TRADE-OFFS BETWEEN EPISTEMIC AND MORAL VALUES IN EVIDENCE-BASED POLICY

Abstract:Proponents of evidence-based policy (EBP) call for public policy to be informed by high-quality evidence from randomized controlled trials. This methodological preference aims to promote several epistemic values, e.g. rigour, unbiasedness, precision, and the ability to obtain causal conclusions. I argue that there is a trade-off between these epistemic values and several non-epistemic, moral and political values. This is because the evidence afforded by standard EBP methods is differentially useful for pursuing different moral and political values. I expand on how this challenges ideals of value-freedom and -neutrality in EBP, and offer suggestions for how EBP methodology might be revised.

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Intensive Triangulation of Qualitative Research and Quantitative Data to Improve Recruitment to Randomized Trials: The QuinteT Approach

Qualitative Health Research ◽

10.1177/1049732319828693 ◽

2019 ◽

Vol 29 (5) ◽

pp. 672-679 ◽

Cited By ~ 8

Author(s):

Leila Rooshenas ◽

Sangeetha Paramasivan ◽

Marcus Jepson ◽

Jenny L. Donovan

Keyword(s):

Qualitative Research ◽

Comparative Effectiveness ◽

Quantitative Data ◽

Randomized Trials ◽

Controlled Trials ◽

High Quality ◽

Randomized Controlled ◽

Health Care Interventions ◽

High Quality Evidence ◽

Quality Evidence

Randomized controlled trials (RCTs) can provide high quality evidence about the comparative effectiveness of health care interventions, but many RCTs struggle with or fail to complete recruitment. RCTs are built on the principles of the experimental method, but their planning, conduct, and interpretation can depend on complex social, behavioral, and cultural factors that may be best understood through qualitative research. Most qualitative studies undertaken alongside RCTs involve interviews that produce data that are used in a supportive or supplicatory role, but there is potential for qualitative research to be more influential. In this article, we describe the research methods underpinning the “QuinteT” (Qualitative Research Integrated Within Trials) approach to understand and address RCT recruitment difficulties. The QuinteT Recruitment Intervention (QRI) brings together multiple qualitative strategies and quantitative data and uses triangulation to understand recruitment issues rapidly. These nuanced understandings are used to inform the implementation of collaborative actions to improve recruitment.

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Therapeutic Evidence of Human Mesenchymal Stem Cell Transplantation for Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

Stem Cells International ◽

10.1155/2020/5701920 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Baocheng Xie ◽

Minyi Chen ◽

Runkai Hu ◽

Weichao Han ◽

Shaobo Ding

Keyword(s):

Cerebral Palsy ◽

Stem Cell ◽

Mesenchymal Stem Cell ◽

Meta Analysis ◽

Human Mesenchymal Stem Cell ◽

Controlled Trials ◽

High Quality ◽

Randomized Controlled ◽

High Quality Evidence ◽

Quality Evidence

Cerebral palsy (CP) is a kind of movement and posture disorder syndrome in early childhood. In recent years, human mesenchymal stem cell (hMSC) transplantation has become a promising therapeutic strategy for CP. However, clinical evidence is still limited and controversial about clinical efficacy of hMSC therapy for CP. Our aim is to evaluate the efficacy and safety of hMSC transplantation for children with CP using a meta-analysis of randomized controlled trials (RCTs). We conducted a systematic literature search including Embase, PubMed, ClinicalTrials.gov, Cochrane Controlled Trials Register databases, Chinese Clinical Trial Registry, and Web of Science from building database to February 2020. We used Cochrane bias risk assessment for the included studies. The result of pooled analysis showed that hMSC therapy significantly increased gross motor function measure (GMFM) scores (standardized mean difference SMD=1.10, 95%CI=0.66‐1.53, P<0.00001, high-quality evidence) and comprehensive function assessment (CFA) (SMD=1.30, 95%CI=0.71‐1.90, P<0.0001, high-quality evidence) in children with CP, compared with the control group. In the subgroup analysis, the results showed that hMSC therapy significantly increased GMFM scores of 3, 6, and 12 months and CFA of 3, 6, and 12 months. Adverse event (AE) of upper respiratory infection, diarrhea, and constipation was not statistically significant between the two groups. This meta-analysis synthesized the primary outcomes and suggested that hMSC therapy is beneficial, effective, and safe in improving GMFM scores and CFA scores in children with CP. In addition, subgroup analysis showed that hMSC therapy has a lasting positive benefit for CP in 3, 6, and 12 months.

