Evidence-Based Policy in the Real World: A Cautionary View

The evidence movement has attended more to improving the supply of evidence than to increasing demand, so even as rigorous evidence production has increased, the use of evidence remains all too rare. A growing body of research indicates that the quality of relationships between researchers, policy-makers, and intermediaries plays a central role in whether rigorous evidence informs decisions in policy and practice. Creating structures to support such relationships remains a major challenge. Yet even when high-quality evidence is used, the intended benefits may not ensue because of broader challenges in society at large. Consequently, we should temper our expectations for the benefits of evidence-based policymaking, but not give up the effort.

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Measurement properties of patient-reported outcome measures (PROMs) in hyperhidrosis: a systematic review

Quality of Life Research ◽

10.1007/s11136-021-02958-3 ◽

2021 ◽

Author(s):

Michaela Gabes ◽

Helge Knüttel ◽

Gesina Kann ◽

Christina Tischer ◽

Christian J. Apfelbacher

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Properties ◽

High Quality ◽

High Quality Evidence ◽

Patient Reported ◽

Quality Evidence

Abstract Purpose To critically appraise, compare and summarize the quality of all existing PROMs that have been validated in hyperhidrosis to at least some extend by applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Thereby, we aim to give a recommendation for the use of PROMs in future clinical trials in hyperhidrosis. Methods We considered studies evaluating, describing or comparing measurement properties of PROMs as eligible. A systematic literature search in three big databases (MEDLINE, EMBASE and Web of Science) was performed. We assessed the methodological quality of each included study using the COSMIN Risk of Bias checklist. Furthermore, we applied predefined quality criteria for good measurement properties and finally, graded the quality of the evidence. Results Twenty-four articles reporting on 13 patient-reported outcome measures were included. Three instruments can be further recommended for use. They showed evidence for sufficient content validity and moderate- to high-quality evidence for sufficient internal consistency. The methodological assessment showed existing evidence gaps for eight other PROMs, which therefore require further validation studies to make an adequate decision on their recommendation. The Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) and the short-form health survey with 36 items (SF-36) were the only questionnaires not recommended for use in patients with hyperhidrosis due to moderate- to high-quality evidence for insufficient measurement properties. Conclusion Three PROMs, the Hyperhidrosis Quality of Life Index (HidroQoL), the Hyperhidrosis Questionnaire (HQ) and the Sweating Cognitions Inventory (SCI), can be recommended for use in future clinical trials in hyperhidrosis. Results obtained with these three instruments can be seen as trustworthy. Nevertheless, further validation of all three PROMs is desirable. Systematic review registration PROSPERO CRD42020170247

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

Economics and Philosophy ◽

10.1017/s0266267118000159 ◽

2018 ◽

Vol 35 (1) ◽

pp. 49-78 ◽

Cited By ~ 3

Author(s):

Donal Khosrowi

Keyword(s):

Controlled Trials ◽

Evidence Based ◽

Epistemic Values ◽

High Quality ◽

Political Values ◽

Randomized Controlled ◽

High Quality Evidence ◽

Evidence Based Policy ◽

Trade Offs ◽

Quality Evidence

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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The effectiveness of M-Health associated with cardiac rehabilitation on functional capacity and cardiovascular risk factors: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.3118 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A C Campagnolo Goncalves Toledo ◽

N Soares De Almeida ◽

A Pierucci ◽

A Straioto Salomao ◽

I Ribeiro Lemes ◽

...

Keyword(s):

Functional Capacity ◽

Meta Analysis ◽

Medium Term ◽

Short Term ◽

High Quality ◽

Quality Of Evidence ◽

High Quality Evidence ◽

Quality Evidence

Abstract Introduction Smartphone applications for health (M-Health) seem to overcome barriers to access Cardiovascular Rehabilitation Programs (CRP), because of their high degree of acceptance and also their potential to influence the frequency of physical exercise in weight loss. Objective To analyze the effectiveness of the combination of M-Health and CRP compared to CRP alone on functional capacity, adherence to CRP, management of cardiovascular risk factors in cardiac patients. Design Systematic Review and Meta-Analysis. Methods The following databases were used Medline via Ovid, EMBASE, Central, PEDro and SPORTDiscus via EBSCOhost from their inception until July/2020. We included randomized controlled trials investigating the effects of M-Health in combination with CRP compared to CRP alone in adults with heart disease, and the interventions with M-Health consisted of text messages, e-mails, and applications. The primary outcome of this review was functional capacity, measured by VO2peak, or self-reported physical activity (METs.min/week). PEDro scale was used to assess the methodological quality of the studies and the GRADE approach to assess the overall quality of evidence. Pooled estimates were calculated using a random effect model to obtain mean difference (MD) or standardized mean differences (SMD) and their respectives 95% confidence intervals (CI). Results Nineteen RCTs were eligible, the median risk of bias was 7 out of 10 points. The primary endpoint was analyzed by subgroups, time of intervention and kind of type CRP, eigthteen of these studies assessed functional capacity. CRP in combination with a m-health intervention was more effective than CRP alone in improving VO2peak, ml/min/kg, (MD: 0.84, CI: 0.30 to 1.38; I2=0%, high quality evidence, 12 trials, n=1889) at short-term follow-up, but at medium-term follow-up (MD: 0.84, CI: −0.26 to 1.41; I2=0%, high quality evidence, 8 trials, n=927,). Similarly, CRP associated with m-health was superior to CRP alone in increasing self-reported at short-term, METs.min/week, (MD:1.31, CI: −0.24 to 2.37; I2 = not aplicable, very low quality evidence, 1 trial, n=18), and at medium-term follow-up (MD: 0.18, CI: −0.01 to 0.36; I2=56%, moderate quality evidence, 4 trials, n=1107). Conclusion High quality of evidence shows that M-Health improves cardiorespiratory fitness at short-term follow-up. In addition, supervised program showed to be more effective than non-supervised. Funding Acknowledgement Type of funding sources: None.

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Evidence-based approaches to psychiatry

Shorter Oxford Textbook of Psychiatry ◽

10.1093/med/9780198747437.003.0006 ◽

2017 ◽

pp. 119-134

Author(s):

Paul Harrison ◽

Philip Cowen ◽

Tom Burns ◽

Mina Fazel

Keyword(s):

Patient Experience ◽

Meta Analysis ◽

Psychiatric Research ◽

Evidence Based ◽

High Quality ◽

Qualitative Methodologies ◽

Meta Analyses ◽

Based Medicine ◽

Quality Evidence

‘Evidence-based approaches to psychiatry’ describes the application of evidence-based medicine (EBM) to psychiatric practice. The chapter covers the key processes in EBM, including the formulation of a clinically relevant question, the systematic search for high-quality evidence and the meta-analytic synthesis of data. It demonstrates how evidence-based approaches to psychiatry have led to important developments showing quantitative effects of different treatments through advanced meta-analysis of data from randomized trials. This has underpinned the development of clinical guidelines that have the aim of improving the reliability and quality of treatments that patients receive. The chapter also describes how meta-analyses should be critically reviewed, as well as their problems and limitations. Not all relevant questions in psychiatric research are susceptible to the quantitative approach offered by EBM, and the chapter also outlines how qualitative methodologies can play a key role in answering important questions related, for example, to the patient experience.

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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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