GRADE, Summary of Findings and ConQual Workshop
|
|
- Alice Cox
- 5 years ago
- Views:
Transcription
1 GRADE, Summary of Findings and ConQual Workshop
2 To discuss Introduction New JBI Levels of Evidence and Grades of Recommendation Moving towards GRADE Summary of Findings tables Qualitative Levels Conclusion University of Adelaide 2
3 JBI Methodology Groups Formed to provide guidance on emerging methods of evidence synthesis Mixed methods, GRADE, qualitative, umbrella, economic, effects, prevalence, correlation Group formed to review JBI Levels of Evidence University of Adelaide 3
4 Levels of Evidence Grades of Recommendation Designate study type Better study designs, with greater methodological quality, are ranked higher Assist in applying research into practice Recommendations assigned a grade
5 History University of Adelaide 5
6 University of Adelaide 6
7 University of Adelaide 7
8 Old levels of evidence University of Adelaide 8
9 Old Grades of recommendation University of Adelaide 9
10 How are they used? University of Adelaide 10
11 Justification for Change Clarity (not specific) Quasi-experimental studies Not all types of evidence No supporting document Experimental studies Adopt GRADE Difficulties creating recommendations Don t say systematic review University of Adelaide 11
12 Working Party Recommendations 1. JBI adopts the GRADE approach to summary of findings tables for all reviews addressing questions of effect. 2. JBI adopts a modified GRADE approach, based on FAME, for forming recommendations for practice. 3. New levels of evidence under the following headings: Intervention/Therapy/ Harms, Diagnostic Accuracy, Prognosis, Economic Analysis, Qualitative research. 4. JBI adopts an approach based on GRADE but sensitive to the nature of qualitative research for qualitative systematic reviews. 5. JBI contact the GRADE working group to discuss GRADE for the use of JBI, and to offer a partnership for developing GRADE for qualitative research. University of Adelaide 12
13 Why GRADE? Grading of Recommendations Assessment, Development and Evaluation (GRADE) International working group Endorsed by many EBHC organisations (WHO, Cochrane, SIGN, etc) Kerwin et al University of Adelaide 13
14 Why GRADE? University of Adelaide 14
15 Forming recommendations with GRADE Balance between benefits, harms and burdens Quality of Evidence How do we determine quality of the evidence? Patients values and preferences Resource use University of Adelaide 15
16 Example meta-analysis discussion From the examples provided, what information would increase or decrease your confidence in these results? University of Adelaide 16
17 Discussion results Decrease Increase University of Adelaide 17
18 GRADE Decrease Methodological quality (risk of bias) Indirectness (i.e applicability, generalisability, transferability etc) Inconsistency (heterogeneity) Imprecision (uncertainty) Publication bias Increase Large, consistent, precise effect All plausible biases underestimate the effect Dose response effect University of Adelaide 18
19 Quality of evidence: beyond risk of bias Definition: The extent to which our confidence in an estimate of the treatment effect is adequate to support a particular recommendation Methodological limitations Inconsistency of results Indirectness of evidence Imprecision of results Publication bias Risk of bias: Allocation concealment Blinding Intention-to-treat Follow-up Stopped early Sources of indirectness: Indirect comparisons Patients Interventions Comparators Outcomes 19
20 GRADEing the evidence Pre-ranking RCTs start as high, Observational studies as low Quality of evidence ranges from HIGH MODERATE LOW VERY LOW Confidence RCTs start with high quality rating Can be downgraded 1 or 2 points for each area of concern Maximum downgrade of 3 points overall
21 GRADE Quality of Evidence In the context of making recommendations: The quality of evidence reflects the extent of our confidence that the estimates of an effect are adequate to support a particular decision or recommendation
22 Likelihood of and confidence in an outcome
23 Interpretation of grades of evidence /A/High: Further research is very unlikely to change confidence in the estimate of effect. /B/Moderate: Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate. /C/Low: Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. /D/Very low: We have very little confidence in the effect estimate: Any estimate of effect is very uncertain.
