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.

Doing no harm: Addressing the quality of evidence in translating research to practice in preliminary research fields

2017 ◽  
Vol 5 (4) ◽  
pp. 490
Author(s):  
Mei'En Lim ◽  
Corrine Reid
Keyword(s):  
Research Evaluation ◽  
Evidence Base ◽  
Current Evidence ◽  
Rating Systems ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Research Fields ◽  
Evidence Quality ◽  
Evidence Rating

Background: Current evidence appraisal rating systems, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, are oriented toward and anchored by randomized controlled trials (RCTs) as the gold standard methodology. In many fields, this standard of evidence is rarely, if ever, met. Often, research at the clinical application end of the translational process is embedded in real world practice that does not lend itself to RCTs and is characterised by more pragmatic research using mixed methodologies. Arguably, accountability through research evaluation is even more important in such cases where research design is preliminary and clinical impact is, often, already a reality. Further, practice translation must be privileged as the central goal of the research synthesis under such circumstances in that the destination of all clinical science is the person of the patient.. Methods: In response to these demand characteristics, a practitioner-informed research framework was used to drive and pilot development of an evidence quality grading system that could accommodate a disparate and oblique evidence base. Reid’s person-centered framework was used to establish whether clinician-derived criteria for quality research practice had been met. Results: This brief report presents the Quality of Evidence Rating System (QERS) in the hope of facilitating discussion about accountability pathways for translational scientist-practitioners.Conclusion: The QERS provides a scaffold to help when looking for evidence that researchers have consciously addressed the issues of evidence quality when reporting their research in the published literature.

Improving quality of cancer care by rapid adoption of new scientific evidence.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 62-62
Author(s):  
Joanne Schottinger ◽  
Violeta Rabrenovich ◽  
David Campen ◽  
Dean Fredriks
Keyword(s):  
Cancer Care ◽  
Scientific Evidence ◽  
Care Program ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Chemotherapy Administration ◽  
Inpatient Settings ◽  
New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

scholarly journals Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhujiazi Zhang ◽  
Luodan Suo ◽  
Jingbin Pan ◽  
Dan Zhao ◽  
Li Lu
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Varicella Vaccine ◽  
Vaccine Effectiveness ◽  
Healthy Children ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Significant Difference ◽  
Evidence Quality

Abstract Background The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. Methods We searched for observational studies on two-dose varicella VE for children in China aged 1–12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. Results A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69–97%). The VE of outbreak studies (87% [95% CI: 76–93%]) was lower than non-outbreak studies (99% [95% CI: 98–99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was “low”, which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was “moderate”. Conclusions The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

scholarly journals Are we ready for evidence-based prosthodontics? - A literature review

2021 ◽  
Vol 7 (4) ◽  
pp. 188-194
Author(s):  
Ayush Srivastava ◽  
Ranjoy Hazra ◽  
Dinesh Kumar ◽  
Amit Khattak ◽  
V S Legha ◽  
...  
Keyword(s):  
Case Reports ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Individual Preference ◽  
Current Evidence ◽  
Evidence Based ◽  
The Individual ◽  
The Right ◽  
The Cost

Traditional methods will be rendered obsolete, if not supplemented by current techniques and evidence. This requires a clinician to continuously recognize, scrutinize and consolidate the best available scientific literature in the field. Continuous improvement in the quality of research conducted, as well as reporting the findings should be encouraged to improve upon current and future treatments. This review showcases the most prominent controversies in prosthodontics and how the current evidence answers the questions. A PubMed, Met line and google scholar search with the keywords, Evidence-based dentistry and Evidence-based Prosthodontics was done from the year 1960-2021. Meta-analysis of randomized control trials and systematic reviews related to the evidence in complete dentures, fixed partial dentures, implants and prosthodontics were considered in the inclusion criteria. Literature reviews and case reports were excluded from the search. Evidence-based practice is a new level of sophistication in the practice of dentistry. Rather than considering the cost of material or the individual preference of the operator, choosing the right technique to maximize clinical efficiency should be based on scientific evidence.

scholarly journals Quality of Evidence Supporting the Role of Acupuncture for the Treatment of Irritable Bowel Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jinke Huang ◽  
Mengxiong Lu ◽  
Yijun Zheng ◽  
Jinxin Ma ◽  
Xiangxue Ma ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Reporting Quality ◽  
Current Evidence ◽  
Assessment Development ◽  
Evidence Quality ◽  
Irritable Bowel ◽  
Meta Analyses

Objectives. To systematically collate, appraise, and synthesize the current evidence on acupuncture for irritable bowel syndrome (IBS). Methods. Systematic reviews (SRs)/meta-analyses (MAs) of acupuncture for IBS were searched in eight databases. For quality evaluation of the enrolled studies, Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) was used for methodological quality, Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) for reporting quality, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for evidence quality. Results. Ten studies were included in our review. According to AMSTAR-2, only one study met all the criteria and was rated as high methodological quality, and the rest were rated as low or very low methodological quality. According to the PRISMA checklist, most of the items were fully reported, with the exception of Q5 (protocol and registration), Q8 (search), and Q27 (funding). With the GRADE system, no outcome measure was rated as high quality. Conclusions. Acupuncture may be a promising therapy for IBS. However, this conclusion must be treated with caution since the quality of SRs/MAs providing evidence is generally low.

