-
Mashup Score: 27Developing guideline recommendations about tests: educational examples of test-management pathways - 12 day(s) ago
Recommendations about healthcare related testing in guidelines are common. Tests can be used for several purposes: screening, surveillance, risk classification, diagnosis, staging, treatment triage, determination of prognosis and monitoring/follow-up.1 The development of testing recommendations in guidelines is challenging, especially because the benefit of a test not only depends on test characteristics, such as sensitivity and specificity, but also on population characteristics and test consequences, such as management.2–4 Furthermore, the role of a new test in comparison to the existing testing scenario should be defined, since this influences the interpretation of the new test’s value. The following roles of new tests have been identified in the literature: triage, replacement, add-on, and parallel/combined.5 As with treatment, testing can have negative consequences, including physical impairment, psychological distress, disease labelling, and costs.6 There is limited evidence on h
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet
-
Mashup Score: 2Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis - 13 day(s) ago
Objectives To assess the efficacy and safety of pharmacological interventions for preventing upper gastrointestinal (GI) bleeding in people admitted to intensive care units (ICUs). Design and setting Systematic review and frequentist network meta-analysis using standard methodological procedures as recommended by Cochrane for screening of records, data extraction and analysis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. Participants Randomised controlled trials involving patients admitted to ICUs for longer than 24 hours were included. Search methods The Cochrane Gut Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Latin American and Caribbean Health Science Information database (LILACS) databases were searched from August 2017 to March 2022. The search in MEDLINE was updated in April 2023. We also searched ClinicalTrials.gov and the World Health O
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis #OriginalResearch by Toews et al. #OpenAccess Link: https://t.co/nl016iKRB2 https://t.co/I8RHQuYi5r
-
-
Mashup Score: 16Meta-analysis of continuous outcomes: a user’s guide for analysis and interpretation - 14 day(s) ago
Binary outcomes, such as mortality and myocardial infarction, are often viewed as most important to patients. However, outcomes that are expressed on a non-dichotomous scale such as quality of life, severity of depression or length of hospitalization, can also be critical to patients. For the purposes of this paper, all of the above examples will be referred to as continuous outcomes. While many binary outcomes are dichotomised from a continuous scale and in some cases can accommodate non-linear associations, such dichotomisation can also lead to loss of information.1 Measures of dispersion (eg, SD or SE) required for conducting a meta-analysis of continuous outcomes are often unavailable in published manuscripts and continuous outcomes are frequently under-reported in published randomised controlled trials, presented with limited details and are at higher likelihood of selective reporting bias.2 Because of these challenges and the unique characteristics of continuous outcomes, we pres
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Meta-analysis of continuous outcomes: a user’s guide for analysis and interpretation #Education by Siedler @EBMUrology et al. @evidencefound @USGRADEnet Link: https://t.co/zsDRlvDx2f https://t.co/9YNA7kLvFM
-
-
Mashup Score: 53Stop searching and you will find it: Search-Resistant Concepts in systematic review searches - 15 day(s) ago
#### WHAT IS ALREADY KNOWN ON THIS TOPIC #### WHAT THIS STUDY ADDS #### HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY Most evidence synthesis projects involving systematic reviewing need a written protocol containing a detailed or brief description of the main review question and its concepts.1 To formulate an answerable question, it is recommended that reviewers follow one of the established frameworks2 that guides them through a better definition and understanding of the review question. The most used framework is known as the PICOS acronym, which stands for its components or concepts: patient, problem or population (P), intervention or index test (I), control or comparison (C), outcome (O) and study design (S). This framework has some limitations,3 and since one size does not fit all and depends on the type of review, study designs and specific needs, many other frameworks and their acronyms have been developed.2 4 While such frameworks help structure the review question,
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Stop searching and you will find it: Search-Resistant Concepts in systematic review searches Education by @FarhadShokrane @EvidenceReviews Link: https://t.co/PAsW4sLzQW https://t.co/dHiMwD7ADt
-
-
Mashup Score: 1539Risk ratios, odds ratios and the risk difference - 15 day(s) ago
### Scenario As a heart surgeon, you regularly perform aortic valve replacement, using a median sternotomy technique. However, you are aware that less-invasive options are available, and you wonder whether these may be as effective and safe as your current practice. After searching the Cochrane Library, you find a systematic review, ‘Limited versus full sternotomy for aortic valve replacement1’. The authors of the review conclude that ‘upper hemi‐sternotomy may have little to no effect on mortality versus full median sternotomy (risk ratio (RR) 0.93, 95% CI 0.45 to 1.94)’. What does this statistic mean in practice? The risk ratio (also known as RR) illustrates the risk of an event occurring in the intervention group compared with the risk of the same event occurring in the control group. For example, in a hypothetical randomised controlled trial (RCT), 50 out of 100 people who received the experimental drug experienced at least one side effect: the risk (or probability) of the event wa
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Risk ratios, odds ratios and the risk difference #Education by @racherichardson @dwan_kerry @afkanellopoulou @cochranecollab @cochranemthds Link: https://t.co/k7P0aTW1kQ https://t.co/iCUtG2wSMz
-
-
Mashup Score: 1540Risk ratios, odds ratios and the risk difference - 16 day(s) ago
