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Journal of Evaluation in Clinical Practice

Mathew Mercuri, Amiram Gafni
RATIONALE, AIMS, AND OBJECTIVES: The GRADE framework has been widely adopted as the preferred method for developing clinical practice recommendations. In the first article of our three part series examining the evolution of GRADE, we showed an absence (in the first two versions of GRADE) of a theoretical basis and/or empirical data to support why the presented criteria for determining the quality of evidence regarding the effect estimate and the components under consideration for determining the strength of the recommendation were included and other criteria/components excluded...
July 17, 2018: Journal of Evaluation in Clinical Practice
Elena Rocca
In "The evidence that evidence-based medicine omits", Brendan Clarke and colleagues argue that when establishing causal facts in medicine, evidence of mechanisms ought to be included alongside evidence of correlations. One of the reasons they provide is that correlations can be spurious and generated by unknown confounding variables. A causal mechanism can provide a plausible explanation for the correlation, and the absence of such an explanation is an indication that the correlation is not causal...
July 17, 2018: Journal of Evaluation in Clinical Practice
Mathew Mercuri, Amiram Gafni
RATIONALE, AIMS, AND OBJECTIVES: The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework has been presented as the best method available for developing clinical recommendations. GRADE has undergone a series of modifications. Here, we present the first part of a three article series examining the evolution of GRADE. Our purpose is to explore if (and if so, how) GRADE provides: (1) a justification (ie, theoretical and/or empirical) for why the criteria/components under consideration in the system are included (and other factors excluded), as well as why some criteria/components where added/modified in the evolution process, (2) clear and functional (ie, how to operationalize them) definitions of the included criteria/components, and (3) instruction and justification for how all the criteria/components are to be integrated when determining a recommendation...
July 16, 2018: Journal of Evaluation in Clinical Practice
Mathew Mercuri, Brian S Baigrie
RATIONALE, AIMS, AND OBJECTIVES: Confidence (or belief) that a therapy is effective is essential to practicing clinical medicine. GRADE, a popular framework for developing clinical recommendations, provides a means for assigning how much confidence one should have in a therapy's effect estimate. One's level of confidence (or "degree of belief") can also be modelled using Bayes theorem. In this paper, we look through both a GRADE and Bayesian lens to examine how one determines confidence in the effect estimate...
July 13, 2018: Journal of Evaluation in Clinical Practice
Ariel Linden
RATIONALE, AIMS, AND OBJECTIVES: Interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single treatment unit's outcome is studied over time and the intervention is expected to "interrupt" the level and/or trend of the outcome, subsequent to its introduction. The internal validity of this analysis is strengthened considerably if the treated unit is contrasted with a comparable control group. However, multiple-group ITSA typically has small sample sizes, and parametric methods for multiple-group ITSA require strong assumptions that are unlikely to be met, possibly resulting in misleading P values...
July 12, 2018: Journal of Evaluation in Clinical Practice
Karin Mohn Engebretsen
The search for causal explanations in medically unexplained syndromes such as burnout has not been resolved by evidence-based medicine. A biomedical model encourages a reductionist diagnostic practice and a dualist split between physical and psychological symptoms. Therefore, diagnosing and treating these syndromes remains a challenge. Depression is a common aspect in burnout and, as a result, clinicians often diagnose burnout patients as depressed. The Norwegian government expects medical efficiency to reduce sick leaves...
July 12, 2018: Journal of Evaluation in Clinical Practice
Scott Eustace
Designing trials and studies to minimize confounding and bias is central to evidence-based medicine (EBM). The widespread use of recent technologies such as machine learning, smartphones, and the World Wide Web to collect, analyse, and disseminate information can improve the efficiency, reliability, and availability of medical research. However, it also has the potential to introduce new sources of significant, technology-induced evidential bias. This paper assesses the extent of the impact by reviewing some of the methods by and principles according to which evidence is collected, analysed, and disseminated in EBM, supported by specific examples...
July 11, 2018: Journal of Evaluation in Clinical Practice
Huw Llewelyn
In order that evidence-based medicine can prevent "too much medicine", it has to provide evidence in support of "gold standard" findings for use as diagnostic criteria, on which the assessment of other diagnostic tests and the outcomes of randomized controlled trials depend. When the results of such gold standard tests are numerical, cut-off points have to be positioned, also based on evidence, to identify those in whom offering a treatment can be justified. Such a diagnosis depends on eliminating conditions that mimic the one to be treated...
July 11, 2018: Journal of Evaluation in Clinical Practice
Patricia García, José Sanchez, Juan Mora, Elena Ronda
RATIONALE, AIMS, AND OBJECTIVE: Contact tracing and screening is an essential strategy in tuberculosis (TB) control. Our aim is to assess factors associated with the degree of compliance with the main recommendations made to contacts of TB cases as part of the contact tracing programme, and to identify factors associated with non-compliance. METHODS: We conducted a retrospective cohort study to assess the TB contact tracing programme at a Spanish hospital over the period 1998-2013...
July 10, 2018: Journal of Evaluation in Clinical Practice
Morgan Recher, Caroline Bertrac, Camille Guillot, Jean Benoit Baudelet, Yasemin Karaca-Altintas, Hervé Hubert, Francis Leclerc, Stéphane Leteurtre
Selected variables for the French Paediatric Intensive Care registry. RATIONALE, AIMS, AND OBJECTIVES: Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA)...
