences are relevant factors when determining action. The degree to which people wish to engage in decisions will vary, as will the level to which they will be made aware that decisions exist, or become informed about the relevant information.1 There is increasing interest in SDM, an ethical imperative,2 and supporting evidence that well-designed tools help people compare options and make more informed choices.3 We as authors, are strong advocates of SDM, and think th...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Elwyn, G., Price, A., Franco, J. V. A., Gulbrandsen, P. Tags: Open access EBM analysis Source Type: research
Shared decision-making as a method of care
Care happens in interaction between the patient and the clinician, in conversation where the patient and clinician uncover or develop a shared understanding of the problematic situation of the patient and identify, discover, or invent ways to make that situation better, given what each patient prioritises and seeks.1 Thus, to get the right care for each patient, patient and clinician collaborate and deliberate together to figure out what to do.2 Shared decision-making (SDM) has been traditionally defined as a collaborative approach by which, in partnership with their clinician, patients are encouraged to think about the av...
Source: Evidence-Based Medicine - July 21, 2023 Category: Internal Medicine Authors: Montori, V. M., Ruissen, M. M., Hargraves, I. G., Brito, J. P., Kunneman, M. Tags: Open access EBM analysis Source Type: research
Using a journal club to navigate a maze of COVID-19 papers in a front-line hospital service
The early stages of the COVID-19 pandemic placed clinicians in a position of having to manage patients with a previously unknown disease, with no well-established information on diagnosis, treatment or prognosis. Simultaneously, the published research addressing these questions increased exponentially. Suddenly, clinicians, health services and governments were making decisions impacting whole populations based on non-peer-reviewed preprints of varying quality. Keeping abreast of the literature and rapid deployment of critical appraisal skills were more vital than ever. In April 2020, PS and colleagues began a regular hospi...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Wenke, R., Stehlik, P., Gerrard, J., Mickan, S., Henry, D. Tags: Open access, COVID-19 Letters Source Type: research
Theory and practice of Bayesian and frequentist frameworks for network meta-analysis
Network meta-analysis (NMA) is an increasingly popular statistical method of synthesising evidence to assess the comparative benefits and harms of multiple treatments in a single analysis. Several automated software packages facilitate conducting NMA using either of two alternative approaches, Bayesian or frequentist frameworks. Researchers must choose a framework for conducting NMA (Bayesian or frequentist) and select appropriate model(s), and those conducting NMA need to understand the assumptions and limitations of different approaches. Bayesian models are more frequently used and can be more flexible but require checki...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Sadeghirad, B., Foroutan, F., Zoratti, M. J., Busse, J. W., Brignardello-Petersen, R., Guyatt, G., Thabane, L. Tags: Research methods and reporting Source Type: research
Using individual participant data to improve network meta-analysis projects
A network meta-analysis combines the evidence from existing randomised trials about the comparative efficacy of multiple treatments. It allows direct and indirect evidence about each comparison to be included in the same analysis, and provides a coherent framework to compare and rank treatments. A traditional network meta-analysis uses aggregate data (eg, treatment effect estimates and standard errors) obtained from publications or trial investigators. An alternative approach is to obtain, check, harmonise and meta-analyse the individual participant data (IPD) from each trial. In this article, we describe potential advanta...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Riley, R. D., Dias, S., Donegan, S., Tierney, J. F., Stewart, L. A., Efthimiou, O., Phillippo, D. M. Tags: Open access Research methods and reporting Source Type: research
