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Find video protocols related to scientific articles indexed in Pubmed.
GENERATING HEALTH TECHNOLOGY ASSESSMENT EVIDENCE FOR RARE DISEASES.
Int J Technol Assess Health Care
PUBLISHED: 11-20-2014
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Objectives: Rare diseases are often heterogeneous in their progression and response to treatment, with only a small population for study. This provides challenges for evidence generation to support HTA, so novel research methods are required. Methods: Discussion with an expert panel was augmented with references and case studies to explore robust approaches for HTA evidence generation for rare disease treatments. Results: Traditional RCTs can be modified using sequential, three-stage or adaptive designs to gain more power from a small patient population or to focus trial design. However, such designs need to maintain important design aspects such as randomization and blinding and be analyzed to take account of the multiple analyses performed. N-of-1 trials use within-patient randomization to test repeat periods of treatment and control until a response is clear. Such trials could be particularly valuable for rare diseases and when prospectively planned across several patients and analyzed using Bayesian techniques, a population effect can be estimated that might be of value to HTA. When the optimal outcome is unclear in a rare disease, disease specific patient reported outcomes can elucidate impacts on patients' functioning and wellbeing. Likewise, qualitative research can be used to elicit patients' perspectives, with just a small number of patients. Conclusions: International consensus is needed on ways to improve evidence collection and assessment of technologies for rare diseases, which recognize the value of novel study designs and analyses in a setting where the outcomes and effects of importance are yet to be agreed.
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A systematic review of contemporary trials of anticoagulants in orthopaedic thromboprophylaxis: suggestions for a radical reappraisal.
J. Thromb. Thrombolysis
PUBLISHED: 11-19-2014
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In the last decade, major advances in venous thromboembolism (VTE) prophylaxis in orthopaedic surgery have included the development of new anticoagulants that are poised to replace low molecular weight heparins (LMWHs) and improvements in operative and perioperative care that have likely led to a decline in the rates of symptomatic VTE and mortality independent of anticoagulant use. A systematic review of the literature was performed to identify phase III randomized controlled trials of VTE prevention that compared new anticoagulants (fondaparinux, rivaroxaban, dabigatran, apixaban) with LMWH (enoxaparin) in major elective orthopaedic surgery. Our aims were to obtain best estimates of the rates of patient important events (symptomatic VTE, mortality, and bleeding) in contemporary trials of VTE prevention, and to consider the implications of these contemporary rates for clinical practice and future research. Fourteen studies, which enrolled 40,285 patients, were included in the analyses. The combined median rates (ranges) for all five anticoagulants for symptomatic VTE and mortality to the end of follow-up were 0.99 % (0.15-2.58 %) and 0.26 % (0-0.92 %) respectively, whereas the median rate (range) of clinically important bleeding was 3.44 % (2.25-7.74 %). In contemporary trials of anticoagulants, the rates of symptomatic VTE and mortality are low, but the rates of clinically important post-operative bleeding remain relatively high. Based on these results, we propose that approaches that minimize bleeding without substantially reducing efficacy merit investigation, particularly if improvement in surgical and perioperative care have also resulted in falling baseline patient important VTE rates independent of anticoagulant use.
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Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the Prevention of Venous Thromboembolism in Critically Ill Patients.
JAMA
PUBLISHED: 11-02-2014
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Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, finding no difference in the primary end point of leg deep-vein thrombosis but a reduced rate of pulmonary embolus and heparin-induced thrombocytopenia among critically ill medical-surgical patients who received dalteparin.
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Patients' values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences.
BMJ Open
PUBLISHED: 10-19-2014
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Symptomatic hip osteoarthritis (OA) is a disabling condition with up to a 25% cumulative lifetime risk. Total hip arthroplasty (THA) is effective in relieving patients' symptoms and improving function. It is, however, associated with substantial risk of complications, pain and major functional limitation before patients can return to full function. In contrast, hip arthroscopy (HA) is less invasive and can postpone THA. However, there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA. Knowing patients' values and preferences (VP) on this expected delay is critical when making recommendations regarding the advisability of HA. Furthermore, little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients' VP.
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Development of a novel multilayered presentation format for clinical practice guidelines.
Chest
PUBLISHED: 10-16-2014
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Background:Bridging the gap between clinical research and everyday healthcare practice requires effective communication strategies. To address current shortcomings in conveying practice recommendations and supporting evidence, we are creating and testing presentation formats for clinical practice guidelines (CPGs). Methods:We carried out multiple cycles of brainstorming and sketching, developing a prototype. Physicians participating in the user testing viewed CPG formats linked to clinical scenarios and engaged in semi-structured interviews applying a think-aloud method for exploring important aspects of user experience. Results:We developed a multilayered presentation format that allows clinicians to successively view more in depth information. Starting with the recommendations clinicians can on demand access a rationale and a key information section containing statements on quality of the evidence, balance between desirable and undesirable consequences, values and preferences, and resource considerations. We collected feedback from 27 stakeholders and performed user testing with 47 practicing physicians from six countries. Advisory group feedback and user testing of the first version revealed problems with conceptual understanding of underlying CPG methodology, as well as difficulties with the complexity of the layout and content. Extensive revisions made before the second round of user testing resulted in most participants expressing overall satisfaction with the final presentation format. Conclusion:We have developed an electronic multilayered CPG format that enhances the usability of CPGs for front-line clinicians. We have implemented the format in electronic guideline tools which guideline organizations can now use when authoring and publishing their guidelines.
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Critical-Sized Defect in the Tibia: Is it Critical? Results From the SPRINT Trial.
J Orthop Trauma
PUBLISHED: 09-19-2014
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The purpose of this study was to determine whether the SPRINT definition of a "critical-sized defect" (fracture gap at least 1 cm in length and involving over 50% of the cortical diameter) was accurate, to discern which factors predict reoperation in patients with these defects, and to compare the patient-based outcomes of these patients with patients without a critical defect.
