Evidence-Based Medicine最新文献_第5页

What does expert opinion in guidelines mean? a meta-epidemiological study. 指南中的专家意见意味着什么？一项元流行病学研究。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-09-18 DOI: 10.1136/ebmed-2017-110798

Oscar J Ponce, Neri Alvarez-Villalobos, Raj Shah, Khaled Mohammed, Rebecca L Morgan, Shahnaz Sultan, Yngve Falck-Ytter, Larry J Prokop, Philipp Dahm, Reem A Mustafa, Mohammad H Murad

{"title":"What does expert opinion in guidelines mean? a meta-epidemiological study.","authors":"Oscar J Ponce, Neri Alvarez-Villalobos, Raj Shah, Khaled Mohammed, Rebecca L Morgan, Shahnaz Sultan, Yngve Falck-Ytter, Larry J Prokop, Philipp Dahm, Reem A Mustafa, Mohammad H Murad","doi":"10.1136/ebmed-2017-110798","DOIUrl":"10.1136/ebmed-2017-110798","url":null,"abstract":"Guidelines often use the term expert opinion (EO) to qualify recommendations. We sought to identify the rationale and evidence type in EO recommendations. We searched multiple databases and websites for contemporary guidelines published in the last decade that used the term EO. We identified 1106 references, of which 69 guidelines were included (2390 recommendations, of which 907 were qualified as EO). A rationale for using EO designation was not provided in most (91%) recommendations. The most commonly cited evidence type was extrapolated from studies that did not answer guideline question (40% from randomised trials, 38% from observational studies and 2% from case reports or series). Evidence extrapolated from populations that were different from those addressed in the guideline was found in 2.5% of EO recommendations. We judged 5.6% of EO recommendations as ones that could have been potentially labelled as good practice statements. None of the EO recommendations were explicitly described as being solely dependent on the clinical experience of the panel. The use of EO as a level of evidence in guidelines remains common. A rationale for such use is not explicitly provided in most instances. Most of the time, evidence labelled as EO was indirect evidence and occasionally was very low-quality evidence derived from case series. We posit that the explicit description of evidence type, as opposed to using the label EO, may add clarity and transparency and may ultimately improve uptake of recommendations.","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"164-169"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35421717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Routine invasive strategies compared with conservative strategies do not lower the all-cause mortality in patients with non-ST elevation myocardial infarction and unstable angina. 非st段抬高型心肌梗死合并不稳定型心绞痛患者的全因死亡率与常规有创策略相比没有降低。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-03 DOI: 10.1136/ebmed-2016-110527

Udho Thadani

引用次数: 0

Meniscal resection may not benefit patients with traumatic meniscal tears. 半月板切除术可能对外伤性半月板撕裂患者无效。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-01 DOI: 10.1136/ebmed-2017-110720

Raine Sihvonen

引用次数: 0

Quality of reporting of harms in randomised controlled trials of pharmacological interventions for rheumatoid arthritis: a systematic review. 类风湿关节炎药物干预的随机对照试验中危害报告的质量:系统评价。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-09-02 DOI: 10.1136/ebmed-2017-110715

Muhammad Abdul Hadi, Gretl A McHugh, Philip G Conaghan

{"title":"Quality of reporting of harms in randomised controlled trials of pharmacological interventions for rheumatoid arthritis: a systematic review.","authors":"Muhammad Abdul Hadi, Gretl A McHugh, Philip G Conaghan","doi":"10.1136/ebmed-2017-110715","DOIUrl":"https://doi.org/10.1136/ebmed-2017-110715","url":null,"abstract":"Background: The quality of reporting of harms data in randomised controlled trials (RCTs) has been reported to be suboptimal. Rheumatoid arthritis (RA) has seen a massive growth in novel pharmacotherapies in the last decade.Objective: The aim of this study was to assess the quality of reporting of harms-related data in RCTs evaluating pharmacological interventions for RA according to the CONSORT (Consolidated Standards of Reporting Trials) statement on harms reporting extension.Study selection: RCTs published between January 2011 and August 2016 in the five highest impact factor journals in general medicine and two in rheumatology subject categories as per 2015 Journal Citation Reports were included. Reports of secondary, supplementary or exploratory analyses of RCTs and non-inferiority trials were excluded. Two reviewers independently extracted data using a structured, pilot-tested, 18-item questionnaire developed based on CONSORT harms extension recommendations.Findings: 68 RCTs were included in the review. Out of a maximum harms reporting score of 18, the mean (SD) score was 8.51 (3.5) (range=0-15). More than half (56.5%) of the RCTs reported ≤50% of items and only three (4.3%) RCTs reported more than 70% (score ≥14) of the items. Multilinear regression analyses found that region of trial origin (p=0.01), sample size (p=0.001) and whether the study was a long-term extension of a trial or not (p=0.04) were independent predictors associated with higher total harms reporting score.Conclusions: The adherence to CONSORT harms extension was poor in recently published RCTs of pharmacological interventions for RA. There is a need to improve quality of harms reporting in RCTs to allow transparent and balanced assessment of the benefit-risk ratio in clinical decision making.","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 5","pages":"170-177"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-110715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35468597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 15