24 Summary of Findings tables Standard table format one for each comparison Focus on outcomes Includes: context results GRADE reasons behind decisions
25 Summary of findings table Improve understanding Improve accessibility Created with GRADEpro
26 Presented in a summary of findings table University of Adelaide 26
27 University of Adelaide 27
28 University of Adelaide 28
29 Forming recommendations with GRADE Balance between benefits, harms and burdens Two recommendations Strong and Weak For or against Quality of Evidence Patients values and preferences Resource use University of Adelaide 29
30 Goldet et al University of Adelaide 30
31 Grade up Grade down RCT start high, obs. data start low P I C O Outcome Outcome Outcome Outcome Systematic review Critical Critical Important Low Summary of findings & estimate of effect for each outcome High Moderate Low Very low 1. Risk of bias 2. Inconsistency 3. Indirectness 4. Imprecision 5. Publication bias 1. Large effect 2. Dose response 3. Confounders Guideline development Formulate recommendations: For or against (direction) Strong or weak (strength) By considering: Quality of evidence Balance benefits/harms Values and preferences Revise if necessary by considering: Resource use (cost) Rate overall quality of evidence across outcomes based on lowest quality of critical outcomes We recommend using We suggest using We recommend against using We suggest against using
32 Why still have levels? Other JBI resources (not just systematic reviews) Assist in pre-ranking Address evidence of other types University of Adelaide 32
33 JBI Levels of Evidence OLD LEVELS OF EVIDENCE Feasibility Appropriateness Meaningfulness Effectiveness NEW PROPOSED LEVELS OF EVIDENCE Therapy, harm Diagnostic/screening studies Prognosis Economic evaluations Meaningfulness University of Adelaide 33
34 University of Adelaide 34
35 Levels of evidence: Diagnostic/screening studies Level 1 Studies of Test Accuracy among consecutive patients Level 1.a Systematic reviews of studies of test accuracy among consecutive patients Level 1.b Studies of test accuracy among consecutive patients Level 2 Studies of Test Accuracy among non-consecutive patients Level 2.a Systematic reviews of studies of test accuracy among non-consecutive patients Level 2.b Studies of test accuracy among non-consecutive patients Level 3 Diagnostic Case control studies Level 3.a Systematic reviews of diagnostic case control studies Level 3.b Diagnostic case-control study Level 4 Diagnostic yield studies Level 4.a Systematic reviews of diagnostic yield studies Level 4.b Individual diagnostic yield study Level 5 Expert Opinion and Bench Research Level 5.a Systematic reviews of expert opinion Level 5.b Expert consensus Level 5.c Bench research/ single expert opinion University of Adelaide 35
36 Levels of evidence: Prognosis Level 1 Inception Cohort Studies Level 1.a Systematic reviews of inception cohort studies Level 1.b Inception cohort studies Level 2 Studies of All or none Level 2.a Systematic reviews of studies of all or none studies Level 2.b All or none studies Level 3 Cohort studies Level 3.a Systematic reviews of cohort studies (or control arm of RCT) Level 3.b Cohort studies (or control arm of RCT) Level 4 Case series/case Controlled/ Historically Controlled studies Level 4.a Systematic reviews of Case series/case Controlled/ Historically Controlled studies Level 4.b Individual Case series/case Controlled/ Historically Controlled studies Level 5 Expert Opinion and Bench Research Level 5.a Systematic reviews of expert opinion Level 5.b Expert consensus Level 5.c Bench research/ single expert opinion University of Adelaide 36
37 Levels of evidence: Economic evaluations Level 1: Systematic review of economic evaluations Level 2: Single economic evaluation Level 3: Systematic review of expert opinion Level 4: Expert opinion University of Adelaide 37
38 Levels of evidence: Meaningfulness 1. Qualitative or mixed-methods systematic review 2. Qualitative or mixed-methods synthesis 3. Single qualitative study 4. Systematic review of expert opinion 5. Expert opinion University of Adelaide 38
39 Summary of findings table: Meaningfulness Incorporating a GRADE like rating of quality for studies related to meaningfulness can it be done? Need to consider what increases or decrease confidence in the results University of Adelaide 39
40 Discussion Activity EXAMPLE META-SYNTHESIS From the examples provided, what information would increase or decrease your confidence in these results? Synthesised finding 1 People undergoing imaging often expect a health issue to be found during their scan, which can then lead to anxiety and worry. Munn & Jordan. The patient experience of high technology medical imaging: a systematic review of the qualitative evidence, JBI Library of Systematic Reviews, 2011; 9(19): Synthesised finding 2 Adjust themselves: Caregivers need to adjust themselves to the caregiving role when living with and taking care of persons with schizophrenia. The ultimate goal is to integrate the caregiving role into their lives. Tungpunkom, Napa, Chaniang & Srikhachin. Caregiving experiences of families living with persons with schizophrenia: a systematic review, 2013; 11(8): University of Adelaide 40
41 Discussion Activity EXAMPLE META-SYNTHESIS What information will increase or decrease your confidence in the results? University of Adelaide 41
42 Discussion Activity (some answers) EXAMPLE META-SYNTHESIS What information will increase or decrease your confidence in the results? Type of data Dependability Confidence University of Adelaide 42
43 Meaningfulness Summary of Findings Table Systematic review title: Population: Phenomena of interest: Context: Synthesised Finding Type of data Dependability Confidence Score Comments University of Adelaide 43