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Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis.
JAMA
PUBLISHED: 09-04-2014
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Many claims have been made regarding the superiority of one diet or another for inducing weight loss. Which diet is best remains unclear.
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Applying new strategies for the national adaptation, updating, and dissemination of trustworthy guidelines: results from the Norwegian adaptation of the Antithrombotic Therapy and the Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based
Chest
PUBLISHED: 09-03-2014
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The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. We describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination.
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Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process.
Chest
PUBLISHED: 09-03-2014
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Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting.
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Midodrine for orthostatic hypotension and recurrent reflex syncope: A systematic review.
Neurology
PUBLISHED: 08-22-2014
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Symptomatic orthostatic hypotension (SOH) and recurrent reflex syncope (RRS) can be disabling. Midodrine has been proposed in the management of patients with these conditions but its impact on patient important outcomes remains uncertain. We performed a systematic review to evaluate the efficacy and safety of midodrine in patients with SOH and RRS.
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Nifedipine versus Terbutaline, Tocolytic Effectiveness and Maternal and Neonatal Adverse Effects: A Randomized, Controlled Pilot Trial.
Basic Clin. Pharmacol. Toxicol.
PUBLISHED: 08-21-2014
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Although previous evidence suggests advantages of nifedipine over terbutaline as tocolytic agents, in some jurisdictions, terbutaline is approved for use and nifedipine is not. In women in preterm labour, we compared the impact of terbutaline versus nifedipine on inhibition of uterine contractions, preterm birth, neonatal sepsis, intracranial haemorrhage or necrotizing enterocolitis, death or admission to a neonatal intensive care unit and maternal adverse reactions. We randomized 32 women to nifedipine and 34 to terbutaline. We found no difference between groups in tocolysis or preterm birth. No serious maternal adverse effects or serious neonatal adverse outcome occurred in either group. Less serious maternal adverse effects less common with terbutaline included flushing (2.94% versus 43.7%) and headache (5.9% versus 31.2%). The administration of terbutaline increased tremor (76.4% versus 0%), nausea (58.8% versus 9.4%) and dizziness (29.4% versus 6.25%). The total number of side effects, and the proportion of women experiencing one or more side effects, proved greater with terbutaline. In this study, terbutaline and nifedipine performed similarly in their tocolytic effects. Each drug has specific side effects, although overall, nifedipine was associated with fewer adverse effects.
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A systematic review and meta-analysis of caudal block as compared to noncaudal regional techniques for inguinal surgeries in children.
Biomed Res Int
PUBLISHED: 08-05-2014
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This systematic review and meta-analysis were designed to compare the analgesic effectiveness and adverse effects with the use of caudal analgesia as compared to noncaudal regional analgesia techniques in children undergoing inguinal surgeries. MEDLINE, EMBASE, and CENTRAL (Cochrane) databases were searched for randomized control trials published in English language from 1946 up to 2013. Use of rescue analgesia and adverse effects were considered as primary and secondary outcomes, respectively. Outcomes were pooled using random effects model and reported as risk ratio (RR) with 95% CI. Out of 3240 hits and 24 reports for final selection, 17 were included in this review. Caudal analgesia was found to be better in both early (RR = 0.81 [0.66, 0.99], P = 0.04) and late (RR = 0.81 [0.69, 0.96], P = 0.01) periods, but with a significant risk of motor block and urinary retention. According to GRADE, the quality of evidence was moderate. Although potentially superior, caudal analgesia increases the chance of motor block and urinary retention. There are limited studies to demonstrate that the technical superiority using ultrasound translates into better clinical success with the inguinal nerve blocks.
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Brazilian medicinal plants to treat upper respiratory tract and bronchial illness: systematic review and meta-analyses-study protocol.
BMJ Open
PUBLISHED: 07-25-2014
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Respiratory illness, often associated with cough and sputum, is frequent. In Brazil, herbal medicines are often recommended as a first-line treatment for respiratory illness. There exists uncertainty regarding the effectiveness of these treatments. No systematic review has evaluated Brazilian medicinal plants (BMP) to treat upper respiratory tract and bronchial illness (URTI).
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Fluid resuscitation in sepsis: a systematic review and network meta-analysis.
Ann. Intern. Med.
PUBLISHED: 07-23-2014
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Fluid resuscitation is the cornerstone of sepsis treatment. However, whether balanced or unbalanced crystalloids or natural or synthetic colloids confer a survival advantage is unclear.
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0179?Independent Medical Evaluations - Important, neglected, in need of reform: a systematic review.
Occup Environ Med
PUBLISHED: 07-15-2014
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Independent medical evaluations (IMEs) are a common and influential form of assessment, often influencing whether patients receive compensation for an injury or illness. To inform the evidence-base underlying IMEs, we conducted a systematic review of all primary literature conducted in North America.
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0161?Development of an instrument assessing recovery expectations in patients receiving disability benefits secondary to mental health disorders.
Occup Environ Med
PUBLISHED: 07-15-2014
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Of workers approved for long-term disability benefits, 31.6% suffer from a primary mental illness. Negative patient recovery expectations are associated with worse outcome in many conditions. Our objectives were: 1) to complete a systematic review to identify measures that assess patient recovery expectations, and 2) using the results from our review, develop an instrument designed to assess recovery expectations in individuals receiving disability benefits secondary to a mental health disorder.
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0160?Development of an instrument assessing symptom exaggeration in patients receiving disability benefits secondary to mental health disorders.
