Evidence-based Medicine Tools Research Articles

The effectiveness and feasibility of TREAT (Tailoring Research Evidence and Theory) journal clubs in allied health: a randomised controlled trial

BackgroundJournal clubs (JC) may increase clinicians’ evidence-based practice (EBP) skills and facilitate evidence uptake in clinical practice, however there is a lack of research into their effectiveness in allied health. We investigated the effectiveness of a structured JC that is Tailored According to Research Evidence And Theory (TREAT) in improving EBP skills and practice compared to a standard JC format for allied health professionals. Concurrently, we explored the feasibility of implementing TREAT JCs in a healthcare setting, by evaluating participating clinicians’ perceptions and satisfaction.MethodsWe conducted an explanatory mixed methods study involving a cluster randomised controlled trial with a nested focus group for the intervention participants. Nine JCs with 126 allied health participants were randomly allocated to receive either the TREAT or standard JC format for 1 h/month for 6 months. We conducted pre-post measures of EBP skills and attitudes using the EBP questionnaire and Assessing Competence in Evidence-Based Medicine tool and a tailored satisfaction and practice change questionnaire. Post-intervention, we also conducted a focus group with TREAT participants to explore their perceptions of the format.ResultsThere were no significant differences between JC formats in EBP skills, knowledge or attitudes or influence on clinical practice, with participants maintaining intermediate level skills across time points. Participants reported significantly greater satisfaction with the organisation of the TREAT format. Participants in both groups reported positive changes to clinical practice. Perceived outcomes to the TREAT format and facilitating mechanisms were identified including the use of an academic facilitator, group appraisal approach and consistent appraisal tools which assisted skill development and engagement.ConclusionsIt is feasible to implement an evidence-based JC for allied health clinicians. While clinicians were more satisfied with the TREAT format, it did not significantly improve their EBP skills, attitudes, knowledge and/or practice, when compared to the standard format. The use of an academic facilitator, group based critical appraisal, and the consistent use of appraisal tools were perceived as useful components of the JC format. A structured JC may maintain EBP skills in allied health clinicians and facilitate engagement, however additional training may be required to further enhance EBP skills.Trial registrationACTRN12616000811404 Retrospectively registered 21 June 2016.

Complexity of Delivering Precision Medicine: Opportunities and Challenges

Precision medicine has emerged as a tool to match patients with the appropriate treatment based on the precise molecular features of an individual patient's tumor. Although examples of targeted therapies exist resulting in dramatic improvements in patient outcomes, comprehensive genomic profiling of tumors has also demonstrated the incredible complexity of molecular alterations in tissue and blood. These sequencing methods provide opportunities to study the landscape of tumors at baseline and serially in response to treatment. These tools also serve as important biomarkers to detect resistance to treatment and determine higher likelihood of responding to particular treatments, such as immune checkpoint blockade. Federally funded and publicly available data repositories have emerged as mechanisms for data sharing. In addition, novel clinical trials are emerging to develop new ways of incorporating molecular matched therapy into clinical trials. Various challenges to delivery of precision oncology include understanding the complexity of advanced tumors based on evolving "omics" and treatment resistance. For physicians, determining when and how to incorporate genetic and molecular tools into clinic in a cost-effective manner is critical. Finally, we discuss the importance of well-designed prospective clinical trials, biomarkers such as liquid biopsies, the use of multidisciplinary tumor boards, and data sharing as evidence-based medicine tools to optimally study and deliver precision oncology to our patients.

Agreement between the results of meta-analyses from case reports and from clinical studies regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I who initiated enzyme replacement therapy in adult age: An example of case reports meta-analyses as an useful tool for evidence-based medicine in rare diseases.

