scholarly journals Expanding the Grading of Recommendations Assessment, Development, and Evaluation (Ex-GRADE) for Evidence-Based Clinical Recommendations: Validation Study

2012 ◽  
Vol 6 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Linda Phi ◽  
Reem Ajaj ◽  
Manisha H Ramchandani ◽  
Xenia MC Brant ◽  
Oluwadayo Oluwadara ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Design Methodology ◽  
Qualitative Assessment ◽  
Evidence Based ◽  
Study Quality ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
New Instrument ◽  
Quality Of Research

Clinicians use general practice guidelines as a source of support for their intervention, but how much confidence should they place on these recommendations? How much confidence should patients place on these recommendations? Various instruments are available to assess the quality of evidence of research, such as the revised Wong scale (R-Wong) which examines the quality of research design, methodology and data analysis, and the revision of the assessment of multiple systematic reviews (R-AMSTAR), which examines the quality of systematic reviews.The Grading of Recommendation Assessment, Development, and Evaluation (GRADE) Working Group developed an instrument called the GRADE system in order to grade the quality of the evidence in studies and to evaluate the strength of recommendation of the intervention that is proposed in the published article. The GRADE looks at four factors to determine the quality of the evidence: study design, study quality, consistency, and directness. After combining the four components and assessing the grade of the evidence, the strength of recommendation of the intervention is established. The GRADE, however, only makes a qualitative assessment of the evidence and does not generate quantifiable data.In this study, we have quantified both the grading of the quality of evidence and also the strength of recommendation of the original GRADE, hence expanding the GRADE. This expansion of the GRADE (Ex-GRADE) permits the creation of a new instrument that can produce tangible data and possibly bridge the gap between evidence-based research and evidence-based clinical practice.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

scholarly journals The use of erythropoietins in oncology

2021 ◽  
Vol 23 (2) ◽  
pp. 248-250
Keyword(s):  
Cancer Patients ◽  
Systematic Reviews ◽  
Gold Standard ◽  
Medical Information ◽  
Evidence Based ◽  
Quality Of Evidence

The editorial article presents information about the problem of the use of erythropoietins in anemia in cancer patients in conjunction with the results of Cochrane systematic reviews the gold standard of the quality of evidence-based medical information.

The Extent and Quality of Evidence in Neurological Physiotherapy: An Analysis of the Physiotherapy Evidence Database (PEDro)

2000 ◽  
Vol 1 (2) ◽  
pp. 130-140 ◽  
Author(s):  
Anne Moseley ◽  
Catherine Sherrington ◽  
Robert Herbert ◽  
Christopher Maher
Keyword(s):  
Systematic Reviews ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Evidence Based ◽  
High Quality ◽  
Quality Of Evidence ◽  
Quality Rating ◽  
Evidence Database ◽  
Randomised Controlled

AbstractEvidence-based practice involves the use of evidence from systematic reviews and randomised controlled trials. The extent of this evidence in neurological physiotherapy has not previously been surveyed. The aim of this study was to describe the quantity and quality of randomised controlled trials, and the quantity and scope of systematic reviews relevant to neurological physiotherapy. PEDro (the Physiotherapy Evidence Database) was searched for trials and reviews relevant to neurological physiotherapy (adult and paediatric). The quality and quantity of trials were analysed, and the topics and conclusions of reviews were synthesised. The search revealed a total of 265 records, consisting of 238 randomised controlled trials and 27 systematic reviews. Since the first trial was published in 1958, the number of trials has expanded exponentially. Fifty-four percent of trials were categorised as being of moderate to high quality, rating five or more out of ten. The first review was published in 1991. Many of the reviews have been unable to reach firm conclusions due to the paucity of available trials. The results show that there is a substantial body of evidence relevant to neurological physiotherapy. However, there remains scope for improvements in the quality of the conduct and reporting of clinical trials. There is an urgent need for more randomised controlled trials and systematic reviews.

scholarly journals Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis

BMJ ◽  
2021 ◽  
pp. e066045 ◽  
Author(s):  
Liang Yao ◽  
Muhammad Muneeb Ahmed ◽  
Gordon H Guyatt ◽  
Peijing Yan ◽  
Xu Hui ◽  
...  
Keyword(s):  
Empirical Analysis ◽  
Data Extraction ◽  
Evaluation Criteria ◽  
Heart Association ◽  
Evidence Based ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Based Guidelines ◽  
Quality Evidence