Occup Environ Med
PUBLISHED: 07-15-2014
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Symptom exaggeration is a significant issue in patients receiving disability benefits secondary to mental health disorders. Measures designed to detect exaggeration of symptoms are valuable for informing more accurate diagnoses, which can impact claim decision-making, both for disability claim approval and patient management. Our objectives were: 1) to complete a systematic review to identify measures that assess symptom exaggeration in mental health disorders, and 2) using the results from the review, develop an instrument assessing symptom exaggeration in individuals receiving disability benefits secondary to mental health disorders.
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0182?Predictors of Workers' Compensation Claim Duration among Workers Disabled Due to Low Back Pain.
Occup Environ Med
PUBLISHED: 07-15-2014
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Low back pain (LBP) is a common complaint among workers receiving Workers' Compensation wage replacement benefits. We used the administrative data from the Ontario Workplace Safety and Insurance Board (WSIB) to explore the association between baseline characteristics and commonly reimbursed therapies and time to claim closure among workers disabled due to LBP.
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How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature.
JAMA
PUBLISHED: 07-10-2014
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Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.
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Shorter or longer anticoagulation to prevent recurrent venous thromboembolism: systematic review and meta-analysis.
BMJ Open
PUBLISHED: 07-06-2014
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Venous thromboembolism (VTE) is a major disease associated with short-term and long-term morbidity and mortality. Patients with a VTE provoked by surgery or immobilisation are at low risk of recurrence and do not require long-term anticoagulation; those with a VTE and metastatic cancer are at high risk of recurrence and require lifetime thromboprophylaxis. In those at intermediate risk of recurrence, it remains controversial whether prolonging anticoagulation and thus incurring treatment burden and bleeding risk is warranted.
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Culprit Vessel Only vs Immediate Complete Revascularization in Patients With Acute ST-Segment Elevation Myocardial Infarction: Systematic Review and Meta-Analysis.
Clin Cardiol
PUBLISHED: 06-27-2014
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Although multivessel coronary artery disease has been associated with poor health outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI), the optimal approach to revascularization remains uncertain. The objective of this review was to determine the benefits and harms of culprit vessel only vs immediate complete percutaneous coronary intervention (PCI) in patients with acute STEMI. We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for randomized controlled trials (RCTs). Teams of 2 reviewers, independently and in duplicate, screened titles and abstracts, completed full-text reviews, and abstracted data. We calculated pooled risk ratios (RRs) and associated 95% confidence intervals (CIs) using random-effect models for nonfatal myocardial infarction (MI), revascularization, cardiovascular mortality, all-cause mortality, and adverse events, and used the GRADE approach to rate confidence in estimates of effect. Of 341 patients randomized to complete revascularization and followed to study conclusion, 31 experienced revascularization, as did 80 of 324 randomized to culprit vessel only revascularization (RR: 0.35, 95% CI: 0.24-0.53). Ten patients in the complete revascularization group and 28 patients in the culprit vessel only revascularization group experienced nonfatal MI (RR: 0.35, 95% CI: 0.17-0.72). All-cause mortality and cardiac deaths did not differ between groups (RR: 0.69, 95% CI: 0.40-1.21 for all-cause mortality; RR: 0.48, 95% CI: 0.22-1.04 for cardiac deaths). Pooled data from 3 RCTs suggest that immediate complete revascularization probably reduces revascularization in patients with acute STEMI; although results suggest possible benefits on MI and death, confidence in estimates is low.
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Trypanocidal drugs for chronic asymptomatic Trypanosoma cruzi infection.
Cochrane Database Syst Rev
PUBLISHED: 05-29-2014
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Prevention of chronic chagasic cardiomyopathy (CCC) by treating infected populations with trypanocidal therapy (TT) remains a challenge. Despite a renewed enthusiasm for TT, uncertainty regarding its efficacy, concerns about its safety and limited availability remain barriers for a wider use of conventional drugs. We have updated a previous version of this review.
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Trial to re-evaluate ultrasound in the treatment of tibial fractures (TRUST): a multicenter randomized pilot study.
Trials
PUBLISHED: 05-21-2014
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The role of low-intensity pulsed ultrasound (LIPUS) in the management of fractures remains controversial. The purpose of this study was to assess the feasibility of a definitive trial to determine the effect of LIPUS on functional and clinical outcomes in tibial fractures managed operatively.
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Digitalis for treatment of heart failure in patients in sinus rhythm.
Cochrane Database Syst Rev
PUBLISHED: 04-29-2014
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Digitalis glycosides have been in clinical use for the treatment of heart failure (HF) for longer than 200 years. In recent years, several trials have been conducted to address concerns about their efficacy and toxicity.
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Considering intellectual, in addition to financial, conflicts of interest proved important in a clinical practice guideline: a descriptive study.
J Clin Epidemiol
PUBLISHED: 04-19-2014
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The American College of Chest Physicians Antithrombotic Guidelines ninth iteration placed restrictions on panelists with recommendations on which they disclosed a primary conflict of interest (COI). We aimed to describe panelists' financial and intellectual COI and evaluate to what extent, beyond assessing financial COI, assessing intellectual COI affected COI management.
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Adaptation of trustworthy guidelines developed using the GRADE methodology: A novel 5-step process.
Chest
PUBLISHED: 04-19-2014
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Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the GRADE methodology aiming for efficiency and transparency. This is the first in a series of four articles describing our adaptation of the 9th iteration of the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis for a Norwegian setting.
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Applying new strategies for the national adaptation, updating and dissemination of trustworthy guidelines: Results from the Norwegian adaptation of the American College of Chest Physicians Evidence-based Guidelines on Antithrombotic Therapy and the Prevention of Thrombo
Chest
PUBLISHED: 04-19-2014
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The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. Here, we describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination.
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Perceptions of authors' contributions are influenced by both byline order and designation of corresponding author.
