Interpretation Of Clinical Evidence Research Articles

PCN287 THE ROLE OF EFFICACY AND EFFECTIVENESS ANALYSES IN HEALTH TECHNOLOGY ASSESSMENTS IN DETERMINING TENDERING RANKS FOR ONCOLOGY DRUGS IN DENMARK & NORWAY

The Danish Medicines Council and Norwegian Medicines Agency appraise pharmaceuticals on clinical and economic grounds. Following recommendations from these institutions, manufacturers enter tendering processes which result in rankings of drugs within an indication. The influence of clinical outcomes on these ranks in oncology in practice has not been assessed. This review aims to determine whether efficacy/effectiveness assessments from HTAs are a key driver of the rankings in Denmark and Norway. Tendering ranks for oncology indications in both countries as of May 2019 were extracted. Indications where at least two different drugs/regimens were ranked were included. HTA reports for the included regimens were identified from agency websites, and preference orders presented by the appraisers based on clinical outcomes and other reported decision criteria (e.g. cost-effectiveness) were extracted, if reported. Were these not available, overall survival and progression-free survival outcomes were extracted and rank orders generated using surface under the cumulative ranking (SUCRA) method in network meta-analyses. Rank orders based on clinical data and HTA reports were compared to tendering rank orders and reasons for differences explored. Across both countries, 26 multiple-regimen ranks were being used in oncology where at least one corresponding HTA had been conducted. In most cases, the most efficacious medicines were included in tendering ranks, but in 38% of indications, efficacy ranks were not aligned with tendering ranks. Possible justification for differences relates to added uncertainty in indirect comparisons and interpretation of clinical evidence. The HTA processes in Denmark and Norway allow market access for the most effective drugs, however it appears to have less of a role in treatment prioritisation in oncology. Tendering presents one method for cost containment for pharmaceuticals, but the impact this has on patient access to efficacious treatments in oncology and other indications needs to be evaluated further.

How good is "evidence" from clinical studies of drug effects and why might such evidence fail in the prediction of the clinical utility of drugs?

Promising evidence from clinical studies of drug effects does not always translate to improvements in patient outcomes. In this review, we discuss why early evidence is often ill suited to the task of predicting the clinical utility of drugs. The current gap between initially described drug effects and their subsequent clinical utility results from deficits in the design, conduct, analysis, reporting, and synthesis of clinical studies-often creating conditions that generate favorable, but ultimately incorrect, conclusions regarding drug effects. There are potential solutions that could improve the relevance of clinical evidence in predicting the real-world effectiveness of drugs. What is needed is a new emphasis on clinical utility, with nonconflicted entities playing a greater role in the generation, synthesis, and interpretation of clinical evidence. Clinical studies should adopt strong design features, reflect clinical practice, and evaluate outcomes and comparisons that are meaningful to patients. Transformative changes to the research agenda may generate more meaningful and accurate evidence on drug effects to guide clinical decision making.

Biases in the Evaluation of Psychiatric Clinical Evidence

The evolution of medical research has vaulted randomized clinical trials to the status of current gold standard of clinical evidence. In parallel, the evolution of the science of decision-making has revealed human beings' universal tendency to make biased judgments and systematic errors in their evaluation of information and choices. As a result of numerous psychological biases, randomized clinical trials are more prone to error, misinterpretation, and faulty judgment than is often acknowledged. Interdisciplinary fields of experimental psychology, economics, and social science are drawn upon to examine psychological biases in the interpretation of clinical evidence. A number of these are postulated to be important, both for the investigators generating clinical evidence and for the clinical observers interpreting clinical trials. This study focuses on the field of psychiatry and on the potentially significant implications of evidence biases for psychiatric practice and clinical understanding.