44 Type of data Ranking scale consists of 4 levels High Moderate Low Very Low Begin by pre-ranking papers based on type of data High for qualitative studies Low for expert opinion University of Adelaide 44
45 Score of dependability: qualitative research Measurement Measured by asking the following questions: 1. Is there congruity between the research methodology and the research question or objectives? 2. Is there congruity between the research methodology and the methods used to collect data? 3. Is there congruity between the research methodology and the representation and analysis of data? 4. Is there a statement locating the researcher culturally or theoretically? 5. Is the influence of the researcher on the research, and vice-versa, addressed? Ranking system: 4-5 yes responses, the finding remains unchanged 2-3 yes responses: move down 1 level 0-1 yes responses: move down 2 levels University of Adelaide 45
46 Score of dependability: expert opinion Measured by asking questions related to the appropriateness of the conduct of the research with research aims and purpose: 1. Does the source of the opinion have standing in the field of expertise? 2. Is the opinion s basis in logic/experience clearly argued? 3. Is the argument developed analytical? 4. Is there reference to the extant literature/evidence and any incongruence with it logically defended? 5. Is the opinion supported by peers? Ranking system: 4-5 yes responses, the paper remains unchanged (0) 2-3 yes responses: move down 1 level (-1) 0-1 yes responses: move down 2 levels (-2) University of Adelaide 46
47 Score of confidence Measurement Assign a level of credibility to the findings: Unequivocal (findings accompanied by an illustration that is beyond reasonable doubt and; therefore not open to challenge) Equivocal (findings accompanied by an illustration lacking clear association with it and therefore open to challenge) Unsupported (findings are not supported by the data, or with no illustration) Ranking The synthesised findings contains only unequivocal findings Remains unchanged Mix of unequivocal/equivocal findings downgraded one (-1) All equivocal finding down grade 2 (-2) Mix of plausible/unsupported findings downgraded three (-3) Not-supported findings downgraded four (-4) University of Adelaide 47
48 Meaningfulness Summary of Findings Table Systematic review title: The patient experience of high technology medical imaging: a systematic review of the qualitative evidence Population: Persons who had undergone high technology medical imaging Phenomena of interest: The meaningfulness of a patients experience of undergoing diagnostic imaging using high technology Context: Male and Female Adult Patients presenting to a medical imaging department Synthesised Finding People undergoing imaging often expect a health issue to be found during their scan, which can then lead to anxiety and worry Type of research Qualitative (HIGH) Dependability Confidence Score Comments (MODERATE) (LOW) University of Adelaide 48 LOW
49 A new spin on FAME The FAME (Feasibility, Appropriateness, Meaningfulness and Effectiveness) scale informs the recommendation. F Feasibility; specifically: What is the cost effectiveness of the practice? Is the resource/practice available? Is their sufficient experience/levels of competency available? A Appropriateness; specifically: Is it culturally acceptable? Is it transferable to the majority of the population? Is it easily adaptable to a variety of circumstances? M Meaningfulness; specifically: Is it associated with positive experiences? Is it not associated with negative experiences? E Effectiveness; specifically: Was there a beneficial effect? Is it safe? (i.e is there a lack of harm associated with the practice? University of Adelaide 49
50 JBI Grades of Recommendation JBI Grades of Recommendation Grade A A strong recommendation for a certain health management strategy where: it is clear that desirable effects outweigh undesirable effects of the strategy; where there is evidence of adequate quality supporting its use; there is a benefit or no impact on resource use, and values, preferences and the patient experience have been taken into account Grade B A weak recommendation for a certain health management strategy where: desirable effects appear to outweigh undesirable effects of the strategy, although this is not as clear; where there is evidence supporting its use, although this may not be of high quality; there is a benefit, no impact or minimal impact on resource use, and values, preferences and the patient experience may or may not have been taken into account. University of Adelaide 50
51 Recommendations People undergoing scanning are aware that is has the power to detect significant health issues, which can lead to anxious waits and uncertainty after imaging. Once imaging is completed, patients should be given information regarding when they will receive their results, and what will happen now the images have been taken (Grade B) Munn & Jordan. The patient experience of high technology medical imaging: a systematic review of the qualitative evidence, JBI Library of Systematic Reviews, 2011; 9(19):
52 University of Adelaide 52
53 Conclusions Improved clarity in levels of evidence In line with international organisations Changes made to fit with JBI s broader view of what constitutes evidence Guidance provided University of Adelaide 53
The Joanna Briggs Institute Reviewers Manual 2014
The Joanna Briggs Institute Reviewers Manual 2014 Summary of Findings Tables for Joanna Briggs Institute Systematic Reviews www.joannabriggs.org Joanna Briggs Institute Reviewers Manual: 2014 edition/supplement
More informationCritical Appraisal Tools
Appendix 2 Critical Appraisal Tools JBI Critical Appraisal Checklist for Experimental Studies 1. Was the assignment to treatment groups random? 2. Were participants blinded to treatment allocation? 3.