J Clin Epidemiol
PUBLISHED: 04-12-2014
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We explored how readers interpret authors' roles based on authorship order and corresponding author.
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Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.
CMAJ
PUBLISHED: 04-11-2014
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Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item.
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Health issues and health care expenses in Canadian bankruptcies and insolvencies.
Int J Health Serv
PUBLISHED: 04-02-2014
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Illness can contribute to financial problems directly, through high medical bills, and indirectly, through lost income. No previous in-depth studies have documented the role of medical problems among Canadian bankruptcy filers. We obtained the bankruptcy filings from a random sample of 5,000 debtors across Canada and mailed surveys to them seeking information about the medical antecedents of their bankruptcy. A total of 521 debtors responded (response rate of 10.4%), of whom 40.1 percent reported losing at least two weeks of work-related income because of illness or injury in the two years before their filing; 8.3 percent reported a similar income loss because of caregiving responsibilities for someone else who was ill. Although 60.1 percent of respondents reported being responsible for a medical bill within the previous two years, only 6.9 percent had bills over $5,000 (all amounts in Canadian Dollars). Prescription drugs were cited as the costliest medical expense by two-thirds of debtors reporting bills > $5,000, with dental bills cited by 22.2 percent. Universal health insurance affords Canadians protection against ruinous doctor and hospital bills. Inadequate coverage for prescription drugs and dental care, however, leaves some with unaffordable out-of-pocket costs. In addition, illness is a frequent indirect cause of bankruptcy through loss of work-related income.
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Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives.
Health Expect
PUBLISHED: 03-31-2014
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Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF.
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Systematic review of percutaneous closure versus medical therapy in patients with cryptogenic stroke and patent foramen ovale.
BMJ Open
PUBLISHED: 03-11-2014
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To provide a comprehensive comparison of patent foramen ovale (PFO) closure versus medical therapy in patients with cryptogenic stroke or transient ischaemic attack (TIA) and demonstrated PFO.
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Adherence to guidelines in the use of biological agents to treat psoriasis in Brazil.
BMJ Open
PUBLISHED: 03-07-2014
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In São Paolo, Brazil, patients can appeal to the courts, registering law suits against the government claiming the need for biological agents for treatment of psoriasis. If the lawsuits are successful, which is usually the case, the government then pays for the biologic agent. The extent to which the management of such patients, after gaining access to government payment for their biologic agents, adheres to authoritative guidelines, is uncertain.
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Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.
Fernando Botto, Pablo Alonso-Coello, Matthew T V Chan, Juan Carlos Villar, Denis Xavier, Sadeesh Srinathan, Gordon Guyatt, Patricia Cruz, Michelle Graham, C Y Wang, Otávio Berwanger, Rupert M Pearse, Bruce M Biccard, Valsa Abraham, German Malaga, Graham S Hillis, Reitze N Rodseth, Deborah Cook, Carisi A Polanczyk, Wojciech Szczeklik, Daniel I Sessler, Tej Sheth, Gareth L Ackland, Martin Leuwer, Amit X Garg, Yannick Lemanach, Shirley Pettit, Diane Heels-Ansdell, Giovanna Luratibuse, Michael Walsh, Robert Sapsford, Holger J Schünemann, Andrea Kurz, Sabu Thomas, Marko Mrkobrada, Lehana Thabane, Hertzel Gerstein, Pilar Paniagua, Peter Nagele, Parminder Raina, Salim Yusuf, P J Devereaux, Matthew J McQueen, Mohit Bhandari, Jackie Bosch, Norman Buckley, Clara K Chow, Richard Halliwell, Stephen Li, Vincent W Lee, John Mooney, Mariana V Furtado, Erica Suzumura, Eliana Santucci, Kátia Leite, Jose Amalth do Espirirto Santo, Cesar A P Jardim, Alexandre Biasi Cavalcanti, Helio Penna Guimaraes, Michael J Jacka, Finlay McAlister, Sean McMurtry, Derek Townsend, Neesh Pannu, Sean Bagshaw, Amal Bessissow, Emmanuelle Duceppe, John Eikelboom, Javier Ganame, James Hankinson, Stephen Hill, Sanjit Jolly, Andre Lamy, Elizabeth Ling, Patrick Magloire, Guillaume Paré, Deven Reddy, David Szalay, Jacques Tittley, Jeff Weitz, Richard Whitlock, Saeed Darvish-Kazim, Justin Debeer, Peter Kavsak, Clive Kearon, Richard Mizera, Martin O'Donnell, Matthew McQueen, Jehonathan Pinthus, Sebastian Ribas, Marko Simunovic, Vikas Tandon, Tomas VanHelder, Mitchell Winemaker, Sarah McDonald, Paul O'Bryne, Ameen Patel, James Paul, Zubin Punthakee, Karen Raymer, Omid Salehian, Fred Spencer, Stephen Walter, Andrew Worster, Anthony Adili, Catherine Clase, Mark Crowther, James Douketis, Azim Gangji, Paul Jackson, Wendy Lim, Peter Lovrics, Sergio Mazzadi, William Orovan, Jill Rudkowski, Mark Soth, Maria Tiboni, Rey Acedillo, Amit Garg, Ainslie Hildebrand, Ngan Lam, Danielle MacNeil, Pavel S Roshanov, Sadeesh K Srinathan, Clare Ramsey, Philip St John, Laurel Thorlacius, Faisal S Siddiqui, Hilary P Grocott, Andrew McKay, Trevor W R Lee, Ryan Amadeo, Duane Funk, Heather McDonald, James Zacharias, Olga Lucia Cortes, Maria Stella Chaparro, Skarlett Vásquez, Alvaro Castañeda, Sílvia Ferreira, Pierre Coriat, Denis Monneret, Jean Pierre Goarin, Cristina Ibanez Esteve, Catherine Royer, Georges Daas, Gordon Y S Choi, Tony Gin, Lydia C W Lit, Alben