Promoting use of the best evidence and patient values and preferences to inform optimal clinical and health policy decisions. https://nitter.gq/t.co/JxbX7cZMgy
Hamilton, On. Canada
Joined June 2014
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During the #COVID-19 pandemic, the MAGIC-supported #WHO living guideline, published in The #BMJ, demonstrated how living guidelines can rapidly translate emerging evidence into trusted clinical recommendations.
A landmark example of living guidelines in action!
bmj.com/content/370/bmj.m337…
Faces of #EBM past and EBM future at recent Guideline International meeting. Arnav Agarwal a brilliant young internist and clinical epidemiologist just finishing his PhD with us and now in a faculty position in Edmonton, already leading the world in guideline methodology. Spectacular contributions sure to be coming.
Measurement of symptoms and #QualityofLlife in patients with chronic obstructive pulmonary disease (#COPD) compares six measurement instruments. Disease-specifc more responsive than generic, Chronic #Respiratory Questionnaire (#CRQ) most responsive of all.
pubmed.ncbi.nlm.nih.gov/1678…
We’ve been educating clinicians about #EBM for over 35 years, looking back nothing beats some early efforts. Example: paper for clinicians explaining measures of association. #AI says: This classic paper bridges the gap between statistical results and clinical decision-making.
pubmed.ncbi.nlm.nih.gov/7828…
At Guideline International meeting with Elie Akl, brilliant contributor to methods guidance including missing data, now Research Dean at the American University in Beirut doing amazing work enhancing research at his institution.
No important advances in critical appraisal of differential diagnosis since this #JAMA Users Guide. Remains the best clear exposition.
pubmed.ncbi.nlm.nih.gov/1019…
Just published big news: ROBUST-RCT first instrument designed for RCTs to show, in the words of the authors: “a reliable and straightforward tool for assessing the risk of bias in systematic reviews”. Contrast with Cochrane Rob 2 which is not straightforward or reliable.
sciencedirect.com/science/ar…
Demonstration of impact of research on policy. This review showed no clear benefits of activity-based funding that pays hospitals a fixed fee per patient and risks of increased post-acute care readmissions helped stop spread of ABF in Canada.
pubmed.ncbi.nlm.nih.gov/2534…
Recent Guideline International meeting Prashanti Eachemapati remarkable presentation: guideline dissemination throughout development process; methods innovation (SPICE #GRADE causal chain biology; JUDGE implementing Core GRADE); startlingly original guideline education strategy. #GIN
youtube.com/watch?v=PVXLkEI3…
Studies of minimally important differences (#MID) in patient reported outcomes can use receiver operating characteristic (#ROC) analysis. This study demonstrates that precision, validity optimal when using the entire cohort rather than just adjacent response categories
pubmed.ncbi.nlm.nih.gov/1901…
With my heroes Inday and Tony Dans who have made enormous contributions to health care in the Philippines including key role in fourfold increase in tabaco taxes, proceeds to health care; at their home in Manilla with three children, spouses, grandkids. See what children are spelling?
#SystematicReview provides moderate certainty evidence of benefit of #midodrine in recurrent reflex #syncope but also demonstrates approaches to pooling results from studies using different instruments to measure same symptoms – a methods challenge that continues to evolve.
pubmed.ncbi.nlm.nih.gov/2515…
Just published @JAMAInternalMed: Brilliant essay describes how clinician-facing #AI medical knowledge platforms risk severe quality degradation over time as private capital and corporate profit motives drive a process of platform decay and what we can do about it.
pubmed.ncbi.nlm.nih.gov/4250…
#GRADE summary of findings tables require footnotes explaining reasons for rating down certainty of evidence for the outcomes included. There’s an art to doing it well: this paper tells you how
pubmed.ncbi.nlm.nih.gov/2679…
Published in @JAMA_current , brilliant demonstration of selective reporting. #Cochrane #MetaAnalyses: for each outcome, on average less than half the eligible trials contributed to estimates. The fewer included, the larger the effect size! Studies with null effect weren’t reporting!
pubmed.ncbi.nlm.nih.gov/1728…
Sample size estimation often a hoax, driven by feasibility and available funding. #SystematicReviews generate precise estimates of effect to guide clinical decisions. Grant submissions should justify #RCTs on contribution to international efforts to answer important questions.
pubmed.ncbi.nlm.nih.gov/1817…
Just published study of #GRADE practice in #SystematicReviews. How often do reviews assess whether results show any effect (threshold the null) and how often whether they show important effect (threshold minimal important difference). Answer, about equal. Both useful approaches.
pubmed.ncbi.nlm.nih.gov/4258…
In Canada in general, and in academic medicine in particular, we’ve come a long way to address gender bias against women. Nevertheless, this study demonstrates underfunding of women applicants to Canada’s most prestigious funding body. Stil a way to go.
pubmed.ncbi.nlm.nih.gov/3161…
Just published brilliant, deeply insightful paper from ethicist and academic pediatrician specializing in adolescent medicine coauthors vividly demonstrates how #EBM has been unconscionably misused by #AntiTrans forces wishing to deny #GenderAffirming care.
pubmed.ncbi.nlm.nih.gov/4254…