Good or best practice statements: proposal for the operationalisation and implementation of GRADE guidance
An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for grading the strength of recommendations is inappropriate. Instead, the GRADE Working Group has recommended developing ungraded best or good practice statement (GPS) and developed guidance under which circumsances the...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Dewidar, O., Lotfi, T., Langendam, M. W., Parmelli, E., Saz Parkinson, Z., Solo, K., Chu, D. K., Mathew, J. L., Akl, E. A., Brignardello-Petersen, R., Mustafa, R. A., Moja, L., Iorio, A., Chi, Y., Canelo-Aybar, C., Kredo, T., Karpusheff, J., Turgeon, A. F Tags: Open access Research methods and reporting Source Type: research
Context matters! What is really tested in an RCT?
The American physician Henry Beecher was stationed in Italy during the Second World War and had to carry out surgery on wounded soldiers. When he ran out of morphine, a nurse suggested injecting the patients with a saline solution. The success of this deception was surprising and Beecher was so impressed that he put his later activities in the service of placebo research. His 1955 article, ‘The Powerful Placebo’,1 played a seminal role in the process of the randomised controlled trial (RCT) becoming the gold standard for determining the effectiveness of a treatment.2 Surprisingly, until today, it is not complet...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Schmidt, S. Tags: EMJ Learning EBM learning Source Type: research
Component network meta-analysis in a nutshell
Introduction Several organisations, such as the WHO, have endorsed network meta-analysis (NMA) as a powerful tool in clinical decision making. NMA is a statistical method, which simultaneously compares multiple (three or more) interventions within a single framework, by synthesising direct and indirect evidence from multiple studies, addressing the same scientific question.1–4 Healthcare interventions can be complex/multicomponent in the sense that they consist of multiple, possibly interacting, components. While NMA focuses on estimating intervention effects, component NMA (CNMA) disentangles the effect of each comp...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Tsokani, S., Seitidis, G., Mavridis, D. Tags: EMJ Learning EBM learning Source Type: research
The complexity underlying treatment rankings: how to use them and what to look at
Highlights/key points Treatment hierarchies obtained by SUCRA, , mean ranks and mean relative effects might differ when there are large differences in the amount of data for each treatment. Different hierarchies do not imply that one is wrong or better than the others, because the methods used to rank treatments address different ‘treatment hierarchy questions’ based on how the ‘preferable treatment’ is defined. The treatment at the top of the ranking may not reflect the ‘best clinical choice’: rankings must be considered together with relative treatment effects and quality of the eviden...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Chiocchia, V., White, I. R., Salanti, G. Tags: Open access, EMJ Learning EBM learning Source Type: research
In-person schooling is essential even during periods of high transmission of COVID-19
During the early phase of the pandemic, school closures were one of the non-pharmaceutical interventions (NPIs) implemented globally to reduce transmission. Given that SARS-CoV-2 will continue to circulate for years to come, school closures may be debated again. As familiar respiratory viruses have returned, their combined pressure alongside COVID-19 caused renewed discussion of closures in the UK and initiation of remote learning in areas of the USA in the winter of 2022.1 2 This suggests that debates around school closures will continue into the future. According to the Oxford COVID-19 policy tracker,3 school closures ar...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Munro, A., Buonsenso, D., Gonzalez-Dambrauskas, S., Hughes, R. C., Bhopal, S. S., Vasquez-Hoyos, P., Cevik, M., Rubio, M. L. M., Roland, D. Tags: Open access, COVID-19 Analysis Source Type: research
School closures during COVID-19: an overview of systematic reviews
Conclusions
School closures during COVID-19 had both positive and negative impacts. We found a large number of SRs and primary studies. However, confidence in the SRs was mostly low to very low, and the certainty of evidence was also mostly very low. We found no SRs assessing the potential drawbacks of in-school mitigations on children, which could be addressed moving forward. This overview provides evidence that could inform policy makers on school closures during future potential waves of COVID-19. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Hume, S., Brown, S. R., Mahtani, K. R. Tags: COVID-19 Original research Source Type: research
Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters
Conclusions
After considering forms of SDM beyond weighing alternatives, SDM was present in most encounters. Clinicians and patients often used different forms of SDM within the same encounter. Recognising a range of SDM forms that clinicians and patients use to respond to problematic situations, as demonstrated in this study, opens new lines of research, education and practice that may advance patient-centred, evidence-based care. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Ruissen, M. M., Montori, V. M., Hargraves, I. G., Branda, M. E., Leon Garcia, M., de Koning, E. J., Kunneman, M. Tags: Open access Original research Source Type: research
US Food and Drug Administration regulatory reviewer disagreements and postmarket safety actions among new therapeutics
Conclusions
This investigation of regulatory reviewer disagreements and postmarket safety actions among new therapeutics suggests that disagreements among regulatory reviewers may lead to important pre-emptive actions, potentially mitigating the need for postmarket safety actions to be taken. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Eadie, A., MacGregor, A., Wallach, J., Ross, J., Herder, M. Tags: Original research Source Type: research