Sigamani, Atiya Faruqui, Radhika Dhanpal, Smitha Almeida, Joseph Cherian, Sultana Furruqh, Lalita Afzal, Preetha George, Shaveta Mala, Holger Schünemann, Paola Muti, Enrico Vizza, G S Y Ong, Marzida Mansor, Alvin S B Tan, Ina I Shariffuddin, V Vasanthan, N H M Hashim, A Wahab Undok, Ushananthini Ki, Hou Yee Lai, Wan Azman Ahmad, Azad H A Razack, Vanessa Valderrama-Victoria, Javier D Loza-Herrera, Maria De Los Angeles Lazo, Aida Rotta-Rotta, Barbara Sokolowska, Jacek Musial, Jacek Górka, Pawel Iwaszczuk, Mateusz Kozka, Maciej Chwala, Marcin Raczek, Tomasz Mrowiecki, Bogusz Kaczmarek, Bruce Biccard, Hussein Cassimjee, Dean Gopalan, Theroshnie Kisten, Aine Mugabi, Prebashini Naidoo, Rubeshan Naidoo, Reitze Rodseth, David Skinner, Alex Torborg, Gerard Urrútia, Mari Luz Maestre, Miquel Santaló, Raúl González, Adrià Font, Cecilia Martínez, Xavier Pelaez, Marta De Antonio, Jose Marcial Villamor, Jesús Alvarez García, Maria José Ferré, Ekaterina Popova, Ignacio Garutti, Carmen Fernandez, Maria Palencia, Susana Díaz, Teresa del Castillo, Alberto Varela, Angeles de Miguel, Manuel Munoz, Patricia Piñeiro, Gabriel Cusati, Maria Del Barrio, Maria José Membrillo, David Orozco, Fidel Reyes, Robert J Sapsford, Julian Barth, Julian Scott, Alistair Hall, Simon Howell, Michaela Lobley, Janet Woods, Susannah Howard, Joanne Fletcher, Nikki Dewhirst, C Williams, A Rushton, I Welters, M Leuwer, Rupert Pearse, Gareth Ackland, Ahsun Khan, Edyta Niebrzegowska, Sally Benton, Andrew Wragg, Andrew Archbold, Amanda Smith, Eleanor McAlees, Cheryl Ramballi, Neil MacDonald, Marta Januszewska, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Ana Gutierrez Del Arroyo, Zhuo Sun, Patrick S Finnegan, Cameron Egan, Hooman Honar, Aram Shahinyan, Krit Panjasawatwong, Alexander Y Fu, Sihe Wang, Edmunds Reineks, Jane Blood, Megan Kalin, David Gibson, Troy Wildes, .
Anesthesiology
PUBLISHED: 02-19-2014
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Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.
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Identification of facilitators and barriers to home dialysis selection by canadian adults with ESRD.
Semin Dial
PUBLISHED: 02-17-2014
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Home dialysis (home HD or home PD) remains underutilized in most jurisdictions. Physicians, advanced-practice nurses, and policy makers working with chronic kidney disease populations can provide insights into patient, healthcare professional, and system-level barriers to home dialysis selection by suitable patients. We used in-depth interviews, with a purposive sampling strategy until informational redundancy was achieved, to elicit barriers and facilitators to home dialysis selection from thirteen informants. We triangulated these data against qualitative data collected in a related survey of nephrologist attitudes. We used a modified grounded theory approach to construct a taxonomy of barriers and facilitators. Informants included nephrologists (n = 11), an advanced-practice nurse, and a health administrator with a provincial renal care organization. We constructed separate taxonomies of barriers and related facilitators that were specific to PD, specific to home HD, and common to both. We distinguished between factors favoring, modifiable factors opposing, and nonmodifiable factors opposing home dialysis selection. Several major themes emerged, including: medical factors, home physical environment, psychological and cognitive factors (knowledge, attitudes, coping styles), social factors (supports, lifestyle), dialysis program, local hospital or regional factors (expertise, resources, local culture), healthcare professional-related factors (knowledge, attitudes, reimbursement), health system-related factors (funding models), and exogenous factors (late referral, technology). We identified several modifiable practices at the level of patient, healthcare professional, dialysis facility, and healthcare system to increase appropriate use of home dialysis. We discuss potential facilitating factors, knowledge gaps, and priorities for future research, and propose potential applications for this novel taxonomy of determinants of dialysis modality choice.
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[Difficulties in the interpretation of the results of biomedical research related to chronic non-communicable disease patient management].
Rev Peru Med Exp Salud Publica
PUBLISHED: 02-12-2014
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The progressive increase in the prevalence of chronic non-communicable diseases (CNCD) has generated a need to change the paradigms in interpreting research about therapeutic and disease control strategies. One aspect to keep in mind is the incorporation of risk awareness that CNCD treatment implies, which creates uncertainty in the treatment result, compared to the curative paradigm that occurs in communicable diseases where a cure is expected. Another aspect is related to clinical trials result reports, where substitute results are used frequently. For example, the therapeutic goal of reducing glycosylated hemoglobin in a diabetic patient instead of showing the results based on treatment benefit (such as prevention of myocardial infarction). Problems arise when looking for a substitute that can replace the result that really matters. That is why we must be alert to the widespread use of results grouping (composite outcomes) which while they allow studies with fewer patients with shorter follow-up times and less expense, they can generate misleading results and show presumed untrue benefits due to improper selection of components of the "composite outcomes". In this article we draw attention to new challenges in the interpretation of scientific studies related to CNCDs.
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Effects of centrally acting angiotensin converting enzyme inhibitors on functional decline in patients with Alzheimer's disease.
