scholarly journals Normalising comparative effectiveness trials as clinical practice

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tom Briffa ◽  
Tanya Symons ◽  
Nikolajs Zeps ◽  
Nicola Straiton ◽  
William Odita Tarnow-Mordi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Comparative Effectiveness ◽  
Practice Variation ◽  
High Quality ◽  
Diverse Range ◽  
Implementation Challenges ◽  
High Quality Evidence ◽  
Real World Evidence ◽  
Effectiveness Trials ◽  
Quality Evidence

AbstractThere is a lack of high-quality evidence underpinning many contemporary clinical practice guidelines embedded in the healthcare systems, leading to treatment uncertainty and practice variation in most medical disciplines. Comparative effectiveness trials (CETs) represent a diverse range of research that focuses on optimising health outcomes by comparing currently approved interventions to generate high-quality evidence to inform decision makers. Yet, despite their ability to produce real-world evidence that addresses the key priorities of patients and health systems, many implementation challenges exist within the healthcare environment.This manuscript aims to highlight common barriers to conducting CETs and describes potential solutions to normalise their conduct as part of a learning healthcare system.

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

2019 ◽  
Vol 29 (5) ◽  
pp. 672-679 ◽  
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.

scholarly journals Neurosurgery - More Eminence than Evidence: Results of an International Survey (Preprint)

2017 ◽  
Author(s):  
Jill Martens
Keyword(s):  
Clinical Practice ◽  
Publication Rate ◽  
Formal Training ◽  
High Quality ◽  
Web Based ◽  
Medical Specialties ◽  
High Quality Evidence ◽  
Level Ii ◽  
Level I ◽  
Quality Evidence

BACKGROUND The publication rate of neurosurgical guidelines has increased tremendously over the past decade. However, only a small proportion of clinical decisions appears to be based on high-quality evidence. OBJECTIVE To evaluate the available evidence within neurosurgery and its value within clinical practice according to neurosurgeons. METHODS A web-based survey was sent to 2552 neurosurgeons, who were members of the European Association of Neurosurgical Societies. RESULTS The response rate to the survey was 7% (173 respondents). According to 49% of the respondents, neurosurgery is based on less evidence compared with other medical specialties, and not enough high-quality evidence is available on which to base clinical practice. However, 84% of the respondents believed neurosurgery is amenable to evidence. Of the respondents, 59% considered the neurosurgical guidelines in their hospital to be based on high-quality evidence. Responders that did consider the neurosurgical guidelines in their hospital to be based on high-quality evidence did consider their own treatments more often as based on Level I and/or Level II (84% resp. 55%) (P < .001). Also, neurosurgeons with formal training believed they could understand, criticize and interpret statistical outcomes presented in journals better than those without formal training (93% resp. 68%) (P < .001). CONCLUSIONS According to the respondents, neurosurgery is based less often on high-quality evidence than other medical specialties. When looking at the results of the survey, formal training in EBM is desirable, so neurosurgeons can better understand, criticize and interpret statistical outcomes presented in journals.

scholarly journals Show Me the Evidence

2016 ◽  
Vol 25 (4) ◽  
pp. 203-204
Author(s):  
Wendy C. Budin
Keyword(s):  
Clinical Practice ◽  
High Quality ◽  
High Quality Evidence ◽  
Quality Evidence

ABSTRACTIn this column, the editor of The Journal of Perinatal Education discusses the need for current high-quality evidence to guide clinical practice. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Minimal intervention in oral cancer management: idealistic or realistic?