More informationConfidence in qualitative synthesis findings: The ConQual Approach
Confidence in qualitative synthesis findings: The ConQual Approach SR@PU Anna Lloyd May 2018 Aims of session To introduce ConQual as a method for establishing confidence in qualitative synthesis findings
More informationEstablishing confidence in qualitative evidence. The ConQual Approach
Establishing confidence in qualitative evidence The ConQual Approach Objectives To review the JBI conceptualisation of what constitutes evidence for decision making To provide an overview of the JBI approach
More informationGRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2018
GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2018 Previous grading system Level of evidence Strength of recommendation Level of evidence
More informationGRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2014
GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2014 Previous grading system Level of evidence Strength of recommendation Level of evidence
More informationChecklist for Text and Opinion. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Text and Opinion http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationIntroduzione al metodo GRADE
Introduzione al metodo GRADE Atto Billio MD, MSc EBHC Ematologia e TMO-Bolzano Gruppo linee guida SIE Critique of EBM De-emphasizes patient values Doesn t account for individual variation Devalues clinical
More informationCopyright GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD
GRADE ING THE QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS NANCY SANTESSO, RD, PHD ASSISTANT PROFESSOR DEPARTMENT OF CLINICAL EPIDEMIOLOGY AND BIOSTATISTICS, MCMASTER UNIVERSITY Nancy Santesso,
More informationClinical problems and choice of study designs
Evidence Based Dentistry Clinical problems and choice of study designs Asbjørn Jokstad University of Oslo, Norway Nov 21 2001 1 Manipulation with intervention Yes Experimental study No Non-experimental
More informationWhy is ILCOR moving to GRADE?
1 Why is ILCOR moving to GRADE? Associate Professor Peter Morley Director Medical Education Royal Melbourne Hospital University of Melbourne 10 min 2 3 4 5 6 7 Apart from international consensus Allows
More informationWashington, DC, November 9, 2009 Institute of Medicine
Holger Schünemann, MD, PhD Chair, Department of Clinical Epidemiology & Biostatistics Michael Gent Chair in Healthcare Research McMaster University, Hamilton, Canada Washington, DC, November 9, 2009 Institute
More informationChecklist for Randomized Controlled Trials. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Randomized Controlled Trials http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationChecklist for Randomized Controlled Trials. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Randomized Controlled Trials http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationSystematic reviews: From evidence to recommendation. Marcel Dijkers, PhD, FACRM Icahn School of Medicine at Mount Sinai
Systematic reviews: From evidence to recommendation Session 2 - June 18, 2014 Going beyond design, going beyond intervention: The American Academy of Neurology (AAN) Clinical Practice Guideline process
More informationChecklist for Diagnostic Test Accuracy Studies. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Diagnostic Test Accuracy Studies http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationAre the likely benefits worth the potential harms and costs? From McMaster EBCP Workshop/Duke University Medical Center
CRITICAL REVIEW FORM FOR THERAPY STUDY Did experimental and control groups begin the study with a similar prognosis? Were patients randomized? Was randomization concealed? Were patients analyzed in the
More informationDeterminants of quality: Factors that lower or increase the quality of evidence
Determinants of quality: Factors that lower or increase the quality of evidence GRADE Workshop CBO, NHG and Dutch Cochrane Centre CBO, April 17th, 2013 Outline The GRADE approach: step by step Factors
More informationJBI GRADE Research School Workshop. Presented by JBI Adelaide GRADE Centre Staff
JBI GRADE Research School Workshop Presented by JBI Adelaide GRADE Centre Staff Declarations of Interest Presented by members of the GRADE Working Group www.gradeworkinggroup.org The Joanna Briggs Institute
More informationCochrane-GRADE Workshop
Cochrane-GRADE Workshop Modena, June 2017 Holger Schünemann, Elena Parmelli, Sara Balduzzi Jane Noyes, Heather Munthe-Kaas, Claire Glenton Background / history of GRADE and GRADE CERQual Deep vein thrombosis
More informationChecklist for Analytical Cross Sectional Studies. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Analytical Cross Sectional Studies http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationCHECK-LISTS AND Tools DR F. R E Z A E I DR E. G H A D E R I K U R D I S TA N U N I V E R S I T Y O F M E D I C A L S C I E N C E S
CHECK-LISTS AND Tools DR F. R E Z A E I DR E. G H A D E R I K U R D I S TA N U N I V E R S I T Y O F M E D I C A L S C I E N C E S What is critical appraisal? Critical appraisal is the assessment of evidence
More informationAlcohol interventions in secondary and further education
National Institute for Health and Care Excellence Guideline version (Draft for Consultation) Alcohol interventions in secondary and further education NICE guideline: methods NICE guideline Methods
More informationObjectives. Information proliferation. Guidelines: Evidence or Expert opinion or???? 21/01/2017. Evidence-based clinical decisions
Guidelines: Evidence or Expert opinion or???? Objectives Need for guidelines? Prakesh Shah Professor, Department of Pediatrics, Mount Sinai Hospital Institute of Health Policy Management and Evaluation
More informationChecklist for Case Control Studies. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org The Joanna Briggs
More informationACR OA Guideline Development Process Knee and Hip
ACR OA Guideline Development Process Knee and Hip 1. Literature searching frame work Literature searches were developed based on the scenarios. A comprehensive search strategy was used to guide the process
More informationGuideline Development at the American College of Physicians. American College of Physicians
Guideline Development at the American College of Physicians Melissa Starkey, PhD American College of Physicians Institute of Medicine Committee on Preventive Services for Women March 9, 2011 Who is ACP?
