scholarly journals Evidence-Based Guidelines Should Be Used to Inform COVID-19 Management

2020 ◽  
Author(s):  
Thomas L. Holland
Keyword(s):  
Treatment Algorithm ◽  
Trial Data ◽  
Evidence Based ◽  
High Quality ◽  
Recent Commentary ◽  
Quality Trial ◽  
High Quality Trial ◽  
Evidence Based Guidelines

A recent commentary by McCullough (1) includes a recommended COVID treatment algorithm that is outdated and parts of which are contradicted by high quality trial data.…

scholarly journals Aspirin for Primary Prevention in Adults Older than 70 Years is Not Supported by High-Quality Trial Data and May Cause Harm

2020 ◽  
Vol 133 (7) ◽  
pp. e389-e390
Author(s):  
Suzanne E. Mahady ◽  
Robyn L. Woods ◽  
Rory Wolfe ◽  
Mark R. Nelson ◽  
Anne M. Murray ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Trial Data ◽  
High Quality ◽  
Quality Trial ◽  
High Quality Trial

Organizing and delivering treatment for ADHD

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.

scholarly journals Children Are Not Just Small Adults: The Urgent Need for High-Quality Trial Evidence in Children

PLoS Medicine ◽  
2008 ◽  
Vol 5 (8) ◽  
pp. e172 ◽  
Author(s):  
Terry P Klassen ◽  
Lisa Hartling ◽  
Jonathan C Craig ◽  
Martin Offringa
Keyword(s):  
High Quality ◽  
Quality Trial ◽  
High Quality Trial ◽  
Trial Evidence

scholarly journals Investigation-Based Drug Value Framework in Hodgkin Lymphoma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2262-2262
Author(s):  
Ohad Oren
Keyword(s):  
Clinical Trials ◽  
Hodgkin Lymphoma ◽  
Scoring System ◽  
Conflicts Of Interest ◽  
High Quality ◽  
Nccn Guidelines ◽  
Significant Toxicity ◽  
Anti Cancer ◽  
Quality Trial ◽  
High Quality Trial

Abstract Background Currently available drug value frameworks integrate data about a medication's benefits and risks. However, the strength of the research data supporting the use of one medication versus another is highly variable. The greater the number and quality of well-conducted trials underlying a certain intervention, the stronger its potential favorable contribution to public health. Drug value should therefore also be a function of the magnitude of clinical evidence gleaned from high-quality clinical trials. Methods We propose an investigation-driven value framework that determines the merit of a drug based on the overall available evidence, including the rigour of relevant trials. The NCCN Hodgkin Lymphoma guidelines were reviewed and data collected about commonly used regimens for Classic HL. Value scores were determined for each drug combination. Results A model was designed incorporating information about the number of RCTs conducted, the total number of participants enrolled, and the generalizability to real-world populations, in addition to the drug's efficacy, significant toxicity and cost (Figure 1). Practice-changing trials supporting each of the currently-endorsed regimens were collected from the HL NCCN guidelines (ABVD, 4; Stanford V 4; Esc BEACOPP 2). The average number of participants per trial was higher for ABVD (1,126) and Esc BEACOPP (1,890) than for Stanford V (267). The generalizability score for the three compounds was 0.5 (ABVD), 0.25 (Stanford V) and -1 (Esc BEACOPP). The mean 5-year overall survival rate was higher in the case of ABVD (96.2%) and Esc BEACOPP (96.1%) compared with Stanford V (92.0%). The toxicity score was 1.24 (ABVD), 3 (Stanford V) and 2.5 (Esc BEACOPP). Using a multi-factorial value scoring system, ABVD, Esc BEACOPP and Stanford V obtained 11.5, 9.5 and 8.5 points, respectively. A scoring system that focused on traditional factors alone (efficacy, toxicity, cost) yielded different scores (ABVD, 7.7; Stanford V 6.7; Esc BEACOPP, 6.5). Conclusion The robustness of clinical trials investigating anti-cancer regimens deserves special consideration when defining drug value. Three high-quality trial characteristics help stratify common regimens in HL into higher/lower value strata using a simple, easy to use algorithm. Disclosures No relevant conflicts of interest to declare.

Critical Issues That Need to Be Addressed to Improve Outcomes for Patients With Carotid Stenosis

Angiology ◽  
2016 ◽  
Vol 67 (5) ◽  
pp. 420-426 ◽  
Author(s):  
Anne Abbott
Keyword(s):  
Quality Assurance ◽  
Carotid Stenosis ◽  
Multidisciplinary Approach ◽  
Trial Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Research Reporting ◽  
Evidence Quality ◽  
Critical Issues ◽  
Evidence Based Guidelines

Significant improvement in outcomes for patients with carotid stenosis requires liberation from the historic fixation with randomization and a procedurally based, late-stage, reactive approach to medical care. We require a multipronged and multidisciplinary approach that includes all of the following: (i) removal of overreliance on, and biased use of, randomized trial data; (ii) using accurate ways to rank evidence quality and relevance; (iii) improved research reporting standards; (iv) building quality assurance and other research capability into routine practice; (v) producing evidence-true rather than evidence-based guidelines; (vi) bringing current optimal medical treatment to the community and measuring its effectiveness; (vii) funding only interventions known to help patients when and where they are treated and use the savings to fund vital research, including quality assurance in routine practice; and (viii) recognize that making the indication for carotid procedures obsolete is a good thing.