In localised prostate cancer, radical prostatectomy was associated with more sexual dysfunction and urinary incontinence than radiation or active surveillance. 在局部前列腺癌中，根治性前列腺切除术比放疗或主动监测更容易出现性功能障碍和尿失禁。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-16 DOI: 10.1136/ebmed-2017-110772

Zachary L Smith, Scott E Eggener

引用次数: 1

Comparing levels of evidence between Choosing Wisely and Essential Evidence Plus. 比较明智选择和必要证据Plus之间的证据水平。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-17 DOI: 10.1136/ebmed-2017-110801

Joseph R Yancey, Kenneth W Lin

引用次数: 3

Caffeine does not increase the arrhythmic burden in patients with heart failure and left ventricular systolic dysfunction. 咖啡因不会增加心衰和左心室收缩功能不全患者的心律失常负担。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-17 DOI: 10.1136/ebmed-2017-110729

Daniel Caldeira

引用次数: 0

Parent-delivered CBT may reduce intervention cost, but questions arise about effectiveness. 父母提供的CBT可能会降低干预成本，但关于有效性的问题出现了。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-08-17 DOI: 10.1136/ebmed-2017-110792

Gabriela M Hungerford, Lauren C Santucci, John R Weisz

引用次数: 0

Longer screening intervals are recommended following a negative HPV test in primary cervical screening. 初次子宫颈筛检结果呈阴性后，建议延长筛检间隔。

Evidence-Based Medicine Pub Date : 2017-10-01 Epub Date: 2017-07-22 DOI: 10.1136/ebmed-2016-110625

Julian Peto, Clare Gilham

引用次数: 0

Evidence based medicine manifesto for better healthcare: A response to systematic bias, wastage, error and fraud in research underpinning patient care. 改善医疗保健的循证医学宣言:对支持患者护理的研究中的系统性偏见、浪费、错误和欺诈的回应。

Evidence-Based Medicine Pub Date : 2017-08-01 Epub Date: 2017-07-18 DOI: 10.1136/ebmed-2017-j2973rep

Carl Heneghan, Kamal R Mahtani, Ben Goldacre, Fiona Godlee, Helen Macdonald, Duncan Jarvies

{"title":"Evidence based medicine manifesto for better healthcare: A response to systematic bias, wastage, error and fraud in research underpinning patient care.","authors":"Carl Heneghan, Kamal R Mahtani, Ben Goldacre, Fiona Godlee, Helen Macdonald, Duncan Jarvies","doi":"10.1136/ebmed-2017-j2973rep","DOIUrl":"https://doi.org/10.1136/ebmed-2017-j2973rep","url":null,"abstract":"Informed decision-making requires clinicians and patients to identify and integrate relevant evidence. But with the questionable integrity of much of today's evidence, the lack of research answering questions that matter to patients and the lack of evidence to inform shared decision-making how are they expected to do this?\u0000\u0000Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal.1 As the volume of clinical research activity has grown,2 the quality of evidence has often worsened,3 which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.\u0000\u0000The BMJ and the University of Oxford's Centre for Evidence Based Medicine have collaborated on Evidence Live, a yearly conference designed to ‘develop, disseminate and implement better evidence for better healthcare’. Through this work and other projects, we know of substantial problems but also progress and solutions spanning the breadth of the evidence ecosystem, from basic research to implementation in clinical practice.\u0000\u0000The EBM manifesto offered here grew from that awareness. It is an open invitation for others to contribute to and join a movement towards better evidence by providing a roadmap for how to achieve the listed priorities and to share the lessons from achievements already made. Its aim is to complement and unite existing efforts as well as create new ones.\u0000\u0000Serious systematic bias, error and waste of medical …","PeriodicalId":12182,"journal":{"name":"Evidence-Based Medicine","volume":"22 4","pages":"120-122"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/ebmed-2017-j2973rep","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35179111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 24