More informationCochrane Pregnancy and Childbirth Group Methodological Guidelines
Cochrane Pregnancy and Childbirth Group Methodological Guidelines [Prepared by Simon Gates: July 2009, updated July 2012] These guidelines are intended to aid quality and consistency across the reviews
More informationMINI SYMPOSIUM - EUMASS - UEMASS European Union of Medicine in Assurance and Social Security
MINI SYMPOSIUM - EUMASS - UEMASS European Union of Medicine in Assurance and Social Security Quality of Evidence and Grades of Recommendations in guidelines A role for insurance medicine? Prof. Regina
More informationA Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy
A Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy Executive summary Aims of the review The main aim of the review was to assess the
More informationTraumatic brain injury
Introduction It is well established that traumatic brain injury increases the risk for a wide range of neuropsychiatric disturbances, however there is little consensus on whether it is a risk factor for
More informationThe detection and management of pain in patients with dementia in acute care settings: development of a decision tool: Research protocol.
The detection and management of pain in patients with dementia in acute care settings: development of a decision tool: Research protocol. Aims and Objectives of the overall study The aim of this study
More informationQuality of Clinical Practice Guidelines
Evidence Based Dentistry Quality of Clinical Practice Guidelines Asbjørn Jokstad University of Oslo, Norway 07/04/2005 1 Justification for developing guidelines Demand for effectiveness and efficacy studies
More informationCONSORT 2010 checklist of information to include when reporting a randomised trial*
CONSORT 2010 checklist of information to include when reporting a randomised trial* Section/Topic Title and abstract Introduction Background and objectives Item No Checklist item 1a Identification as a
More informationOnline Annexes (5-8)
Online Annexes (5-8) to WHO Policy guidance: The use of molecular line probe assay for the detection of resistance to second-line anti-tuberculosis drugs THE END TB STRATEGY Online Annexes (5-8) to WHO
More informationPractice guidelines : overview of methodology with focus on GRADE
Practice guidelines : overview of methodology with focus on GRADE Benjamin Djulbegovic, M.D.,Ph.D. Distinguished Professor USF, Dpt of Internal Medicine Chief, Division of Evidence-based Medicine and Health
More informationAppendix 2 Quality assessment tools. Cochrane risk of bias tool for RCTs. Support for judgment
Appendix 2 Quality assessment tools Cochrane risk of bias tool for RCTs Item Judgment (H/L/Unclear) Random sequence generation (selection bias) Allocation concealment (selection bias) Blinding of participants
More informationProblem solving therapy
Introduction People with severe mental illnesses such as schizophrenia may show impairments in problem-solving ability. Remediation interventions such as problem solving skills training can help people
More informationCHAMP: CHecklist for the Appraisal of Moderators and Predictors
CHAMP - Page 1 of 13 CHAMP: CHecklist for the Appraisal of Moderators and Predictors About the checklist In this document, a CHecklist for the Appraisal of Moderators and Predictors (CHAMP) is presented.
More informationThe comparison or control group may be allocated a placebo intervention, an alternative real intervention or no intervention at all.
1. RANDOMISED CONTROLLED TRIALS (Treatment studies) (Relevant JAMA User s Guides, Numbers IIA & B: references (3,4) Introduction: The most valid study design for assessing the effectiveness (both the benefits
More informationUser Manual The Journal Club
User Manual The Journal Club TABLE OF CONTENTS Table of Contents...1 Your Journal Club: Getting Started...2 About Journal Club...4 Home/Login Page...4 JBI Journal Club access denied page.5 Forgot your
More informationMapping the Informed Health Choices (IHC) Key Concepts (KC) to core concepts for the main steps of Evidence-Based Health Care (EBHC).