Differential Diagnosis: The Interpretation of Clinical Evidence

When I was a medical student more than half a century ago, I had the pleasant and exciting experience of hearing the late Richard Cabot each week presenting a Clinical-Pathological Conference. It was essentially an exercise in differential diagnosis in which he stopped at each symptom, sign, or laboratory finding and mentioned its possible importance and the common conditions in which it appears, eliminating one after another as he went along until he was left with what was generally the correct diagnosis, by exclusion. He then tried to fit the entire clinical picture into that diagnosis. This format, considerably modified, is the basis of the very popular Case Records of the Massachusetts General Hospital, which still appear each week in the New England Journal of Medicine . Most of my fellow students in those days generally referred to French's Index of Differential Diagnosis , which was a sort of dictionary-type alphabetic list

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence

A Method of Formal Assessment and Rational Interpretation of Clinical Evidence in the Diagnosis of Acute Abdominal Pain

A Method of Formal Assessment and Rational Interpretation of Clinical Evidence in the Diagnosis of Acute Abdominal Pain

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence.

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence.

Differential Diagnosis. The Interpretation of Clinical Evidence.

Differential Diagnosis. The Interpretation of Clinical Evidence.

Differential Diagnosis: The Interpretation of Clinical Evidence.

This is a very large book which tries to encompass a very large subject with moderate success. I am not sure what I expected to find when I read it, but I was left with an ill defined sense of disappointment. This text could be conveniently divided into three separate publications. The first would be a short paper introducing the work: a lucid exposition of the basic principles and elements of differential diagnosis. However, this information is available elsewhere in greater detail and in at least as good form. The second publication would be a textbook containing descriptions of disease entities. This has been done better, with more detail and better organization, in standard texts, although the large Tables of Differential Diagnosis are among the best I have seen anywhere. The third text would be a compilation of illustrative case records, most of them previously published, which demonstrate the thought

Differential Diagnosis: The Interpretation of Clinical Evidence

The interpretation of clinical evidence is what this book is all about. If you can do it well, you're a doctor. If you can't, you're not. How to learn the interpretation of clinical evidence? The learning has several facets. First in line is acquiring familiarity with the disorders we call disease, to become aware of the possibilities; to program our brains for certain types of input when we hear the story and see the picture presented by the patient. For this there are the traditional textbooks. Next is the elicitation of additional facts which point the way to a particular diagnosis. In our thinking, these facts are assigned various degrees of significance according to the frequency with which they are associated with disease, and according to the specificity with which they, either singly or in certain combinations, are associated with recognized nosologic entities. Added to this are other facts gathered

Differential Diagnosis: The Interpretation of Clinical Evidence.

Differential Diagnosis: The Interpretation of Clinical Evidence.

Differential Diagnosis: The Interpretation of Clinical Evidence

Medical Journal of AustraliaVolume 1, Issue 8 p. 250-250 Review Differential Diagnosis: The Interpretation of Clinical Evidence First published: 01 February 1958 https://doi.org/10.5694/j.1326-5377.1958.tb86235.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue8February 1958Pages 250-250 RelatedInformation

Differential Diagnosis. The Interpretation of Clinical Evidence

Differential Diagnosis. The Interpretation of Clinical Evidence

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence.

Book ReviewDifferential Diagnosis: The interpretation of clinical evidence.

Differential Diagnosis: The Interpretation of Clinical Evidence.

I am glad I read the text of this book before reading the introduction. I formed the opinion that the book reflected much more than just the contributions of Harvey and Bordley—thatthat it was, in fact, the embodiment of work done in the great clinical tradition of William Osler, handed down through Thayer, Barker, Hamman, and Longcope to the authors. The introduction demonstrates this as the purpose and the method. This book in a way develops the history of clinical medicine as it evolved at the Johns Hopkins Hospital and Medical School. But in a larger sense it exemplifies certain characteristically American features of clinical teaching, emphasizing the clinical pathological conference and teaching at the bedside. This book plays on varying themes—— the clinical history, clinical examination, laboratory examinations, the narrative of the course of a disease, and the final exposition by the pathologist of the findings at autopsy. The

Differential Diagnosis—The Interpretation of Clinical Evidence

Differential Diagnosis—The Interpretation of Clinical Evidence

Book Review: Differential Diagnosis: The Interpretation of Clinical Evidence

Book Review: Differential Diagnosis: The Interpretation of Clinical Evidence