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The Article Alert for the week of September 28, 2015 (sample articles)
Missiou A, Tatsioni A. Systematic reviews do not comment on applicability for primary care. J.Clin.Epidemiol. 2015 Oct;68(10):1152-60. PMID: 26093310.
Objectives: How often authors comment on applicability for primary care in systematic reviews of clinical trials.
Study Design and Setting: We selected 4% of the Cochrane Database for Systematic Reviews (CDSRs; January 2008 to October 2013). We excluded reviews when primary care trials were not eligible. We extracted whether authors explicitly reported in methods that primary care trials were eligible or this was unclear/missing. Reporting any comment on applicability for primary care in discussion was considered as primary outcome.
Results: Of the 163 reviews, 30 (18.4%) stated that primary care trials were eligible, whereas 133 (81.6%) provided no data. Of the 30 reviews, 19 (63.0%) reported in discussion that results might be applicable for primary care and one (4.0%) that were feasible in nonspecialized settings. Of the 133 reviews, 6 (4.5%) mentioned in discussion that results might be applicable for primary care and 12 (9.0%) that were applicable in specialized care only. Commenting on applicability for primary care in discussion was significantly associated with reporting in methods that primary care trials were eligible (odds ratio 6.7, 95% confidence interval 2.6-17.4; P-value <0.001).
Conclusions: Authors usually do not comment on the applicability of results for primary care.
Copyright © 2015 Elsevier Inc. All rights reserved.
- DOI: http://dx.doi.org/10.1016/j.jclinepi.2015.06.003
- PubMed: http://www.ncbi.nlm.nih.gov/pubmed/26093310
Pearce W, Raman S, Turner A. Randomised trials in context: practical problems and social aspects of evidence-based medicine and policy. Trials. 2015 Sep 1;16(1):394. PMID: 26341114.
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.
- FREE FULL TEXT: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560875/pdf/13063_2015_Article_917.pdf
- DOI: http://dx.doi.org/10.1186/s13063-015-0917-5
- PubMed: http://www.ncbi.nlm.nih.gov/pubmed/26341114
- PubMed Central: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560875/
Yoong SL, Clinton-McHarg T, Wolfenden L. Systematic reviews examining implementation of research into practice and impact on population health are needed. J.Clin.Epidemiol. 2015 Jul;68(7):788-91. PMID: 25619562.
Objectives: To examine the research translation phase focus (T1-T4) of systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). Briefly, T1 includes reviews of basic science experiments; T2 includes reviews of human trials leading to guideline development; T3 includes reviews examining how to move guidelines into policy and practice; and T4 includes reviews describing the impact of changing health practices on population outcomes.
Study Design and Setting: A cross-sectional audit of randomly selected reviews from CDSR (n = 500) and DARE (n = 500) was undertaken. The research translation phase of reviews, overall and by communicable disease, noncommunicable disease, and injury subgroups, were coded by two researchers.
Results: A total of 898 reviews examined a communicable, noncommunicable, or injury-related condition. Of those, 98% of reviews within CDSR focused on T2, and the remaining 2% focused on T3. In DARE, 88% focused on T2, 8.7% focused on T1, 2.5% focused on T3, and 1.3% focused on T4. Almost all reviews examining communicable (CDSR 100%, DARE 93%), noncommunicable (CDSR 98%, DARE 87%), and injury (CDSR 95%, DARE 88%) were also T2 focused.
Conclusion: Few reviews exist to guide practitioners and policy makers with implementing evidence-based treatments or programs.
Copyright © 2015 Elsevier Inc. All rights reserved.