2018 ◽  
Vol 9 (4) ◽  
pp. 151-154 ◽  
Author(s):  
Peter Thomson
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Oral Cancer ◽  
Clinical Care ◽  
Interventional Therapy ◽  
High Quality ◽  
Minimal Intervention ◽  
Cancer Management ◽  
High Quality Evidence ◽  
Quality Evidence

For many years, early diagnosis and management of OSCC have been areas of clinical practice where variability in decision-making and lack of high-quality evidence confounded treatment initiatives. Could an improved understanding of minimal interventional therapy offer an opportunity to improve clinical care?

scholarly journals High-quality evidence to inform clinical practice

The Lancet ◽  
2019 ◽  
Vol 394 (10199) ◽  
pp. 633-634 ◽  
Author(s):  
Alexander C Fanaroff ◽  
Robert M Califf ◽  
Renato D Lopes
Keyword(s):  
Clinical Practice ◽  
High Quality ◽  
High Quality Evidence ◽  
Quality Evidence

scholarly journals SARS-CoV-2 Infection in Healthcare Workers During the COVID-19 Pandemic

2020 ◽  
Vol 01 (01) ◽  
pp. 33-37
Author(s):  
Wentao Ji ◽  
Fang Xie ◽  
Lulong Bo
Keyword(s):  
Clinical Practice ◽  
Healthcare Workers ◽  
Emergency Physicians ◽  
High Quality ◽  
High Quality Evidence ◽  
Anesthesia Providers ◽  
The World ◽  
Working Together ◽  
Current Experience ◽  
Quality Evidence

Since December 2019, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic has become a once-in-a-century pandemic sweeping across the whole world. While countries around the world are working together to combat the pandemic, the world still faces serious threats. Current experience shows that prevention is more important than treatment, especially for healthcare workers (HCWs), the infection of whom is tantamount to in-hospital secondary transmission to other HCWs and inpatients. Anesthesia providers, emergency physicians, and healthcare workers in the ICU are at an enhanced risk of contamination; hence, we give some advice derived from clinical practice and other guidance on how to protect HCWs from SARS-CoV-2 infection. Despite high-quality evidence regarding the association between transmission of COVID-19 among the HCWs and aerosol-generating procedures, such as endotracheal intubation, being inadequate, HCWs should raise their vigilance in these procedures and more evidence should be generated.

scholarly journals Evidence-based clinical practice guideline for the management of primary immune thrombocytopenia (ITP) in pediatric population

2021 ◽  
Vol 69 (3) ◽  
Author(s):  
Edgar Vladimir Cabrera-Bernal ◽  
Ana Marcela Torres-Amaya ◽  
María Teresa Vallejo-Ortega ◽  
Adriana LInares-Ballesteros ◽  
Isabel Cristina Sarmiento-Urbina ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Immune Thrombocytopenia ◽  
Pediatric Population ◽  
Evidence Based ◽  
High Quality ◽  
High Quality Evidence ◽  
Primary Immune Thrombocytopenia ◽  
Quality Evidence

Introduction: Primary immune thrombocytopenia (ITP) is the most frequent cause of thrombocytopenia in pediatric population, with a reported incidence of 1.1-12.5 cases per 100 000 children. However, currently there are different definitions of ITP, as well as diagnostic and therapeutic approaches. Objective: To develop an evidence-based clinical practice guideline (CPG) to unify ITP definitions, and this way, reduce the variability of its diagnosis, and to provide indications for the treatment of acute, persistent, and chronic ITP in patients under 18 years of age Materials and methods: The CPG was developed by a multidisciplinary group that followed the standard methods of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the development of CPGs, formulated PICO clinical questions, and conducted systematic reviews. GRADE evidence profiles were created and recommendations, with their respective level of evidence and strength, were made after a panel of experts assessed the benefit-risk balance, the quality of evidence, the patients’ values and preferences and the context in which they should be implemented. Results: A total of 23 recommendations for the treatment of acute, persistent and chronic ITP by pediatricians, hematologist and health professionals working in emergency services were made. Overall, the evidence of the GPC is of low quality and the recommendations were formulated in order to improve the treatment success rate of ITP and the prognosis of children with this condition. Conclusions: Despite ITP is the main cause of thrombocytopenia in pediatric population, so far there is not enough high quality evidence supporting the recommendations presented here for its proper classification and treatment in children. Thus, further studies providing high quality evidence on this issue are required.

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