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Structural Allograft Versus PEEK Implants in Anterior Cervical Discectomy and Fusion: A Systematic Review

Global Spine Journal ◽

10.1177/2192568219883256 ◽

2019 ◽

Vol 10 (6) ◽

pp. 775-783

Author(s):

Amit Jain ◽

Majd Marrache ◽

Andrew Harris ◽

Varun Puvanesarajah ◽

Brian J. Neuman ◽

...

Keyword(s):

Systematic Review ◽

Patient Reported Outcomes ◽

Controlled Trials ◽

High Quality ◽

Randomized Controlled ◽

High Quality Evidence ◽

Structural Allograft ◽

Patient Reported ◽

Spine Degeneration ◽

Quality Evidence

Study Design: Systematic literature review. Objective: Our primary objective was to compare reported fusion rates after anterior cervical discectomy and fusion (ACDF) using structural allograft versus polyetheretherketone (PEEK) interbody devices in patients with cervical spine degeneration. Our secondary objectives were to compare differences in rates of subsidence and reoperation and in patient-reported outcomes between the 2 groups. Methods: Through a systematic review of the English-language literature using various databases, we identified 4702 articles. After we applied inclusion and exclusion criteria, 14 articles (7 randomized controlled trials, 4 prospective studies, and 3 retrospective studies) reporting fusion rates of structural allograft or PEEK interbody devices were eligible for our analysis. No randomized controlled trials compared outcomes of structural allograft versus PEEK interbody devices. Extracted data included authors, study years, study designs, sample sizes, patient ages, duration of follow-up, types of interbody devices used, fusion rates, definition of fusion, reoperation rates, subsidence rates, and patient-reported outcomes. Results: Fusion rates were 82% to 100% for allograft and 88% to 98% for PEEK interbody devices. The reported data were insufficient to perform meta-analysis. Structural allograft had the highest reported rate of reoperation (14%), and PEEK interbody devices had the highest reported subsidence rate (18%). Patient-reported outcomes improved in both groups. There was insufficient high-quality evidence to compare the associations of various PEEK modifications with fusion rates. Conclusion: Fusion rates were similar between structural allograft and PEEK interbody devices when used for ACDF for cervical spine degeneration. Currently, there is insufficient high-quality evidence to assess associations of PEEK modifications with fusion rates. Level of Evidence: II.

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The Importance of High-Quality Evidence of the Long-Term Impact of Nonfatal Events Used in Randomized Controlled Trials: A Case Study of Prasugrel

Clinical Pharmacology & Therapeutics ◽

10.1038/clpt.2011.61 ◽

2011 ◽

Vol 90 (1) ◽

pp. 27-29 ◽

Cited By ~ 6

Author(s):

C Y Lu ◽

J Karnon ◽

M J Sorich

Keyword(s):

Randomized Controlled Trials ◽

Controlled Trials ◽

High Quality ◽

Randomized Controlled ◽

High Quality Evidence ◽

Long Term Impact ◽

Quality Evidence

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Clinical studies of incidental intracranial meningiomas—towards high-quality evidence-based practice

Acta Neurochirurgica ◽

10.1007/s00701-020-04214-y ◽

2020 ◽

Vol 162 (3) ◽

pp. 673-674

Author(s):

Abdurrahman I. Islim ◽

Christopher P. Millward ◽

Kirsty J. Martin-McGill ◽

Ruwanthi Kolamunnage-Dona ◽

Thomas Santarius ◽

...