J. Alzheimers Dis.
PUBLISHED: 02-06-2014
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Centrally acting angiotensin converting enzyme inhibitors (CACE-Is) are associated with reduced rates of cognitive decline in patients with dementia. CACE-Is may also improve exercise tolerance in functionally impaired older adults with normal cognition, suggesting that CACE-Is may positively influence activities of daily living (ADL) in dementia.
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The statistical significance of randomized controlled trial results is frequently fragile: a case for a Fragility Index.
J Clin Epidemiol
PUBLISHED: 02-05-2014
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A P-value <0.05 is one metric used to evaluate the results of a randomized controlled trial (RCT). We wondered how often statistically significant results in RCTs may be lost with small changes in the numbers of outcomes.
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How to use a subgroup analysis: users' guide to the medical literature.
JAMA
PUBLISHED: 01-23-2014
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Clinicians, when trying to apply trial results to patient care, need to individualize patient care and, potentially, manage patients based on results of subgroup analyses. Apparently compelling subgroup effects often prove spurious, and guidance is needed to differentiate credible from less credible subgroup claims. We therefore provide 5 criteria to use when assessing the validity of subgroup analyses: (1) Can chance explain the apparent subgroup effect; (2) Is the effect consistent across studies; (3) Was the subgroup hypothesis one of a small number of hypotheses developed a priori with direction specified; (4) Is there strong preexisting biological support; and (5) Is the evidence supporting the effect based on within- or between-study comparisons. The first 4 criteria are applicable to individual studies or systematic reviews, the last only to systematic reviews of multiple studies. These criteria will help clinicians deciding whether to use subgroup analyses to guide their patient care.
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A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity.
J Gen Intern Med
PUBLISHED: 01-18-2014
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Many patients of all ages have multiple conditions, yet clinicians often lack explicit guidance on how to approach clinical decision-making for such people. Most recommendations from clinical practice guidelines (CPGs) focus on the management of single diseases, and may be harmful or impractical for patients with multimorbidity. A major barrier to the development of guidance for people with multimorbidity stems from the fact that the evidence underlying CPGs derives from studies predominantly focused on the management of a single disease. In this paper, the investigators from the Improving Guidelines for Multimorbid Patients Study Group present consensus-based recommendations for guideline developers to make guidelines more useful for the care of people with multimorbidity. In an iterative process informed by review of key literature and experience, we drafted a list of issues and possible approaches for addressing important coexisting conditions in each step of the guideline development process, with a focus on considering relevant interactions between the conditions, their treatments and their outcomes. The recommended approaches address consideration of coexisting conditions at all major steps in CPG development, from nominating and scoping the topic, commissioning the work group, refining key questions, ranking importance of outcomes, conducting systematic reviews, assessing quality of evidence and applicability, summarizing benefits and harms, to formulating recommendations and grading their strength. The list of issues and recommendations was reviewed and refined iteratively by stakeholders. This framework acknowledges the challenges faced by CPG developers who must make complex judgments in the absence of high-quality or direct evidence. These recommendations require validation through implementation, evaluation and refinement.
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Heparin-induced thrombocytopenia in the critically ill: interpreting the 4Ts test in a randomized trial.
J Crit Care
PUBLISHED: 01-09-2014
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Thrombocytopenia occurs in 20% to 45% of critically ill medical-surgical patients. The 4Ts heparin-induced thrombocytopenia (HIT) score (with 4 domains: Thrombocytopenia, Timing of thrombocytopenia, Thrombosis and oTher reason[s] for thrombocytopenia) might reliably identify patients at low risk for HIT. Interobserver agreement on 4Ts scoring is uncertain in this setting.
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Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: a multicenter survey.
J Crit Care
PUBLISHED: 01-06-2014
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The objective of this study was to identify the self-reported barriers to and facilitators of prescribing low-molecular-weight heparin (LMWH) thromboprophylaxis in the intensive care unit (ICU).
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World Health Organization recommendations are often strong based on low confidence in effect estimates.
J Clin Epidemiol
PUBLISHED: 01-03-2014
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Expert guideline panelists are sometimes reluctant to offer weak/conditional/contingent recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against strong recommendations when confidence in effect estimates is low or very low, suggesting that such recommendations may seldom be justified. We aim to characterize the classification of strength of recommendations and confidence in estimates in World Health Organization (WHO) guidelines that used the GRADE approach and graded both strength and confidence (GRADEd).
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Activity-based funding of hospitals and its impact on mortality, readmission, discharge destination, severity of illness, and volume of care: a systematic review and meta-analysis.
PLoS ONE
PUBLISHED: 01-01-2014
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Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care.
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Systematic review of observational studies assessing bleeding risk in patients with atrial fibrillation not using anticoagulants.
PLoS ONE
PUBLISHED: 01-01-2014
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Patients with atrial fibrillation considering use of anticoagulants must balance stroke reduction against bleeding risk. Knowledge of bleeding risk without the use of anticoagulants may help inform this decision.
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Jejunostomy tube feeding in patients undergoing esophagectomy.
Can J Surg
PUBLISHED: 11-29-2013
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Surgical jejunostomy tubes are a routine part of elective esophagectomies in patients with carcinomas and provide a route for nutritional support in those who experience complications. We wished to determine how frequently oral intake is delayed and the amount of nutrition delivered via the jejunostomy tube.
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Fluid resuscitation in severe sepsis and septic shock: systematic description of fluids used in randomized trials.
Pol. Arch. Med. Wewn.
PUBLISHED: 11-04-2013
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 Fluid therapy is one of the cornerstones of initial management of sepsis, but the choice of fluids used for resuscitation is controversial. 
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A methodological survey of the analysis, reporting and interpretation of Absolute Risk ReductiOn in systematic revieWs (ARROW): a study protocol.