KC No KC Short Title KC Statement EBHC concept EBHC sub concept EBHC statement EBHC Step Reported 1.01 Treatments can harm Treatments may be harmful Explain the use of harm/aetiologies for (rare) adverse
More informationEvidence Based Medicine
Course Goals Goals 1. Understand basic concepts of evidence based medicine (EBM) and how EBM facilitates optimal patient care. 2. Develop a basic understanding of how clinical research studies are designed
More informationRecent developments for combining evidence within evidence streams: bias-adjusted meta-analysis
EFSA/EBTC Colloquium, 25 October 2017 Recent developments for combining evidence within evidence streams: bias-adjusted meta-analysis Julian Higgins University of Bristol 1 Introduction to concepts Standard
More informationOnline Annexes (5-8)
2016 Online Annexes (5-8) to WHO Policy guidance: The use of molecular line probe assay for the detection of resistance to second-line anti-tuberculosis drugs 1 Contents: Annex 5: GRADE summary of findings
More informationLIHS Mini Master Class
Alexandru Nicusor Matei 2013 CC BY-NC-ND 2.0 Grading the evidence Liz Mitchell Liz Mitchell University of Leeds 2015. This work is made available for reuse under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike
More informationEvaluating the Strength of Clinical Recommendations in the Medical Literature: GRADE, SORT, and AGREE
Evaluating the Strength of Clinical Recommendations in the Medical Literature: GRADE, SORT, and AGREE Mayra Buainain de Castro Maymone 1, Stephanie D. Gan 2 and Michael Bigby 3 Journal of Investigative
More information11 questions to help you make sense of a case control study
Critical Appraisal Skills Programme (CASP) making sense of evidence 11 questions to help you make sense of a case control study How to use this appraisal tool Three broad issues need to be considered when
More informationResults. NeuRA Treatments for internalised stigma December 2017
Introduction Internalised stigma occurs within an individual, such that a person s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of selfworth, anticipation
More informationSystematic reviews and meta-analyses of observational studies (MOOSE): Checklist.
Systematic reviews and meta-analyses of observational studies (MOOSE): Checklist. MOOSE Checklist Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease:
More information1. Draft checklist for judging on quality of animal studies (Van der Worp et al., 2010)
Appendix C Quality appraisal tools (QATs) 1. Draft checklist for judging on quality of animal studies (Van der Worp et al., 2010) 2. NICE Checklist for qualitative studies (2012) 3. The Critical Appraisal
More informationNeuRA Sleep disturbance April 2016
Introduction People with schizophrenia may show disturbances in the amount, or the quality of sleep they generally receive. Typically sleep follows a characteristic pattern of four stages, where stage
More informationAppendix A: Literature search strategy
Appendix A: Literature search strategy The following databases were searched: Cochrane Library Medline Embase CINAHL World Health organisation library Index Medicus for the Eastern Mediterranean Region(IMEMR),
More informationImproving reporting for observational studies: STROBE statement
Improving reporting for observational studies: STROBE statement Technical meeting on the reporting of human studies submitted for the scientific substantiation of health claims EFSA Parma 20 November 2013
More informationControlled Trials. Spyros Kitsiou, PhD
Assessing Risk of Bias in Randomized Controlled Trials Spyros Kitsiou, PhD Assistant Professor Department of Biomedical and Health Information Sciences College of Applied Health Sciences University of
More informationResults. NeuRA Mindfulness and acceptance therapies August 2018
Introduction involve intentional and non-judgmental focus of one's attention on emotions, thoughts and sensations that are occurring in the present moment. The aim is to open awareness to present experiences,
More informationGLOSSARY OF GENERAL TERMS
GLOSSARY OF GENERAL TERMS Absolute risk reduction Absolute risk reduction (ARR) is the difference between the event rate in the control group (CER) and the event rate in the treated group (EER). ARR =
More informationResults. NeuRA Hypnosis June 2016
Introduction may be experienced as an altered state of consciousness or as a state of relaxation. There is no agreed framework for administering hypnosis, but the procedure often involves induction (such
More informationChecklist for Prevalence Studies. The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews
The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Prevalence Studies http://joannabriggs.org/research/critical-appraisal-tools.html www.joannabriggs.org
More informationISPOR Task Force Report: ITC & NMA Study Questionnaire
INDIRECT TREATMENT COMPARISON / NETWORK META-ANALYSIS STUDY QUESTIONNAIRE TO ASSESS RELEVANCE AND CREDIBILITY TO INFORM HEALTHCARE DECISION-MAKING: AN ISPOR-AMCP-NPC GOOD PRACTICE TASK FORCE REPORT DRAFT
More informationSurveillance report Published: 13 April 2017 nice.org.uk. NICE All rights reserved.
