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Cebm-Levels-Of-Evidence-Background-Document-2-1.Pdf
Background document Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence Introduction The OCEBM Levels of Evidence was designed so that in addition to traditional critical appraisal, it can be used as a heuristic that clinicians and patients can use to answer clinical questions quickly and without resorting to pre-appraised sources. Heuristics are essentially rules of thumb that helps us make a decision in real environments, and are often as accurate as a more complicated decision process. A distinguishing feature is that the Levels cover the entire range of clinical questions, in the order (from top row to bottom row) that the clinician requires. While most ranking schemes consider strength of evidence for therapeutic effects and harms, the OCEBM system allows clinicians and patients to appraise evidence for prevalence, accuracy of diagnostic tests, prognosis, therapeutic effects, rare harms, common harms, and usefulness of (early) screening. Pre-appraised sources such as the Trip Database (1), (2), or REHAB+ (3) are useful because people who have the time and expertise to conduct systematic reviews of all the evidence design them. At the same time, clinicians, patients, and others may wish to keep some of the power over critical appraisal in their own hands. History Evidence ranking schemes have been used, and criticised, for decades (4-7), and each scheme is geared to answer different questions(8). Early evidence hierarchies(5, 6, 9) were introduced primarily to help clinicians and other researchers appraise the quality of evidence for therapeutic effects, while more recent attempts to assign levels to evidence have been designed to help systematic reviewers(8), or guideline developers(10). -
A Critical Examination of the Idea of Evidence‑Based Policymaking
A critical examination of the idea of evidence‑based policymaking KARI PAHLMAN Abstract Since the election of the Labour Government in the United Kingdom in the 1990s on the platform of ‘what matters is what works’, the notion that policy should be evidence-based has gained significant popularity. While in theory, no one would suggest that policy should be based on anything other than robust evidence, this paper critically examines this concept of evidence-based policymaking, exploring the various complexities within it. Specifically, it questions the political nature of policymaking, the idea of what actually counts as evidence, and highlights the way that evidence can be selectively framed to promote a particular agenda. This paper examines evidence-based policy within the realm of Indigenous policymaking in Australia. It concludes that the practice of evidence-based policymaking is not necessarily a guarantee of more robust, effective or successful policy, highlighting implications for future policymaking. Since the 1990s, there has been increasing concern for policymaking to be based on evidence, rather than political ideology or ‘program inertia’ (Nutley et al. 2009, pp. 1, 4; Cherney & Head 2010, p. 510; Lin & Gibson 2003, p. xvii; Kavanagh et al. 2003, p. 70). Evolving from the practice of evidence-based medicine, evidence-based policymaking has recently gained significant popularity, particularly in the social services sectors (Lin & Gibson 2003, p. xvii; Marston & Watts 2003, p. 147; Nutley et al. 2009, p. 4). It has been said that nowadays, ‘evidence is as necessary to political conviction as it is to criminal conviction’ (Solesbury 2001, p. 4). This paper will critically examine the idea of evidence-based policymaking, concluding that while research and evidence should necessarily be a part of the policymaking process and can be an important component to ensuring policy success, there are nevertheless significant complexities. -
Final Roadmap: March 2015 2
Final Roadmap: March 2015 2 Photo: ©Fotolia Grant agreement no. 282586 ROAMER: A roadmap for mental health research in Europe Coordination and Support Action Objective THEME [HEALTH.2011.3.3-4] Roadmap for Mental Health and Well-being Research in Europe Deliverable reference number and title: D11.4 Due date of deliverable: month 42 Actual submission date: 27/05/2015 Start date of project: October the 1st 2011 Duration: 42 months 2UJDQLVDWLRQQDPHRIOHDGEHQH¿FLDU\IRUWKLVGHOLYHUDEOH KCL - IOPPN / UNIMAN AUTHORS Prof. Til Wykes / Dr. Stefano Belli / Prof. Shôn Lewis (WP11) CIBERSAM-PSSJD Dr. Josep Maria Haro, Dr. Carla Obradors Tarragó (COORD) APPROVAL KCL - IOPPN / UNIMAN WORK-PACKAGE LEADER Prof. Til Wykes (WP11) CIBERSAM-PSSJD PROJECT COORDINATOR Dr. Josep Maria Haro (COORD) AUTHORISATION EUROPEAN PROJECT OFFICER Barbara Kerstiens COMMISSION Project co-funded by the European Commission within the Seventh Framework Programme (2007-2013) Dissemination Level(Please choose) PU Public X PP Restricted to other programme participants (including the Commission Services) RE 5HVWULFWHGWRDJURXSVSHFL¿HGE\WKHFRQVRUWLXP LQFOXGLQJWKH&RPPLVVLRQ6HUYLFHV CO &RQ¿GHQWLDORQO\IRUPHPEHUVRIWKHFRQVRUWLXP LQFOXGLQJWKH&RPPLVVLRQ6HUYLFHV Contents Contents ................................................................... 4 Partners.................................................................... 6 Executive Summary ......................................................... 8 1.Introduction ............................................................. 11 Structure -