The Pandoras Box of Evidence Synthesis and the case for a living Evidence Synthesis Taxonomy
Introduction Have we, as an evidence-based health community, opened the Pandora’s box of evidence synthesis? There now exists a plethora of overlapping evidence synthesis approaches and duplicate, redundant and poor-quality reviews.1–4 After years of advocating for the need for systematic reviews of the evidence, there is a risk that this message been disseminated too widely and has been misinterpreted in this process. We have reached a point where in some fields more reviews exist than clinical trials, where same topic reviews are being conducted in parallel, and evidence syntheses possess limited utility for ...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Munn, Z., Pollock, D., Barker, T. H., Stone, J., Stern, C., Aromataris, E., Schünemann, H. J., Clyne, B., Khalil, H., Mustafa, R. A., Godfrey, C., Booth, A., Tricco, A. C., Pearson, A. Tags: Open access EBM opinion and debate Source Type: research
Responsible dissemination of health and medical research: some guidance points
Ravinetto and Singh argue that better practices can be implemented when disseminating research findings through abstracts, preprints, peer-reviewed publications, press releases and social media Dissemination has been defined as ‘the targeted distribution of information and intervention materials to a specific public health or clinical practice audience’,1 and as being ‘simply about getting the findings of your research to the people who can make use of them, to maximise the benefit of the research without delay’.2 Ethics guidelines concur that research stakeholders have ethical obligations to dissem...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Ravinetto, R., Singh, J. A. Tags: Open access EBM analysis Source Type: research
An opportunity for evidence-based care of individuals with monkeypox
What is monkeypox and why is it important now? Monkeypox virus is an orthopoxvirus, in the family poxviridae, which belongs to the same genus as smallpox (the causative agent of smallpox) and vaccinia viruses (the virus used in the smallpox vaccine).1 Monkeypox is a viral zoonotic infection that is endemic in the tropical forest of central and western Africa and is sporadically exported to other regions. Animal-to-human transmission occurs through contact with infected animal tissue, for example through a bite or the ingestion of infected meat. Human-to-human transmission occurs through direct contact with mucocutaneous le...
Source: Evidence-Based Medicine - May 22, 2023 Category: Internal Medicine Authors: Donato, M., Izcovich, A., Tortosa, F., Ragusa, M. A., Saenz, C., Reveiz, L. Tags: Open access EBM analysis Source Type: research
Swallowing outcomes in dysphagia interventions in Parkinsons disease: a scoping review
Conclusions
The high variability of outcomes emphasises the need for an agreed standardised COS. This will inform clinical trial design in OD in PD, increase the quality of OD trials in PD and facilitate synthesising and comparing study results to reach conclusion on the safety and effectiveness of OD interventions in PD. It will not prevent or restrict researchers from examining other outcomes.
Trial registration number
The COS-DIP study, including the scoping review, was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 (www.comet-initiative.org, registration n...
Source: Evidence-Based Medicine - May 4, 2023 Category: Internal Medicine Authors: Hirschwald, J., Hofacker, J., Duncan, S., Walshe, M. Tags: Open access Original research Source Type: research
In memory of Richard Saitz (1963-2022): former editor of BMJ Evidence-Based Medicine
It was with sadness that we marked the passing of our friend and former Editor of BMJ-EBM, Dr Richard Saitz. What does it mean to be a good man? It means to be kind, compassionate, diligent, to optimise your potential and use it to contribute, to teach and mentor and to create conditions for collaboration to flourish. Rich was a good man. We all in our own ways treasured Rich and what we learnt from him as we worked together. It was an honour and a pleasure to be part of an editorial team for a journal that valued our contributions. As such, we were able to travel and to meet annually for team building. Perhaps Rich could ...
Source: Evidence-Based Medicine - March 23, 2023 Category: Internal Medicine Authors: Campbell-Scherer, D., Khan, K., Fenton, J., Kistin, C. J. Tags: Letters Source Type: research
Development of literature search strategies for evidence syntheses: pros and cons of incorporating text mining tools and objective approaches
The problem Systematic reviews and related evidence synthesis products (eg, rapid reviews, evidence maps and scoping reviews) are foundational to evidence-based medicine, informing all levels of healthcare, from patient–provider decisions to national policy-making.1 However, an ongoing challenge to systematic reviews is the exponential growth in the number of journal articles and other related reports of medical research (eg, clinical trial records, conference abstracts and preprint articles). Since 2017, there have been over a million new records added annually to PubMed alone.2 Thus, there is a compelling need to s...
Source: Evidence-Based Medicine - March 23, 2023 Category: Internal Medicine Authors: Adam, G. P., Paynter, R. Tags: EBM learning Source Type: research
Thresholds for interpreting the fragility index derived from sample of randomised controlled trials in cardiology: a meta-epidemiologic study
In conclusion, FI values that range 19–22 may meet various definitions of precision and can be used as a rule of thumb to suggest that a treatment effect is likely precise and less susceptible to random error. The number of patients lost to follow-up should be presented alongside FI to better illustrate fragility. (Source: Evidence-Based Medicine)
Source: Evidence-Based Medicine - March 23, 2023 Category: Internal Medicine Authors: Murad, M. H., Kara Balla, A., Khan, M. S., Shaikh, A., Saadi, S., Wang, Z. Tags: General Medicine Research methods and reporting Source Type: research