### Scenario As a heart surgeon, you regularly perform aortic valve replacement, using a median sternotomy technique. However, you are aware that less-invasive options are available, and you wonder whether these may be as effective and safe as your current practice. After searching the Cochrane Library, you find a systematic review, ‘Limited versus full sternotomy for aortic valve replacement1’. The authors of the review conclude that ‘upper hemi‐sternotomy may have little to no effect on mortality versus full median sternotomy (risk ratio (RR) 0.93, 95% CI 0.45 to 1.94)’. What does this statistic mean in practice? The risk ratio (also known as RR) illustrates the risk of an event occurring in the intervention group compared with the risk of the same event occurring in the control group. For example, in a hypothetical randomised controlled trial (RCT), 50 out of 100 people who received the experimental drug experienced at least one side effect: the risk (or probability) of the event wa
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Risk ratios, odds ratios and the risk difference #Education by @racherichardson @dwan_kerry @afkanellopoulou @cochranecollab @cochranemthds Link: https://t.co/k7P0aTW1kQ https://t.co/iCUtG2wSMz
-
-
Mashup Score: 20Simple tool implementing Bucher’s method for indirect treatment comparisons in meta-analyses - 17 day(s) ago
Healthcare practitioners and patients are often required to make choices between two treatment options which may have never been compared directly. When performing standard ‘pairwise’ meta-analysis, it is common to find trials comparing one of two experimental treatments against a common control (standard of care or placebo) but no head-to-head trials. Statistical methods are available to perform indirect comparisons between two treatments when direct evidence is lacking. Here, we provide a simple, easy-to-use, Excel spreadsheet capable of performing these calculations. The statistical foundation for indirect comparisons in the setting of meta-analysis was first described by Bucher et al .1 They discussed the common situation where two treatments have been compared with the same control treatment but have not been compared directly to each other. Figure 1 displays this simple type of ‘network’ where a common control (treatment A) is compared with treatments B and C. The key to Bucher’s
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Simple tool implementing Bucher’s method for indirect treatment comparisons in meta-analyses #Education #OpenAccess by @SamJTingle et al. Link: https://t.co/zulX04l8HW https://t.co/5KSk4WysSQ
-
-
Mashup Score: 24
Rapid reviews (RRs) are produced using abbreviated methods compared with standard systematic reviews (SR) to expedite the process for decision-making. This paper provides interim guidance to support the complete reporting of RRs. Recommendations emerged from a survey informed by empirical studies of RR reporting, in addition to collective experience. RR producers should use existing, robustly developed reporting guidelines as the foundation for writing RRs: notably Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020; reporting for SRs), but also preferred reporting items for overviews of reviews (PRIOR) items (reporting for overviews of SRs) where SRs are included in the RR. In addition, a minimum set of six items were identified for RRs: three items pertaining to methods and three addressing publication ethics. Authors should be reporting what a priori-defined iterative methods were used during conduct, what distinguishes their RR from an SR, and knowl
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Rapid review method series: interim guidance for the reporting of rapid reviews #RMR by @AStevens_PhD @ATricco @arche4evidence et al. #OpenAccess LInk: https://t.co/3s0fSsygU7 https://t.co/ek8EISbBul
-
-
Mashup Score: 1504Risk ratios, odds ratios and the risk difference - 19 day(s) ago
### Scenario As a heart surgeon, you regularly perform aortic valve replacement, using a median sternotomy technique. However, you are aware that less-invasive options are available, and you wonder whether these may be as effective and safe as your current practice. After searching the Cochrane Library, you find a systematic review, ‘Limited versus full sternotomy for aortic valve replacement1’. The authors of the review conclude that ‘upper hemi‐sternotomy may have little to no effect on mortality versus full median sternotomy (risk ratio (RR) 0.93, 95% CI 0.45 to 1.94)’. What does this statistic mean in practice? The risk ratio (also known as RR) illustrates the risk of an event occurring in the intervention group compared with the risk of the same event occurring in the control group. For example, in a hypothetical randomised controlled trial (RCT), 50 out of 100 people who received the experimental drug experienced at least one side effect: the risk (or probability) of the event wa
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Risk ratios, odds ratios and the risk difference #Education by @racherichardson @dwan_kerry @afkanellopoulou @cochranecollab @cochranemthds Link: https://t.co/k7P0aTW1kQ https://t.co/iCUtG2wSMz
-
-
Mashup Score: 5
Objective To determine the added diagnostic value of dipsticks for urinary tract infections (UTI) in acutely hospitalised individuals. Design Prospective population-based cohort study. Setting North Denmark. Participants All adults (≥18 years) examined with dipsticks at emergency departments in North Denmark Region from September 20 through 23 October 2021. Main outcome measures UTI was defined as ≥1 symptom of new-onset frequency, dysuria or suprapubic tenderness combined with a positive urine culture. Positive dipsticks were defined as any reaction for leucocyte esterase and/or nitrite. Results Dipsticks were used in 1052/2495 (42%) of acutely hospitalised patients with a median age of 73 years (IQR 57–82) and 540 (51%) were female. Overall, 89/1052 (8%) fulfilled the UTI criteria and urine cultures were done in 607/1052 (58%) patients. Among patients examined with both dipstick and urine culture, sensitivity and specificity for UTI were 87% (95% CI 78% to 93%) and 45% (95% CI 41% to
Source: ebm.bmj.comCategories: General Medicine News, PayerTweet-
Diagnostic accuracy of dipsticks for urinary tract infections in acutely hospitalised patients: a prospective population-based observational cohort study #OriginalResearch by Kristensen et al. #OpenAccess Link: https://t.co/WbnJlfUaYv https://t.co/KmiTswPE8Q
-
How to best convey continuous outcomes in patient decision aids #Analysis by @glynelwyn et al. Link: https://t.co/T2hY9EMYfs https://t.co/6i9iBqzi46