Health Research Policy and Systems Provided by Pubmed Central Biomed Central
View metadata, citation and similar papers at core.ac.uk brought to you by CORE Health Research Policy and Systems provided by PubMed Central BioMed Central Guide Open Access SUPPORT Tools for evidence-informed health Policymaking (STP) 17: Dealing with insufficient research evidence Andrew D Oxman*1, John N Lavis2, Atle Fretheim3 and Simon Lewin4 Address: 1Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway, 2Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University, 1200 Main St. West, HSC-2D3, Hamilton, ON, Canada, L8N 3Z5, 3Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway; Section for International Health, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Norway and 4Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway; Health Systems Research Unit, Medical Research Council of South Africa Email: Andrew D Oxman* - [email protected]; John N Lavis - [email protected]; Atle Fretheim - [email protected]; Simon Lewin - [email protected] * Corresponding author Published: 16 December 2009 <supplement>byof thethe fundersEuropean had<title> Commission's a role <p>SUPPORT in drafting, 6th Framework revising Tools for or evidence-informedINCOapproving programme, the content health contract of thisPolicymaking 031939. series.</note> The (STP)</p> Norwegian </sponsor> </title> Agency <note>Guides</note> <editor>Andy for Development Oxman Cooperation<url>http://www.biomedcentral.com/content/pdf/1478-4505-7-S1-info.pdf</url> and Stephan (N Hanney</editor>orad), the Alliance <sponsor> for Health <note>This Policy and seriesSystems of articlesResearch, was and prepared the </supplement> Milbank as part Memorial of the SUPPORT Fund provided project, additional which wasfunding. -
Evidence-Based Medicine: Is It a Bridge Too Far?
Fernandez et al. Health Research Policy and Systems (2015) 13:66 DOI 10.1186/s12961-015-0057-0 REVIEW Open Access Evidence-based medicine: is it a bridge too far? Ana Fernandez1*, Joachim Sturmberg2, Sue Lukersmith3, Rosamond Madden3, Ghazal Torkfar4, Ruth Colagiuri4 and Luis Salvador-Carulla5 Abstract Aims: This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components; and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. Results: The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer’s ability to handle large amounts of data, have paved the way for the development of the EBM movement. It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients’ values and the context. -
Iain Chalmers Coordinator, James Lind Initiative GIMBE Convention
La campagna Lancet-REWARD: Some highlights over the past 40 years of ridurre gli sprechi e premiare my association with Italian colleagues il rigore scientifico Iain Chalmers Coordinator, James Lind Initiative GIMBE Convention Nazionale Bologna, 9 novembre 2016 1 Established 1994 2015 2012 1994 La campagna Lancet-REWARD: ridurre gli sprechi e premiare il rigore scientifico Evolution of concern about waste in research What should we think about researchers who use the wrong techniques, use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions? We should be appalled. Yet numerous studies of the medical literature, in both general and specialist journals, have shown that all of the above phenomena are common. This is surely a scandal. We need less research, better research, and research done for the right reasons. 2 Recent evolution of concern about waste in research 2009 2 2014 42 2015 236 Lancet Adding Value, Reducing Lancet Adding Value, Reducing Waste 2014 Waste 2014 www.researchwaste.net www.researchwaste.net NIHR Adding Value in Research NIHR Adding Value in Research Framework Framework Lancet Adding Value, Reducing Waste 2014 www.researchwaste.net NIHR Adding Value in Research Framework 1. Waste resulting from funding and endorsing unnecessary or badly designed research 3 Alessandro Liberati Reports of new research should begin and end with systematic reviews of what is already known. Reports of new research should begin and end with systematic reviews of what is already known. Failure to do this has resulted in avoidable suffering and death. 4 Inappropriate continued use of placebo controls in clinical trials assessing the effects on death of antibiotic prophylaxis for colorectal surgery Horn J, Limburg M. -
Working with Bipolar Disorder During the Covid-19 Pandemic: Both Crisis and Opportunity