Syst Rev
PUBLISHED: 09-10-2013
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Clinicians, providers and guideline panels use absolute effects to weigh the advantages and downsides of treatment alternatives. Relative measures have the potential to mislead readers. However, little is known about the reporting of absolute measures in systematic reviews. The objectives of our study are to determine the proportion of systematic reviews that report absolute measures of effect for the most important outcomes, and ascertain how they are analyzed, reported and interpreted.
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Predictors of Mortality in Patients With an Implantable Cardiac Defibrillator: A Systematic Review and Meta-analysis.
Can J Cardiol
PUBLISHED: 08-07-2013
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Many current predictors of mortality in heart failure (HF) were evaluated before the use of implantable cardioverter defibrillators (ICDs). We conducted a meta-analysis to identify factors associated with mortality in ICD-HF patients.
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Creating clinical practice guidelines we can trust, use, and share: a new era is imminent.
Chest
PUBLISHED: 08-07-2013
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Standards and guidance for developing trustworthy clinical practice guidelines are now available, and a number of leading guidelines adhere to the key standards. Even current trustworthy guidelines, however, generally suffer from a cumbersome development process, suboptimal presentation formats, inefficient dissemination to clinicians at the point of care, high risk of becoming quickly outdated, and suboptimal facilitation of shared decision-making with patients. To address these limitations, we have--in our innovative research program and nonprofit organization, MAGIC (Making GRADE the Irresistible Choice)--constructed a conceptual framework and tools to facilitate the creation, dissemination, and dynamic updating of trustworthy guidelines. We have developed an online application that constitutes an authoring and publication platform that allows guideline content to be written and structured in a database, published directly on our web platform or exported in a computer-interpretable language (eg, XML) enabling dissemination through a wide range of outputs that include electronic medical record systems, web portals, and applications for smartphones/tablets. Modifications in guidelines, such as recommendation updates, will lead to automatic alterations in these outputs with minimal additional labor for guideline authors and publishers, greatly facilitating dynamic updating of guidelines. Semiautomated creation of a new generation of decision aids linked to guideline recommendations should facilitate face-to-face shared decision-making in the clinical encounter. We invite guideline organizations to partner with us (www.magicproject.org) to apply and further improve the tools for their purposes. This work will result in clinical practice guidelines that we cannot only trust, but also easily share and use.
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Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review.
Circ Heart Fail
PUBLISHED: 07-25-2013
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Optimal management of heart failure requires accurate assessment of prognosis. Many prognostic models are available. Our objective was to identify studies that evaluate the use of risk prediction models for mortality in ambulatory patients with heart failure and describe their performance and clinical applicability.
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Mandatory contrast-enhanced venography to detect deep-vein thrombosis (DVT) in studies of DVT prophylaxis: upsides and downsides.
Thromb. Haemost.
PUBLISHED: 07-12-2013
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The introduction of venography into patient care was a major advance because it was the first accurate method for the diagnosis of DVT. Compression ultrasound has since become the preferred test for patients with suspected DVT because, unlike venography, it is simple, non-invasive and widely available. Venography has facilitated the development and approval of new anticoagulants and remains widely used as an efficacy outcome in trials of venous thromboembolism prevention. Most thrombi detected by screening venography are, however, small and unimportant for patients. In order to calculate the trade-off between an asymptomatic thrombus and a bleed we require an estimate of the number of asymptomatic thrombi that must be prevented to avoid a patient-important thrombus. A credible estimate of this ratio is not available. Therefore when used as a measure of efficacy in trials of thromboprophylaxis, venography has limitations for comparingthe relative effects of alternative antithrombotic agents on outcomes important to patients.
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The Quick Mild Cognitive Impairment screen correlated with the Standardized Alzheimers Disease Assessment Scale-cognitive section in clinical trials.
J Clin Epidemiol
PUBLISHED: 07-06-2013
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The Alzheimers Disease Assessment Scale-cognitive section and its standardized version (SADAS-cog) are the current standard for assessing cognitive outcomes in clinical trials of dementia. This study compares a shorter cognitive instrument, the Quick Mild Cognitive Impairment (Qmci) screen, with the SADAS-cog as outcome measures in clinical trials.
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Using GRADE for evaluating the quality of evidence in hyperbaric oxygen therapy clarifies evidence limitations.
J Clin Epidemiol
PUBLISHED: 06-05-2013
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The current evidence rating for hyperbaric oxygen therapy indications uses the American Heart Association system, which mainly depends on the study design.
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Initiation and continuation of randomized trials after the publication of a trial stopped early for benefit asking the same study question: STOPIT-3 study design.
Trials
PUBLISHED: 06-03-2013
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Randomized control trials (RCTs) stopped early for benefit (truncated RCTs) are increasingly common and, on average, overestimate the relative magnitude of benefit by approximately 30%. Investigators stop trials early when they consider it is no longer ethical to enroll patients in a control group. The goal of this systematic review is to determine how investigators of ongoing or planned RCTs respond to the publication of a truncated RCT addressing a similar question.Methods/designWe will conduct systematic reviews to update the searches of 210 truncated RCTs to identify similar trials ongoing at the time of publication, or started subsequently, to the truncated trials (subsequent RCTs). Reviewers will determine in duplicate the similarity between the truncated and subsequent trials. We will analyze the epidemiology, distribution, and predictors of subsequent RCTs. We will also contact authors of subsequent trials to determine reasons for beginning, continuing, or prematurely discontinuing their own trials, and the extent to which they rely on the estimates from truncated trials.
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Opioids for chronic non-cancer pain: a protocol for a systematic review of randomized controlled trials.
Syst Rev
PUBLISHED: 05-14-2013
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Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.
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Assessing and presenting summaries of evidence in Cochrane Reviews.