July 10, 2018: Journal of Evaluation in Clinical Practice
Borja García-Lorenzo, Amado Rivero-Santana, Laura Vallejo-Torres, Iván Castilla-Rodríguez, Sonia García-Pérez, Lidia García-Pérez, Lilisbeth Perestelo-Pérez
RATIONALE, AIMS AND OBJECTIVES: Self-monitoring of blood glucose (SMBG) is recommended to monitor glycaemic levels. The recent development of real-time continuous glucose monitoring (RT-CGM) enables continuous display of glucose concentration alerting patients in the event of relevant glucose fluctuations, potentially avoiding hypoglycaemic events and reducing long-term complications related to glycosylated haemoglobin (HbA1c) levels. This paper aims to evaluate the cost-effectiveness of RT-CGM compared to SMBG in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) which should support decision-making on public funding of RT-CGM in Spain...
July 3, 2018: Journal of Evaluation in Clinical Practice
Petra Mäkelä
Older people who live with a combination of conditions experience fluctuations over time, which others may interpret as a need for medical attention. For some nursing home residents, this results in transitions in and out of hospital. Such transfers may be arranged without expectation of improved quality of life, can be associated with significant morbidity and mortality, and may preclude end-of-life preferences. Factors affecting avoidable hospitalization for nursing home residents are not well understood...
July 3, 2018: Journal of Evaluation in Clinical Practice
Lynette Reid
Assumptions about the epistemic ideal of objectivity, closely related to ontological assumptions about the nature of disease as pathophysiological abnormality, lead us into oversimplified ways of thinking about medical imaging. This is illustrated by current controversies in the early detection of cancer. Improvements in the technical quality of imaging failed to address the problem of overdiagnosis in breast cancer screening and exacerbate the problem in thyroid cancer diagnosis. Drawing on Douglas and on Daston and Galison, I distinguish 3 dimensions of objectivity (accuracy, reliability, and precision) and demonstrate ways they may be at odds, as illustrated in the early detection of cancer...
July 2, 2018: Journal of Evaluation in Clinical Practice
Andrew Jones, Daniel Steel
How should the quality of medical evidence be evaluated? Proponents of evidence-based medicine advocate the use evidence hierarchies to rank the quality of evidence on the basis that certain methods produce more reliable evidence. Some criticisms of this approach focus on whether certain methods deserve their place in the hierarchy, while others claim that evidence hierarchies should be abandoned in favour of other evidence assessment techniques. We claim that this debate pays insufficient attention to the real-world contexts in which medical decisions are made...
June 28, 2018: Journal of Evaluation in Clinical Practice
Michael P Kelly
When evidence-based medicine (EBM) became established, its dominant rhetoric was empiricist, in spite of rationalist elements in its practice. Exploring some of the key statements about EBM down the years, the paper examines the tensions between empiricism and rationalism and argues for a rationalist turn in EBM to help to develop the next generation of scholarship in the field.
June 28, 2018: Journal of Evaluation in Clinical Practice
Pengli Jia, Pujing Zhao, Jingjing Chen, Mingming Zhang
BACKGROUND: Systematic reviews (SRs) have shown that clinical decision support systems (CDSSs) have the potential to improve diabetes care. However, methods of measuring and presenting outcomes are varied, and conclusions have been inconsistent. In addition, the reporting and methodological quality in this field is unknown, which could affect the integrity and accuracy of research. Therefore, it is difficult to confirm whether CDSSs are effective in improving diabetes care. OBJECTIVE: To comprehensively evaluate the effects of CDSS on diabetes care and to examine the methodological and reporting qualities...
June 26, 2018: Journal of Evaluation in Clinical Practice
Rositsa Dimova, Rumyana Stoyanova, Ilian Doykov
RATIONALE, AIMS, AND OBJECTIVES: Patient safety is recognized as a key indicator of quality of medical care. International experience has shown that all efforts should focus on the delivery of a safer work environment and health care system as a whole in order to reduce or mitigate medical errors and their impact on society. The aim of this study is to investigate and classify the most common incidents regarding patient safety as well as their contributory factors, based on personal real-life experiences and situations in medical care reported by health care professionals...
June 26, 2018: Journal of Evaluation in Clinical Practice
Ross E G Upshur
No abstract text is available yet for this article.
June 21, 2018: Journal of Evaluation in Clinical Practice
Alexandra Pârvan
The paper proposes that frameworks typical to metaphysics and art could be used in clinical treatment in somatic and psychiatric contexts to ensure improved care. The concept of the "body electric" of somatic patients which I introduced in previous work is developed further and paired with the "mind electric" of psychiatric patients. Both are defined as a patient's personally generated metaphysical possibility of being healthy-within-illness which is experientially actualized. Both concepts are used here to explore the alternative and the serious challenges to treatment approaches focused on clinical categories, disease, provision, and promotion of standardized or "black-box" therapies...
June 21, 2018: Journal of Evaluation in Clinical Practice
Stavros Ioannidis, Stathis Psillos
In this paper, we offer a minimal characterization of the concept of mechanism in biomedicine, according to which a mechanism is a theoretically described causal pathway. We argue that this conception can be drawn from scientific practice, as illustrated by how a central biological and biomedical mechanism, the mechanism of apoptosis, was first identified and characterized. We will use the example of cytological and biochemical theoretical descriptions of the mechanism of apoptosis to draw lessons about the meaning of the concept of mechanism in biomedical contexts and to contrast our preferred account of mechanism with some prominent accounts within the philosophical literature...
June 21, 2018: Journal of Evaluation in Clinical Practice
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