Case reports might have a prominent role in the rare diseases field, due to the small number of patients affected by one such disease. A previous systematic review regarding the efficacy of laronidase therapy in patients with mucopolysaccharidosis type I (MPS-I) who initiated enzyme replacement therapy (ERT) in adult age has been published. The review included a meta-analysis of 19 clinical studies and the description of eleven case reports. It was of interest to perform a meta-analysis of those case reports to explore the role of such meta-analyses as a tool for evidence-based medicine in rare diseases. The study included all case reports with standard treatment regimen. Primary analysis was the percentage of case reports showing an improvement in a specific outcome. Only when that percentage was statistically higher than 5%, the improvement was confirmed as such. The outcomes that accomplished this criterion were ranked and compared to the GRADE criteria obtained by those same outcomes in the previous meta-analysis of clinical studies. There were three outcomes that had a significant improvement: Urine glycosaminoglycans, liver volume and 6-minute walking test. Positive and negative predictive values, sensitivity and specificity for the results of the meta-analysis of case reports as compared to that of clinical studies were 100%, 88.9%, 75% and 100%, respectively. Accordingly, absolute (Rho=0.82, 95%CI: 0.47 to 0.95) and relative agreement (Kappa=0.79, 95%CI: 0.593 to 0.99) between the number of case reports with improvement in a specific outcome and the GRADE evidence score for that outcome were good. Sensitivity analysis showed that agreement between the meta-analysis of case reports and that of the clinical studies were good only when using a strong confirmatory strategy for outcome improvement in case reports. We found an agreement between the results of meta-analyses from case reports and from clinical studies in the efficacy of laronidase therapy in patients with MPS-I who initiated ERT in adult age. This agreement suggests that combining case reports quantitatively, rather than analyzing them separately or qualitatively, may improve conclusions in the field of rare diseases.

The 10-D assessment and evidence-based medicine tool for authors and peer reviewers in clinical pharmacology .

Background: Peer reviewers and authors of clinical pharmacology manuscripts need to meet the standards for Evidence-Based Medicine (EBM) and Good Publication Practices (GPP), and editors of clinical pharmacology journals have to maintain an overview of the peer review process. Methods and results: The peer review process can be monitored and facilitated using the 10-D assessment, which comprises peer review criteria to determine if: 1. design of the study, 2. diagnoses employed, 3. drug molecules involved, 4. dosages applied, 5. data collected, 6. discussion of the findings, 7. deductions made, 8. documentation, 9. declarations, and 10. dHS (drug hypersensitivity syndrome) risk assessment is in accord with the objectives of the study and meet the requirements of EBM and GPP. Conclusions: The 10-D assessment tool, although easy to apply, requires a high level of clinical pharmacology expertise, especially in the fields of drug disposition, pharmacokinetics, and drug action. Its application will facilitate the peer review of clinical research and clinical trial reports and thus promote safety in drug development and pharmacotherapy and meet the needs of Good Publication Practices.

Endoscopic Laser-Based 3D Imaging for Functional Voice Diagnostics

Recently, we reported on the in vivo application of a miniaturized measuring device for 3D visualization of the superior vocal fold vibrations from high-speed recordings in combination with a laser projection unit (LPU). As a long-term vision for this proof of principle, we strive to integrate the further developed laserendoscopy as a diagnostic method in daily clinical routine. The new LPU mainly comprises a Nd:YAG laser source (532 nm/CW/2 ω ) and a diffractive optical element (DOE) generating a regular laser grid (31 × 31 laser points) that is projected on the vocal folds. By means of stereo triangulation, the 3D coordinates of the laser points are reconstructed from the endoscopic high-speed footage. The new design of the laserendoscope constitutes a compromise between robust image processing and laser safety regulations. The algorithms for calibration and analysis are now optimized with respect to their overall duration and the number of required interactions, which is objectively assessed using binary classifiers. The sensitivity and specificity of the calibration procedure are increased by 40.1% and 22.3%, which is statistically significant. The overall duration for the laser point detection is reduced by 41.9%. The suggested semi-automatic reconstruction software represents an important stepping-stone towards potential real time processing and a comprehensive, objective diagnostic tool of evidence-based medicine.

Health care professionals\u2019 attitudes towards evidence-based medicine in the workers\u2019 compensation setting: a cohort study

BackgroundProblems may arise during the approval process of treatment after a compensable work injury, which include excess paperwork, delays in approving services, disputes, and allegations of over-servicing. This is perceived as undesirable for injured people, health care professionals and claims managers, and costly to the health care system, compensation system, workplaces and society. Introducing an Evidence Based Medicine (EBM) decision tool in the workers’ compensation system could provide a partial solution, by reducing uncertainty about effective treatment. The aim of this study was to investigate attitudes of health care professionals (HCP) to the potential implementation of an EBM tool in the workers’ compensation setting.MethodsThe study has a mixed methods design. The quantitative study consisted of an online questionnaire asking about self-reported knowledge, attitudes and behaviour to EBM in general. The qualitative study consisted of interviews about an EBM tool being applied in the workers’ compensation process. Participants were health care practitioners from different clinical specialties. They were recruited through the investigators’ clinical networks and the workers’ compensation government regulator’s website.ResultsParticipants completing the questionnaire (n = 231) indicated they were knowledgeable about the evidence-base in their field, but perceived some difficulties when applying EBM. General practitioners reported having the greatest obstacles to applying EBM. Participants who were interviewed (n = 15) perceived that an EBM tool in the workers’ compensation setting could potentially have some advantages, such as reducing inappropriate treatment, or over-servicing, and providing guidance for clinicians. However, participants expressed substantial concerns that the EBM tool would not adequately reflect the impact of psychosocial factors on recovery. They also highlighted a lack of timeliness in decision making and proper assessment, particularly in pain management.ConclusionsOverall, HCP are supportive of EBM, but have strong concerns about implementation of EBM based decision making in the workers’ compensation setting. The participants felt that an EBM tool should not be applied rigidly and should take into account clinical judgement and patient variability and preferences. In general, the treatment approval process in the workers’ compensation insurance system is a sensitive area, in which the interaction between HCP and claims managers can be improved.

Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine

Guidelines for conduct of journal club for postgraduates: A tool for evidence-based medicine

Intelligent system for diabetes prediction in patients with chronic pancreatitis

This paper presents the results of the JSM-method for automated support of scientific research (ASSR JSM-method) implemented in a computer intelligent system (IS-JSM), which predicts the development of diabetes in patients with chronic pancreatitis. For the first time the ASSR JSM-method is applied to a sequence of expanding databases of facts, which was used for the detection of empirical regularities (ERs), viz., preserved causes of the studied effect (development of diabetes in patients with chronic pancreatitis). To recognize ERs in the IS-JSM, we used an algebraic lattice of JSM-reasoning strategies (inductive inference rules). These results have an informative clinical interpretation and prove the usefulness of data mining using the IS-JSM, which can be used as a tool for evidence-based medicine.

Rehabilitation interventions in children and adults with infectious encephalitis: a systematic review protocol

IntroductionMany encephalitis survivors can benefit from rehabilitation. However, there is currently no comprehensive review describing rehabilitation intervention outcomes among children and adults with infectious encephalitis. This is a protocol for...

Role of Librarians in Developing Evidence-Based Practice in PGIMER, Chandigarh (India)

Evidence-based medicine (EBM) practice has emerged as clinical decision-making tool for better patient care. Health science librarians play a vital role in supporting EBM through searching, organising, evaluating, reviewing and offering evidence to the doctors at the time of patient care. But health science librarian are not fully trained to search, evaluate, review and critically appraise the research papers, so formal training is required to undertake literature searches, critically analysing and conducting systematic reviews. This study is carried out in PGIMER library to sought out whether and how health science librarian's roles have been changing to support EBM and what obstacles are coming on their way to provide the service. As EBM is new concept in Indian medical libraries, all PGIMER library professionals are fully enthusiast to take up this responsibility. They all feel the need of cultivating new skills and knowledge to use tools for this practice. Majority of participants even did not know to use basic searching tools. Proper training focused on EBM tools, skills, medical terminology, biostatistics, research methodology, and review of literature needs to be provided to the health science librarians so that they can accept EBM services with full fervour and zeal. This will further establish their profile at par with other professionals.

A corpus for research in text processing for evidence based medicine

Evidence based medicine (EBM) urges the medical doctor to incorporate the latest available clinical evidence at point of care. A major stumbling block in the practice of EBM is the difficulty to keep up to date with the clinical advances. In this paper we describe a corpus designed for the development and testing of text processing tools for EBM, in particular for tasks related to the extraction and summarisation of answers and corresponding evidence related to a clinical query. The corpus is based on material from the Clinical Inquiries section of The Journal of Family Practice. It was gathered and annotated by a combination of automated information extraction, crowdsourcing tasks, and manual annotation. It has been used for the original summarisation task for which it was designed, as well as for other related tasks such as the appraisal of clinical evidence and the clustering of the results. The corpus is available at SourceForge ( http://sourceforge.net/projects/ebmsumcorpus/ ).

The dilemma of heterogeneity tests in meta-analysis: a challenge from a simulation study.