scholarly journals Controversies in psychiatry

2018 ◽  
Vol 20 (3) ◽  
pp. 151-152 ◽  
Keyword(s):  
Clinical Assessment ◽  
Evidence Based ◽  
Controversial Issues ◽  
Psychiatric Diseases ◽  
High Quality ◽  
High Quality Research ◽  
Quality Research ◽  
Anniversary Issue ◽  
20Th Anniversary ◽  
Evidence Based Guidelines

Neuroimaging and recent genetics discoveries have raised many questions regarding the current diagnostic criteria of psychiatric diseases and the current classifications used, which are still based on subjective clinical assessment. Despite high-quality research in brain neuroscience and evidence-based guidelines in many psychiatric diseases, some therapeutic issues are still a matter of debate. These controversial issues will be discussed in this 20th anniversary issue.

scholarly journals LO24: Is prehospital care supported by evidence-based guidelines? An environmental scan and quality appraisal using AGREE II

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S35-S36
Author(s):  
S. Turner ◽  
E. Lang ◽  
K. Brown ◽  
C. Leyton ◽  
E. Bulger ◽  
...  
Keyword(s):  
Life Support ◽  
Guideline Development ◽  
Prehospital Care ◽  
Evidence Based ◽  
High Quality ◽  
Agree Ii ◽  
Level Of Evidence ◽  
High Quality Evidence ◽  
Evidence Based Guidelines ◽  
Quality Evidence

Introduction: The Institute of Medicine (IOM) has recommended that high-quality, evidence-based guidelines be developed for emergency medical services (EMS). The National Association of EMS Physicians (NAEMSP) has outlined a strategy that will see this task fulfilled, consisting of multiple working groups focused on all aspects of guideline development and implementation. A first step, and our objective, was a cataloguing and appraisal of the current guidelines targeting EMS providers. Methods: A systematic search of the literature was conducted in MEDLINE (1175), EMBASE (519), PubMed (14), Trip (416), and guidelines.gov (64) through May 1, 2016. Two independent reviewers screened titles for relevance to prehospital care, and then abstracts for essential guideline features, including a systematic review, a grading system, and an association between level of evidence and strength of recommendation. All disagreements were moderated by a third party. Citations meeting inclusion criteria were appraised with the AGREE II tool, which looks at six different domains of guideline quality, containing a total of 23 items rated from 1 to 7. Each guideline was appraised by three separate reviewers, and composite scores were calculated by averaging the scaled domain totals. Results: After primary (kappa 97%) and secondary (kappa 93%) screening, 49 guidelines were retained for full review. Only three guidelines obtained a score of >90%, the topics of which included aeromedical transport, analgesia in trauma, and resuscitation of avalanche victims. Only two guidelines scored between 80% and 90%, the topics of which included stroke and pediatric seizure management. One guideline, splinting in an austere environment, scored between 70% and 80%. Nine guidelines scored between 60% and 70%, the topics of which included ischemic stroke, cardiovascular life support, hemorrhage control, intubation, triage, hypothermia, and fibrinolytic use. Of the remaining guidelines, 14 scored between 50% and 60%, and 20 obtained a score of <50%. Conclusion: There are few high-quality, evidence-based guidelines in EMS. Of those that are published, the majority fail to meet established quality measures. Although a lack of randomized controlled trials (RCTs) conducted in the prehospital field continues to limit guideline development, suboptimal methodology is also commonplace within the existing literature.

Feynman-Kac path-integral calculations with high-quality trial wave functions

2000 ◽  
Vol 61 (3) ◽  
Author(s):  
Sumita Datta ◽  
J. L. Fry ◽  
N. G. Fazleev ◽  
S. A. Alexander ◽  
R. L. Coldwell
Keyword(s):  
Path Integral ◽  
Wave Functions ◽  
High Quality ◽  
Quality Trial ◽  
High Quality Trial

Evidence-Based Practice & Practice-Based Evidence Applied to Adult, Medical Speech-Language Pathology

2013 ◽  
Vol 18 (1) ◽  
pp. 14-26 ◽  
Author(s):  
Rik Lemoncello ◽  
Bryan Ness
Keyword(s):  
Evidence Based Practice ◽  
Single Case ◽  
Quality Data ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Clinical Practices ◽  
High Quality ◽  
Randomized Controlled Clinical Trials ◽  
Relative Paucity ◽  
Language Pathology

In this paper, we review concepts of evidence-based practice (EBP), and provide a discussion of the current limitations of EBP in terms of a relative paucity of efficacy evidence and the limitations of applying findings from randomized controlled clinical trials to individual clinical decisions. We will offer a complementary model of practice-based evidence (PBE) to encourage clinical scientists to design, implement, and evaluate our own clinical practices with high-quality evidence. We will describe two models for conducting PBE: the multiple baseline single-case experimental design and a clinical case study enhanced with generalization and control data probes. Gathering, analyzing, and sharing high-quality data can offer additional support through PBE to support EBP in speech-language pathology. It is our hope that these EBP and PBE strategies will empower clinical scientists to persevere in the quest for best practices.

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