Abstract Objective To investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines. Design Empirical analysis. Data source Guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) and the American Society of Clinical Oncology (ASCO) up to 27 March 2021. Study selection Recommendations were clearly categorised as consensus or evidence based, were separated from the remainder of the text, and included both the quality of evidence and the strength of the recommendations. Data extraction Paired authors independently extracted the recommendation characteristics, including type of recommendation (consensus or evidence based), grading system used for developing recommendations, strength of the recommendation, and quality of evidence. The study team also calculated the number of discordant recommendations (strong recommendations with low quality evidence) and inappropriate discordant recommendations (those that did not meet grading of recommendations assessment, development, and evaluation criteria of appropriateness). Results The study included 12 ACC/AHA guidelines that generated 1434 recommendations and 69 ASCO guidelines that generated 1094 recommendations. Of the 504 ACC/AHA recommendations based on low quality evidence, 200 (40%) proved to be consensus based versus 304 (60%) evidence based; of the 404 ASCO recommendations based on low quality evidence, 292 (72%) were consensus based versus 112 (28%) that were evidence based. In both ACC/AHA and ASCO guidelines, the consensus approach yielded more discordant recommendations (ACC/AHA: odds ratio 2.1, 95% confidence interval 1.5 to 3.1; ASCO: 2.9, 1.1 to 7.8) and inappropriate discordant recommendations (ACC/AHA: 2.6, 1.7 to 3.7; ASCO: 5.1, 1.6 to 16.0) than the evidence based approach. Conclusion Consensus based guidelines produce more recommendations violating the evidence based medicine principles than evidence based guidelines. Ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of “trustworthy” guidelines.

Coaching Teachers to Enhance the Implementation Quality of Evidence-Based Programs

2013 ◽  
Author(s):  
Kimberly D. Becker ◽  
Dana Darney ◽  
Celene Domitrovich ◽  
Catherine Bradshaw ◽  
Nicholas S. Ialongo
Keyword(s):  
Evidence Based ◽  
Implementation Quality ◽  
Quality Of Evidence ◽  
Evidence Based Programs

scholarly journals Acupuncture for post-stroke depression: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ran Liu ◽  
Kun Zhang ◽  
Qiu-yu Tong ◽  
Guang-wei Cui ◽  
Wen Ma ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Assessment Development ◽  
Significant Difference ◽  
Post Stroke Depression ◽  
Meta Analyses

Abstract Background Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. Methods An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. Results A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I2 = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I2 = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I2 = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I2 = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. Conclusions The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

scholarly journals Concordance between systematic reviews of randomized controlled trials in assisted reproduction: an overview

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Mariano Mascarenhas ◽  
Theodoros Kalampokas ◽  
Sesh Kamal Sunkara ◽  
Mohan S Kamath
Keyword(s):  
Assisted Reproduction ◽  
Systematic Reviews ◽  
Selective Reporting ◽  
Methodological Issues ◽  
Quality Of Evidence ◽  
Randomized Controlled ◽  
Cochrane Reviews ◽  
Secondary Outcomes ◽  
Meta Analyses

Abstract STUDY QUESTION Are systematic reviews published within a 3-year period on interventions in ART concordant in their conclusions? SUMMARY ANSWER The majority of the systematic reviews published within a 3-year period in the field of assisted reproduction on the same topic had discordant conclusions. WHAT IS KNOWN ALREADY Systematic reviews and meta-analyses have now replaced individual randomized controlled trials (RCTs) at the top of the evidence pyramid. There has been a proliferation of systematic reviews and meta-analyses, many of which suffer from methodological issues and provide varying conclusions. STUDY DESIGN, SIZE, DURATION We assessed nine interventions in women undergoing ART with at least three systematic reviews each, published from January 2015 to December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The systematic reviews which included RCTs were considered eligible for inclusion. The primary outcome was extent of concordance between systematic reviews on the same topic. Secondary outcomes included assessment of quality of systematic reviews, differences in included studies in meta-analyses covering the same search period, selective reporting and reporting the quality of evidence. MAIN RESULTS AND THE ROLE OF CHANCE Concordant results and conclusions were found in only one topic, with reviews in the remaining eight topics displaying partial discordance. The AMSTAR grading for the majority of the non-Cochrane reviews was critically low whilst it was categorized as high for all of the Cochrane reviews. For three of the nine topics, none of the included systematic reviews assessed the quality of evidence. We were unable to assess selective reporting as most of the reviews did not have a pre-specified published protocol. LIMITATIONS, REASONS FOR CAUTION We were limited by the high proportion of reviews lacking a pre-specified protocol, which made it impossible to assess for selective reporting. Furthermore, many reviews did not specify primary and secondary outcomes which made it difficult to assess reporting bias. All the authors of this review were Cochrane review authors which may introduce some assessment bias. The categorization of the review’s conclusions as beneficial, harmful or neutral was subjective, depending on the tone and wording of the conclusion section of the review. WIDER IMPLICATIONS OF THE FINDINGS The majority of the systematic reviews published within a 3-year period on the same topic in the field of assisted reproduction revealed discordant conclusions and suffered from serious methodological issues, hindering the process of informed healthcare decision-making. STUDY FUNDING/COMPETING INTEREST(S) All the authors are Cochrane authors. M.S.K. is an editorial board member of Cochrane Gynaecology and Fertility group. No grant from funding agencies in the public, commercial or not-for-profit sectors was obtained.