IntroductionAfter several decades’ development, meta-analysis has become the pillar of evidence-based medicine. However, heterogeneity is still the threat to the validity and quality of such studies. Currently, Q and its descendant I2 (I square) tests are widely used as the tools for heterogeneity evaluation. The core mission of this kind of test is to identify data sets from similar populations and exclude those are from different populations. Although Q and I2 are used as the default tool for heterogeneity testing, the work we present here demonstrates that the robustness of these two tools is questionable.Methods and FindingsWe simulated a strictly normalized population S. The simulation successfully represents randomized control trial data sets, which fits perfectly with the theoretical distribution (experimental group: p = 0.37, control group: p = 0.88). And we randomly generate research samples Si that fits the population with tiny distributions. In short, these data sets are perfect and can be seen as completely homogeneous data from the exactly same population. If Q and I2 are truly robust tools, the Q and I2 testing results on our simulated data sets should not be positive. We then synthesized these trials by using fixed model. Pooled results indicated that the mean difference (MD) corresponds highly with the true values, and the 95% confidence interval (CI) is narrow. But, when the number of trials and sample size of trials enrolled in the meta-analysis are substantially increased; the Q and I2 values also increase steadily. This result indicates that I2 and Q are only suitable for testing heterogeneity amongst small sample size trials, and are not adoptable when the sample sizes and the number of trials increase substantially.ConclusionsEvery day, meta-analysis studies which contain flawed data analysis are emerging and passed on to clinical practitioners as “updated evidence”. Using this kind of evidence that contain heterogeneous data sets leads to wrong conclusion, makes chaos in clinical practice and weakens the foundation of evidence-based medicine. We suggest more strict applications of meta-analysis: it should only be applied to those synthesized trials with small sample sizes. We call upon that the tools of evidence-based medicine should keep up-to-dated with the cutting-edge technologies in data science. Clinical research data should be made available publicly when there is any relevant article published so the research community could conduct in-depth data mining, which is a better alternative for meta-analysis in many instances.

A survey study of evidence-based medicine training in US and Canadian medical schools.

The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Findings can provide a starting point for discussion to develop a standardized competency framework.

The tools of evidence-based medicine

Evidence-based Pharmacy was first published as a textbook by Phil Wiffen in 2001. The first chapter was published in Eur J Hosp Pharm 2013;20:308–12. One of the exciting developments in...

Evidence-Based Medicine and the Hard Problem of Multimorbidity

Evidence-based medicine (EBM) rests on the proposition that questions in clinical medicine can be formalized, or reduced, into statistical questions. In the reductionist tradition, these statistical questions can then be addressed by studies designed to isolate the effect of a single exposure (typically an intervention) on a single disease outcome. While the results directly address the statistical question, inferences derived from the results are applied back to the complex clinical realm—where generalists live.

Clinical Decision Support: Strategies for Success

Clinical Decision Support Systems (CDSS) are considered essential tools of evidence-based medicine. These systems provide physicians, caregivers and also patients with clinical knowledge needed and patient or disease specific information to help them make effective decisions that would enhance patient care and improve clinical outcomes. The lack of well-described success factors is the main challenge facing design, development and implementation of CDSS. We need to learn more about the factors that can help in increasing usability and acceptance. The medical informatics department at King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia worked on identifying and describing best strategies and requirements for success of CDSS building a detailed plan for development and implementation. The explored recommendations were categorized into ten main topics that should be addressed. These include the right content of CDSS, delivering valid and reliable information, delivering simple messages, providing users with references, saving users’ time, integrating with clinical workflow, improving system response and speed, adopting active and passive alert mechanisms, integrating with other hospital information systems (HIS) and proper management of CDSS knowledge.

Multiple treatment and indirect treatment comparisons: An overview of network meta-analysis.

Randomized control trials and its meta-analysis has occupied the pinnacle in levels of evidence available for research. However, there were several limitations of these trials. Network meta-analysis (NMA) is a recent tool for evidence-based medicine that draws strength from direct and indirect evidence generated from randomized control trials. It facilitates comparisons across multiple treatment options, direct comparisons of which have not been attempted till date due to multitude of reasons. These indirect treatment comparisons of randomized controlled trials are based on similarity and consistency assumptions that follow Bayesian or frequentist statistics. Most NMAuntil date use Microsoft Windows WinBUGs Software for analysis which relies on Bayesian statistics. Methodology of NMA is expected to undergo further refinements and become robust with usage. Power and precision of indirect comparisons in NMA is a concern as it is dependent on effective number of trials, sample size and complete statistical information. However, NMA can synthesize results of considerable relevance to experts and policy makers.

Database Review: ACP Smart Medicine

ACP Smart Medicine is a point-of-care product provided to American College of Physicians members as well as to individual subscribers. It is also available via STAT!Ref and Ovid. Areas of content are reviewed for this evidence-based medicine tool.

Patients with hemodynamic unstable pelvic fractures in extremis: Pelvic packing or angiography?

The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing.We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis?From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.

Pacientes con fractura de pelvis inestables hemodinámicamente in extremis ¿packing pélvico o arteriografía?

The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing.We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis?From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.