Surveillance report 2017 Antisocial behaviour and conduct disorders in children and young people: recognition and management (2013) NICE guideline CG158 Surveillance report Published: 13 April 2017 nice.org.uk
More informationCOMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) POINTS TO CONSIDER ON MISSING DATA
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 15 November 2001 CPMP/EWP/1776/99 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) POINTS TO
More informationBACKGROUND + GENERAL COMMENTS
Response on behalf of Sobi (Swedish Orphan Biovitrum AB) to the European Commission s Public Consultation on a Commission Notice on the Application of Articles 3, 5 and 7 of Regulation (EC) No. 141/2000
More informationOutcomes and GRADE Summary of Findings Tables: old and new
Holger Schünemann, MD, PhD Chair, Dept. of Clinical Epidemiology & Biostatistics Professor of Clinical Epidemiology & Biostatistics and of Medicine Michael Gent Chair in Healthcare Research McMaster University,
More informationComponent of CPG development ILAE Recommendation Document Identifying topic and developing clinical. S3 research question
S1: Summary of recommendations for developing Clinical Practice Guidelines Minimum CPG development requirements (where resources are more limited) are bolded. When full resources are available, every recommendation
More informationMethod. NeuRA Biofeedback May 2016
Introduction is a technique in which information about the person s body is fed back to the person so that they may be trained to alter the body s conditions. Physical therapists use biofeedback to help
More informationOverview and Comparisons of Risk of Bias and Strength of Evidence Assessment Tools: Opportunities and Challenges of Application in Developing DRIs
Workshop on Guiding Principles for the Inclusion of Chronic Diseases Endpoints in Future Dietary Reference Intakes (DRIs) Overview and Comparisons of Risk of Bias and Strength of Evidence Assessment Tools:
More informationAnimal-assisted therapy
Introduction Animal-assisted interventions use trained animals to help improve physical, mental and social functions in people with schizophrenia. It is a goal-directed intervention in which an animal
More informationEVIDENCE-BASED HEALTH CARE
EVIDENCE-BASED HEALTH CARE AND OTHER MYTHS OF A MODERN AGE Peggy Mancuso, PhD, CNM, RN. 1 An Overview of EBM 2 Evidence-Based Health Care Definition Conscientious, explicit, judicious use Current best
More informationGATE CAT Intervention RCT/Cohort Studies
GATE: a Graphic Approach To Evidence based practice updates from previous version in red Critically Appraised Topic (CAT): Applying the 5 steps of Evidence Based Practice Using evidence about interventions
More informationGuideline development in TB diagnostics. Karen R Steingart, MD, MPH McGill University, Montreal, July 2011
Guideline development in TB diagnostics Karen R Steingart, MD, MPH McGill University, Montreal, July 2011 karenst@uw.edu Overview What are guidelines? Quality of guidelines The Grade approach IOM standards
More informationGuidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates
Guidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates 1. Title a. Emphasize the clinical utility of the
More informationOnline Annexes (2-4)
Online Annexes (2-4) to WHO Policy update: The use of molecular line probe assays for the detection of resistance to isoniazid and rifampicin THE END TB STRATEGY Online Annexes (2-4) to WHO Policy update:
More informationContent. Evidence-based Geriatric Medicine. Evidence-based Medicine is: Why is EBM Needed? 10/8/2008. Evidence-based Medicine (EBM)
Content Evidence-based Geriatric Medicine Patricia P. Barry, MD, MPH Review of evidence-based medicine (EBM) and evidence-based practice (EBP) Use of guidelines in evidence-based practice Relevance of
More informationCHECKLIST FOR EVALUATING A RESEARCH REPORT Provided by Dr. Blevins
CHECKLIST FOR EVALUATING A RESEARCH REPORT Provided by Dr. Blevins 1. The Title a. Is it clear and concise? b. Does it promise no more than the study can provide? INTRODUCTION 2. The Problem a. It is clearly
More informationResults. NeuRA Worldwide incidence April 2016
Introduction The incidence of schizophrenia refers to how many new cases there are per population in a specified time period. It is different from prevalence, which refers to how many existing cases there
More informationResearch Approach & Design. Awatif Alam MBBS, Msc (Toronto),ABCM Professor Community Medicine Vice Provost Girls Section
Research Approach & Design Awatif Alam MBBS, Msc (Toronto),ABCM Professor Community Medicine Vice Provost Girls Section Content: Introduction Definition of research design Process of designing & conducting
More informationCEU screening programme: Overview of common errors & good practice in Cochrane intervention reviews
CEU screening programme: Overview of common errors & good practice in Cochrane intervention reviews Since September 2013, the CEU has been responsible for pre-publication screening of new intervention
More informationThe relative importance or values of the main outcomes of interest: Outcome. Survival to Hospital Discharge
Problem Is there a problem priority? Yes The existing evidence, though observational, indirect, imprecise, and thus very low quality, shows a consistent association between hypotension and adverse outcome.
More information5/31/2013. Disclosures. Lumbar Facet Joint Pain: Evidence. I have nothing to disclose
Disclosures : Evidence I have nothing to disclose David J. Lee, MD Professor Pain Management Center Department of Anesthesia Facet Joint Pain Prevalence Spinal pain 54-80% lifetime 80-90% resolve in 6
More information4/10/2018. Choosing a study design to answer a specific research question. Importance of study design. Types of study design. Types of study design
Choosing a study design to answer a specific research question Importance of study design Will determine how you collect, analyse and interpret your data Helps you decide what resources you need Impact
More informationVersion No. 7 Date: July Please send comments or suggestions on this glossary to
Impact Evaluation Glossary Version No. 7 Date: July 2012 Please send comments or suggestions on this glossary to 3ie@3ieimpact.org. Recommended citation: 3ie (2012) 3ie impact evaluation glossary. International
More informationAuthors face many challenges when summarising results in reviews.