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.

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 Herbal Medicine (Sihogayonggolmoryeo-Tang or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for Treating Hypertension:A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Boram Lee ◽  
Chan-Young Kwon
Keyword(s):  
Herbal Medicine ◽  
Adverse Events ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Consistent Difference ◽  
Serious Adverse Events ◽  
Quality Of Evidence ◽  
Assessment Development

Introduction. For situations in which effective and safe natural-derived products to treat hypertension are needed, recent studies suggest that an herbal medicine, Sihogayonggolmoryeo-tang (SYM), can improve both hypertension and concurrent mood symptoms. We aimed to evaluate the effectiveness and safety of SYM in treating hypertension. Methods. Thirteen English, Korean, and Chinese databases were comprehensively searched from their inception to May 2020. Randomized controlled trials (RCTs) using SYM as a monotherapy or adjunctive therapy for hypertension were evaluated. The primary outcome was the systolic and diastolic blood pressure (BP). Descriptive analyses of the relevant data were conducted, and where appropriate data were available, a meta-analysis was performed, and the results were presented as a risk ratio or mean difference with 95% confidence intervals. The risk of bias was assessed using the Cochrane risk of bias tool, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results. Seven RCTs with 711 participants were included. Compared with placebo, SYM significantly lowered systolic and diastolic BP and concurrent depression. SYM significantly lowered systolic and diastolic BP compared with active controls; however, subgroup analysis revealed no differences between SYM and antihypertensives. In addition, SYM significantly decreased the level of concurrent depression compared with antidepressants. There was no consistent difference in BP reduction between SYM combined with antihypertensives and antihypertensives alone. No serious adverse events were reported following SYM administration. Most of the included studies had an unclear risk of bias, and the quality of evidence was generally rated “low.” Conclusion. Current evidence suggests that SYM may have the potential to lower hypertension and concurrent depressive symptoms without serious adverse events. Additional high-quality, placebo-controlled RCTs should be conducted to confirm the efficacy of SYM.

Plasma Ablation vs Other Hot Techniques for Tonsillectomy: A Meta-analysis

2020 ◽  
Vol 163 (5) ◽  
pp. 860-869
Author(s):  
Guo Liu ◽  
Ciyun Xiao ◽  
Xu Zhou ◽  
Feng Liu
Keyword(s):  
Postoperative Pain ◽  
Meta Analysis ◽  
Postoperative Bleeding ◽  
Normal Diet ◽  
Current Evidence ◽  
Assessment Development ◽  
Plasma Ablation ◽  
Evidence Quality ◽  
The Difference

Objective To evaluate whether plasma ablation tonsillectomy is superior to other hot techniques in reducing postoperative morbidity. Data Sources The databases of PubMed, EMBASE, and Web of Science were used to search the literature, from inception to January 2, 2020. Randomized controlled trials (RCTs) that compared plasma ablation tonsillectomy with any other hot techniques were eligible. Review Methods A modified Cochrane tool was used to assess the risk of bias. The standardized mean difference (SMD) and 95% confidence interval (CI) were used to estimate pooled effects of postoperative pain, and the risk ratio (RR) was used for postoperative bleeding. Subgroup analysis was prespecified to explore the source of heterogeneity. The evidence quality of each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results A total of 15 RCTs were included (n = 1293). Comparing with other hot techniques, plasma ablation tonsillectomy may cause less pain on postoperative day 7 (SMD, −0.53; 95% CI, −0.84 to −0.23). However, the magnitude of the difference may be clinically meaningless. There were no significant differences not only in terms of postoperative pain on day 1 and day 3 but also in the incidence of postoperative bleeding, reoperation hemostasis, and return to normal diet and activities between the 2 groups. Conclusion There is still substantial uncertainty on postoperative pain, bleeding, and recovery. The current evidence is insufficient to demonstrate that plasma ablation is superior to other hot techniques for tonsillectomy.

scholarly journals Scientific Evidence of Xuebijing Injection in the Treatment of Sepsis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Sa Tian ◽  
Defang Qin ◽  
Yixuan Ye ◽  
Huawei Yang ◽  
Shuguang Chen ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Scientific Evidence ◽  
Reporting Quality ◽  
Current Evidence ◽  
Quality Reporting ◽  
Xuebijing Injection ◽  
Evidence Quality ◽  
Meta Analyses

Objectives. To systematically collate, appraise, and synthesize the current evidence on the Xuebijing injection (XBJI) for sepsis. Methods. Eight databases were searched for systematic reviews (SRs) or meta-analyses (MAs) on XBJI for sepsis. Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2), Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA), and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methods were used to assess the methodological quality, reporting quality, and evidence quality of the enrolled studies, respectively. Results. Out of the 13 studies that were included, all studies were rated critically low quality based on AMSTAR-2 results. Based on the results obtained from PRISMA, all studies were reported to be over 80%, while the GRADE system yielded three outcome measures rated high-quality, 16 were of moderate quality, and the rest were of low or critically low quality. Conclusions. The combination of XBJI and Western medicine (WM) showed significant synergy for the treatment of sepsis compared to WM alone. However, this conclusion should be treated with caution since the quality of the SRs/MAs providing the evidence was relatively low.

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