Keyword(s):

Clinical Studies ◽

Evidence Based Practice ◽

Evidence Based ◽

High Quality ◽

High Quality Evidence ◽

Intracranial Meningiomas ◽

Quality Evidence

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Addressing the information needs of older patients

Reviews in Clinical Gerontology ◽

10.1017/s0959259802012121 ◽

2002 ◽

Vol 12 (1) ◽

pp. 5-11 ◽

Cited By ~ 8

Author(s):

Matthew Harris ◽

Antony Bayer ◽

Win Tadd

Keyword(s):

Therapeutic Intervention ◽

Older Patients ◽

Information Needs ◽

Clinical Governance ◽

Reliable Information ◽

Evidence Based ◽

High Quality ◽

High Quality Evidence ◽

Risk Framework ◽

Quality Evidence

The availability of high-quality, evidence-based, clearly communicated, user-focused information is central to the new NHS. Reliable information empowers patients and their families and enables them to become more knowledgeable about their care and condition following consultation and diagnosis or before a therapeutic intervention. It is an integral part of clinical governance and the clinical risk framework.

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Organizing and delivering treatment for ADHD

10.1093/med/9780198739258.003.0045 ◽

2018 ◽

Author(s):

David Coghill ◽

Marina Danckaerts

Keyword(s):

Treatment Initiation ◽

Careful Consideration ◽

Routine Clinical Practice ◽

Evidence Based ◽

High Quality ◽

Children With Adhd ◽

High Quality Evidence ◽

Ongoing Care ◽

Evidence Based Guidelines ◽

Quality Evidence

Following diagnosis, all children with ADHD will require some form of intervention, and most will require treatment over a relatively prolonged period of time. Whilst there are now several high-quality evidence-based guidelines for the management of ADHD, these are often difficult to operationalize into routine clinical practice and as a consequence studies report considerable variations in care at local, national, and international levels. We describe a structured, but flexible, approach to the organization and delivery of ADHD treatments that aims to optimize care and reduce variation in practice. This pathway pays particular attention to optimizing care through careful consideration of the initial targets for treatment and choice of first treatment, initiation and titration of medication treatments, monitoring ongoing care and identifying adverse events, and the adjustment and switching of treatments when outcomes are not optimal.

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Asthma guidelines: which is the best of three?

Practice Nursing ◽

10.12968/pnur.2020.31.8.344 ◽

2020 ◽

Vol 31 (8) ◽

pp. 344-351

Author(s):

Andrew Booth

Keyword(s):

Health Professional ◽

Evidence Based ◽

High Quality ◽

Pharmacological Management ◽

International Guidelines ◽

Diagnosis And Management ◽

Asthma Guideline ◽

High Quality Evidence ◽

The Uk ◽

Quality Evidence

Andrew Booth offers a comprehensive look into national and international guidelines surrounding the diagnosis and management of asthma National and international guidelines provide evidence-based advice on the diagnosis and management of asthma. There are now three potential asthma guidelines to follow, each taking its own unique, and sometimes conflicting direction, creating a total of over 700 pages of high-quality evidence. A puzzle is thus presented to the busy health professional: which guideline do I follow? This article compares and contrasts two national and one international asthma guideline, focusing particularly on diagnosis and pharmacological management. Mortality from asthma is increasing in the UK, making the need for a conjoined guideline more urgent than ever.

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Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

The Scientific World JOURNAL ◽

10.1100/tsw.2010.218 ◽

2010 ◽

Vol 10 ◽

pp. 2228-2237 ◽

Cited By ~ 16

Author(s):

William T. Lowrance ◽

Tatum V. Tarin ◽

Shahrokh F. Shariat

Keyword(s):

Cost Effectiveness ◽

Radical Prostatectomy ◽

Radical Retropubic Prostatectomy ◽

Evidence Based ◽

High Quality ◽

Robotic Assisted ◽

Retropubic Prostatectomy ◽

Open Radical Prostatectomy ◽

High Quality Evidence ◽

Quality Evidence

The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

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