Journal Articles 2020 Working with bipolar disorder during the covid-19 pandemic: Both crisis and opportunity E. A. Youngstrom S. P. Hinshaw A. Stefana J. Chen K. Michael See next page for additional authors Follow this and additional works at: https://academicworks.medicine.hofstra.edu/articles Part of the Psychiatry Commons Recommended Citation Youngstrom EA, Hinshaw SP, Stefana A, Chen J, Michael K, Van Meter A, Maxwell V, Michalak EE, Choplin EG, Vieta E, . Working with bipolar disorder during the covid-19 pandemic: Both crisis and opportunity. 2020 Jan 01; 7(1):Article 6925 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/articles/ 6925. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. For more information, please contact [email protected]. Authors E. A. Youngstrom, S. P. Hinshaw, A. Stefana, J. Chen, K. Michael, A. Van Meter, V. Maxwell, E. E. Michalak, E. G. Choplin, E. Vieta, and +3 additional authors This article is available at Donald and Barbara Zucker School of Medicine Academic Works: https://academicworks.medicine.hofstra.edu/articles/6925 WikiJournal of Medicine, 2020, 7(1):5 doi: 10.15347/wjm/2020.005 Encyclopedic Review Article What are Systematic Reviews? Jack Nunn¹* and Steven Chang¹ et al. Abstract Systematic reviews are a type of review that uses repeatable analytical methods to collect secondary data and analyse it. Systematic reviews are a type of evidence synthesis which formulate research questions that are broad or narrow in scope, and identify and synthesize data that directly relate to the systematic review question.[1] While some people might associate ‘systematic review’ with 'meta-analysis', there are multiple kinds of review which can be defined as ‘systematic’ which do not involve a meta-analysis. -
The Prospect of Data-Based Medicine in the Light of ECPC
The Prospect of Data-based Medicine in the Light of ECPC FREDERICK MOSTELLER Harvard School o f Public Health esides st e a d il y in f u s i n g th eir contributions to medicine over the last century, scientific researchers increas ingly have applied their methods to assess new medical technolo Bgies (Institute of Medicine 1985). Physicians learned that predictions from basic science alone were not enough; they had to find out whether innovations actually helped the patient. Often, new treatments did help, as demonstrated by the examples of vaccination, insulin, and anes thetics; sometimes, as in the experiments with gastric freezing, they did not; in other situations, like routine iron and folate supplements for pregnant women, we still do not know whether benefits follow from the innovation (Chalmers, Enkin, and Keirse 1989). Assessment techniques are many and include data-gathering methods such as randomized clini cal trials (RCTs), controlled observational studies, case-controlled stud ies, sample surveys, studies of claims records, and laboratory analyses. Although differing in how well they assess interventions, these methods nevertheless provide the findings that make it possible to base a practice of medicine on data or evidence. What Is ECPC? One group at Oxford, led by Iain Chalmers, has collected the results of empirical investigations in a particular field — obstetrics — and has orga- The Milbank Quarterly, Vol. 71, No. 3, 1993 © 1993 Milbank Memorial Fund 5 M Frederick Mosteller nized the experimental, epidemiologic, -
Hong Kong Principles
1 The Hong Kong Principles for Assessing Researchers: 2 Fostering Research Integrity 3 4 David Moher1,2, Lex Bouter3,4, Sabine Kleinert5, Paul Glasziou6, Mai Har Sham7 5 Virginia Barbour8, Anne-Marie Coriat9, Nicole Foeger10, Ulrich Dirnagl11 6 7 1Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute; 2School of 8 Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; 3Department of Epidemiology 9 and Biostatistics, Amsterdam University Medical Centers, location VUmc; 4Department of Philosophy, 10 Faculty of Humanities, Vrije Universiteit, Amsterdam, The Netherlands; 5The Lancet, London Wall Office, 11 London, UK; 6Institute for Evidence-Based healthcare, Bond University, Gold Coast, Qld, Australia; and 12 7School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong 13 Kong SAR, China; 8Queensland University of Technology (QUT), Brisbane, Australia; 9Wellcome Trust, 14 London; 10Austrian Agency for Research Integrity, Vienna, Austria; 11Berlin Institute of Health, QUEST 15 Center for Transforming Biomedical Research, Berlin, Germany 16 17 David Moher: ORCID 0000-0003-2434-4206 18 Lex Bouter: ORCID 0000-0002-2659-5482 19 Sabine Kleinert: ORCID 0000-0001-7826-1188 20 Paul Glasziou: ORCID 0000-0001-7564-073X 21 Mai Har Sham: ORCID 0000-0003-1179-7839 22 Virginia Barbour: ORCID: 0000-0002-2358-2440 23 Anne-Marie Coriat: ORCID 0000-0003-2632-1745 24 Nicole Foeger: ORCID 0000-0001-7775-7325 25 Ulrich Dirnagl: ORCID 0000-0003-0755-6119 26 27 28 23rd November 2019 29 Abstract 30 31 The primary goal of research is to advance knowledge. For that knowledge to benefit research and 32 society, it must be trustworthy. -
Annual Report 1995 to 1996 and Strategic Plan