Describing results Authors face many challenges when summarising results in reviews. This document aims to help authors to develop clear, consistent messages about the effects of interventions in reviews,
More informationModels for potentially biased evidence in meta-analysis using empirically based priors
Models for potentially biased evidence in meta-analysis using empirically based priors Nicky Welton Thanks to: Tony Ades, John Carlin, Doug Altman, Jonathan Sterne, Ross Harris RSS Avon Local Group Meeting,
More informationResults. NeuRA Family relationships May 2017
Introduction Familial expressed emotion involving hostility, emotional over-involvement, and critical comments has been associated with increased psychotic relapse in people with schizophrenia, so these
More informationCritical appraisal: Systematic Review & Meta-analysis
Critical appraisal: Systematic Review & Meta-analysis Atiporn Ingsathit MD.PhD. Section for Clinical Epidemiology and biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University What is a
More informationEvidence Based Medicine
Hamadan University of medical sciences School of Public Health Department of Epidemiology Evidence Based Medicine Amin Doosti-Irani, PhD in Epidemiology 10 March 2017 a_doostiirani@yahoo.com 1 Outlines
More informationCRITICAL APPRAISAL OF CLINICAL PRACTICE GUIDELINE (CPG)
CRITICAL APPRAISAL OF CLINICAL PRACTICE GUIDELINE (CPG) Atiporn Ingsathit MD, PhD. 1 Rationale for Clinical Practice Guidelines Worldwide concerns about: Unexplained variations in clinical practice Rising
More informationSystematic Reviews and Meta- Analysis in Kidney Transplantation
Systematic Reviews and Meta- Analysis in Kidney Transplantation Greg Knoll MD MSc Associate Professor of Medicine Medical Director, Kidney Transplantation University of Ottawa and The Ottawa Hospital KRESCENT
More informationResults. NeuRA Forensic settings April 2016
Introduction Prevalence quantifies the proportion of individuals in a population who have a disease during a specific time period. Many studies have reported a high prevalence of various health problems,
More informationQuality of Clinical Practice Guidelines
Evidence Based Dentistry Quality of Clinical Practice Guidelines Asbjørn Jokstad University of Oslo, Norway 23 Aug 2001 1 PRACTICE GUIDELINES IN MEDLINE 1400 >1300 1200 1000 800 815 600 592 400 374 200
More informationStatistical considerations in indirect comparisons and network meta-analysis
Statistical considerations in indirect comparisons and network meta-analysis Said Business School, Oxford, UK March 18-19, 2013 Cochrane Comparing Multiple Interventions Methods Group Oxford Training event,
More informationThe Effective Public Health Practice Project Tool
The Effective Public Health Practice Project Tool International Workshop on Evidence-Based Public Health: Concepts and Methods Munich, 17th and 18th November 2010 Dr. Eva Rehfuess Institute for Medical
More informationNeuRA Decision making April 2016
Introduction requires an individual to use their knowledge and experience of a context in order to choose a course of action 1. A person s ability to autonomously make decisions is referred to as their
More informationDistraction techniques
Introduction are a form of coping skills enhancement, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia,
More informationMeta-analyses: analyses:
Meta-analyses: analyses: how do they help, and when can they not? Lee Hooper Senior Lecturer in research synthesis & nutrition l.hooper@uea.ac.uk 01603 591268 Aims Systematic Reviews Discuss the scientific
More informationGRADE Evidence Profiles on Long- and Rapid-Acting Insulin Analogues for the treatment of Diabetes Mellitus [DRAFT] October 2007
GRADE Evidence Profiles on Long- and Rapid-Acting Insulin Analogues for the treatment of Diabetes Mellitus October 2007 Canadian Agency for Drugs and Technologies in Health Disclaimer This report is prepared
More informationImplementation of Evidence Based Medicine in Clinical Teaching and Practices
Implementation of Evidence Based Medicine in Clinical Teaching and Practices Pisake Lumbiganon, MD, MS (Penn) Professor of Ob & Gyn President, Royal Thai College of Obstetricians and Gynecologists Convenor,
More informationLearning objectives. Examining the reliability of published research findings
Examining the reliability of published research findings Roger Chou, MD Associate Professor of Medicine Department of Medicine and Department of Medical Informatics and Clinical Epidemiology Scientific
More informationCRITICAL APPRAISAL SKILLS PROGRAMME Making sense of evidence about clinical effectiveness. 11 questions to help you make sense of case control study
CRITICAL APPRAISAL SKILLS PROGRAMME Making sense of evidence about clinical effectiveness 11 questions to help you make sense of case control study General comments Three broad issues need to be considered
More information