Syst Rev
PUBLISHED: 05-09-2013
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Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care. The goal of the Cochrane Applicability and Recommendation Methods Group (ARMG) is to develop approaches, strategies and guidance that facilitate the uptake of information from Cochrane Reviews and their use by a wide audience with specific focus on developers of recommendations and on healthcare decision makers. This paper is part of a series highlighting developments in systematic review methodology in the 20 years since the establishment of The Cochrane Collaboration, and its aim is to present current work and highlight future developments in assessing and presenting summaries of evidence, with special focus on Summary of Findings (SoF) tables and Plain Language Summaries.A SoF table provides a concise and transparent summary of the key findings of a review in a tabular format. Several studies have shown that SoF tables improve accessibility and understanding of Cochrane Reviews.The ARMG and GRADE Working Group are working on further development of the SoF tables, for example by evaluating the degree of acceptable flexibility beyond standard presentation of SoF tables, developing SoF tables for diagnostic test accuracy reviews and interactive SoF tables (iSoF).The plain language summary (PLS) is the other main building block for dissemination of review results to end-users. The PLS aims to summarize the results of a review in such a way that health care consumers can readily understand them. Current efforts include the development of a standardized language to describe statistical results, based on effect size and quality of supporting evidence.Producing high quality PLS and SoF tables and making them compatible and linked would make it easier to produce dissemination products targeting different audiences (for example, providers, health policy makers, guideline developers).Current issues of debate include optimal presentation formats of SoF tables, the training required to produce SoF tables, and the extent to which the authors of Cochrane Reviews should provide explicit guidance to target audiences of patients, clinicians and policy-makers.
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A users guide to understanding therapeutic substitutions.
J Clin Epidemiol
PUBLISHED: 03-16-2013
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Therapeutic substitutions are common at the level of ministries of health, clinicians, and pharmacy dispensaries. Guidance in determining whether drugs offer similar risk-benefit profiles is limited. Those making decisions on therapeutic substitutions should be aware of potential biases that make differentiating therapeutic agents difficult. Readers should consider whether the biological mechanisms and doses are similar across agents, whether the evidence is sufficiently valid across agents, and whether the safety and therapeutic effects of each drug are similar. This article uses a problem-based format to address the biological mechanism, validity, and results of a scenario in which therapeutic substitutions may be considered.
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Changes in circulating progenitor cells are associated with outcome in heart failure patients: a longitudinal study.
Can J Cardiol
PUBLISHED: 03-04-2013
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Circulating progenitor cells (CPCs) are involved in the process of endothelial repair and are a prognostic factor in cardiovascular diseases. We evaluated the association between serial measurements of CPCs and functional capacity and outcomes in heart failure (HF).
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Patient-reported outcomes in meta-analyses - part 2: methods for improving interpretability for decision-makers.
Health Qual Life Outcomes
PUBLISHED: 02-11-2013
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Systematic reviews and meta-analyses of randomized trials that include patient-reported outcomes (PROs) often provide crucial information for patients, clinicians and policy-makers facing challenging health care decisions. Based on emerging methods, guidance on improving the interpretability of meta-analysis of patient-reported outcomes, typically continuous in nature, is likely to enhance decision-making. The objective of this paper is to summarize approaches to enhancing the interpretability of pooled estimates of PROs in meta-analyses. When differences in PROs between groups are statistically significant, decision-makers must be able to interpret the magnitude of effect. This is challenging when, as is often the case, clinical trial investigators use different measurement instruments for the same construct within and between individual randomized trials. For such cases, in addition to pooling results as a standardized mean difference, we recommend that systematic review authors use other methods to present results such as relative (relative risk, odds ratio) or absolute (risk difference) dichotomized treatment effects, complimented by presentation in either: natural units (e.g. overall depression reduced by 2.4 points when measured on a 50-point Hamilton Rating Scale for Depression); minimal important difference units (e.g. where 1.0 unit represents the smallest difference in depression that patients, on average, perceive as important the depression score was 0.38 (95%CI 0.30 to 0.47) units less than the control group); or a ratio of means (e.g. where the mean in the treatment group is divided by the mean in the control group, the ratio of means is 1.27, representing a 27%relative reduction in the mean depression score).
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Patient-reported outcomes in meta-analyses--Part 1: assessing risk of bias and combining outcomes.
Health Qual Life Outcomes
PUBLISHED: 02-11-2013
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Systematic reviews and meta-analyses of randomized trials that include patient-reported outcomes (PROs) often provide crucial information for patients and clinicians facing challenging health care decisions. Based on emerging methods, guidance on combining PROs in meta-analysis is likely to enhance their usefulness.The objectives of this paper are: i) to describe PROs and why they are important for health care decision-making, ii) illustrate the key risk of bias issues that systematic reviewers should consider and, iii) address outcome characteristics of PROs and provide guidance for combining outcomes.We suggest a step-by-step approach to addressing issues of PROs in meta-analyses. Systematic reviewers should begin by asking themselves if trials have addressed all the important effects of treatment on patients quality of life. If the trials have addressed PROs, have investigators chosen the appropriate instruments? In particular, does evidence suggest the PROs used are valid and responsive, and is the review free of outcome reporting bias? Systematic reviewers must then decide how to categorize PROs and when to pool results.
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GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendations direction and strength.
J Clin Epidemiol
PUBLISHED: 01-16-2013
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In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADEs approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention.
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Adjudication of bleeding outcomes in an international thromboprophylaxis trial in critical illness.
Thromb. Res.
PUBLISHED: 01-12-2013
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Measuring bleeding in critical care trials is challenging. We determined the reliability of adjudicated bleeding assessments in a large thromboprophylaxis trial in the intensive care unit (ICU).
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.