The Nordic Cochrane Centre and Network Report 1995-1996 and Strategic plan for 1997 ADDRESS: The Nordic Cochrane Centre Rigshospitalet, Dept. 5222 Blegdamsvej 9 DK-2100 Copenhagen Ø Denmark Tel: +45 35 45 55 71 Fax: +45 35 45 65 28 Email: [email protected] 25 November 1996 CONTENTS SUMMARY 1 THE COCHRANE COLLABORATION 2 Background 2 Aims and principles 2 Collaboration 3 Organization 3 Collaborative review groups 3 Handsearchers 3 Fields 3 Cochrane Centres 4 Methods working groups 4 Steering Group 4 Financial support 5 The Cochrane Library 5 Derivative publications 6 THE NORDIC COCHRANE CENTRE AND NETWORK 6 Aims 6 Current staff at the Nordic Cochrane Centre 7 Nordic Cochrane Network 7 Advisory Board 8 Sources of funding support 8 ACTIVITIES 1995-1996 8 Third annual Cochrane Colloquium 9 Handsearching of randomised trials 9 Review groups 9 Methods working groups 10 Cochrane Workshops 10 Courses on systematic reviews 10 Exploratory and other meetings for review groups 11 Advisory Board meetings 11 Software development 11 Dissemination 11 References 12 Acknowledgements 12 STRATEGIC PLAN FOR 1997 13 Principal objectives 13 Targets 14 APPENDIX 1. Relevant publications 1995-1996 16 APPENDIX 2. Meetings and courses addressed 1995-1996 19 APPENDIX 3. Visitors received at the Centre since 1993 21 1 SUMMARY Reports of original medical research are far too numerous and dispersed to be of practical value to clinicians and other decision makers in health care. Reviews of research thus occupy a key position in the chain which links research with clinical practice. However, because scientific principles have not generally guided reviews of research evidence, useless and even harmful forms of health care have not been distinguished efficiently from useful forms of care. -
COVID-19 Rush Journal Club
COVID-19 Rush Journal Club NOVEL CORONAVIRUS SARS-COV-2. Transmission electron micrograph of SARS-CoV-2 virus particles, iso- lated from a patient. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: NIAID Available at: https://www.flickr.com/photos/niaid/49597768397/in/al- bum-72157712914621487/. Accessed April 19, 2020. This document is a collection of efforts from students of Rush University. It provides brief reviews of research articles regarding COVID-19. We hope that this will be helpful to clinicians, students, community leaders, and the general public. This document, however, does not act as a replacement of the original source documents. Please use the DOI on each page to read more. Student Editors Blake Beehler, MD Alyssa Coleman, MS3 Kelsey Danley, MD Shyam Desai, MD Joshua Doppelt, MD Lindsay Friedman, MS3 Danesha Lewis, PhD student John Levinson, MS2 Luke McCormack, MS2 Diana Parker, MS2 Ayesan Rewane, MSCR Lance Shaull, MD Audrey Sung, MS3 Jackie Urban, MD Student Editors in Chief Beth Hall, MD Bijan Zarrabi, MS2 Faculty Editors and Mentors Frank Cockerill, MD - Adjunct Professor of Medicine Mete Altintas, PhD - Associate Professor of Internal Medicine Graphic design Sam Auger, MD Beth Hall, MD Is there a study you’d like us to review? Do you have questions or feedback? Please email: [email protected] COVID-19Reviews are provided by students at Rush University and edited by Rush Rushfaculty. Journal Level Club of evidence in each study, if applicable, -
Randomised Trials in Context: Practical Problems and Social Aspects of Evidence-Based Medicine and Policy Warren Pearce1*, Sujatha Raman1 and Andrew Turner2
Pearce et al. Trials (2015) 16:394 DOI 10.1186/s13063-015-0917-5 TRIALS REVIEW Open Access Randomised trials in context: practical problems and social aspects of evidence-based medicine and policy Warren Pearce1*, Sujatha Raman1 and Andrew Turner2 Abstract Randomised trials can provide excellent evidence of treatment benefit in medicine. Over the last 50 years, they have been cemented in the regulatory requirements for the approval of new treatments. Randomised trials make up a large and seemingly high-quality proportion of the medical evidence-base. However, it has also been acknowledged that a distorted evidence-base places a severe limitation on the practice of evidence-based medicine (EBM). We describe four important ways in which the evidence from randomised trials is limited or partial: the problem of applying results, the problem of bias in the conduct of randomised trials, the problem of conducting the wrong trials and the problem of conducting the right trials the wrong way. These problems are not intrinsic to the method of randomised trials or the EBM philosophy of evidence; nevertheless, they are genuine problems that undermine the evidence that randomised trials provide for decision-making and therefore undermine EBM in practice. Finally, we discuss the social dimensions of these problems and how they highlight the indispensable role of judgement when generating and using evidence for medicine. This is the paradox of randomised trial evidence: the trials open up expert judgment to scrutiny, but this scrutiny in turn requires further expertise. Background expertise to interpret and integrate research evidence Randomised trials can provide excellent evidence of with patient values is always contingent on social and treatment benefit in medicine.