Qualitative generalising in accounting research: concepts and strategies

2016 ◽  
Vol 29 (6) ◽  
pp. 1100-1131 ◽  
Author(s):  
Lee D. Parker ◽  
Deryl Northcott
Keyword(s):  
Design Methodology ◽  
Research Literature ◽  
Key Factors ◽  
General Applicability ◽  
Information Systems Management ◽  
Content Type ◽  
Accounting Research ◽  
Research Findings ◽  
Quality Of Research

Purpose – The purpose of this paper is to identify and articulate concepts and approaches to qualitative generalisation that will offer qualitative accounting researchers avenues for enhancing and justifying the general applicability of their research findings and conclusions. Design/methodology/approach – The study and arguments draw from multidisciplinary approaches to this issue. The analysis and theorising is based on published qualitative research literatures from the fields of education, health sciences, sociology, information systems, management and marketing, as well as accounting. Findings – The paper develops two overarching generalisation concepts for application by qualitative accounting researchers. These are built upon a number of qualitative generalisation concepts that have emerged in the multidisciplinary literatures. It also articulates strategies for enhancing the generalisability of qualitative accounting research findings. Research limitations/implications – The paper provides qualitative accounting researchers with understandings, arguments and justifications for the generalisability of their research and the related potential for wider accounting and societal contributions. It also articulates the key factors that impact on the quality of research generalisation that qualitative researchers can offer. Originality/value – This paper presents the most comprehensively sourced and developed approach to the concepts, strategies and unique deliverables of qualitative generalising hitherto available in the accounting research literature.

scholarly journals Who guarantees the quality of the quality assurance agencies? The exploration of the establishment and growth of the Asia-Pacific Quality Register (APQR)

2017 ◽  
Vol 11 (2) ◽  
pp. 58-67 ◽  
Author(s):  
Jianxin Zhang ◽  
Jagannath Patil
Keyword(s):  
Higher Education ◽  
Quality Assurance ◽  
Design Methodology ◽  
Asia Pacific ◽  
Qualitative Assessment ◽  
Future Prospects ◽  
Asia Pacific Region ◽  
Content Type ◽  
Quality Register

Purpose After the “quantity era,” today higher education has entered into the “quality era” and as “the gate keepers of quality,” quality assurance agencies (QAAs) are playing more and more irreplaceable important roles and their social status are becoming more and more prominent. However, how to guarantee the quality of the QAAs? Who can review the QAAs? The purpose of this paper is based exploration of these questions. Design/methodology/approach Following the founding of the European Quality Assurance Register (EQAR) for Higher Education, the Asia Pacific Quality Register (APQR) became the second in the international quality assurance (QA) networks to implement QA register, in 2015 with initiative of Asia-Pacific Quality Network. Findings This paper first retrospects the history and process of APQR, and subsequently the implementation of APQR is described in detail from the two aspects of the criteria and the procedure, and at the end, the paper concludes with a summary of the three characteristics of this first formal implement of APQR: APQR is an international register open to all the QAAs; APQR emphasizes characteristics evaluation of diversity; and APQR highlights the combination of quantitative assessment and qualitative assessment. Originality/value Today on the international stage of QA, APQR has emerged as “the watchman of quality” in the Asia-Pacific region as counterpart of EQAR in Europe. How far away does such newly emerging form of guaranteeing the QAAs’ quality go forward, what is its future prospects and other concerning issues, are some of the question that need enthusiastic attention and contribution.

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