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Chalmers I. Adrian Grant's pioneering use of evidence synthesis in perinatal medicine, 1980-1992. Reprod Health 2018; 15:79. [PMID: 29764443 PMCID: PMC5952701 DOI: 10.1186/s12978-018-0518-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
Systematic reviews of existing research are needed to help reduce the enormous amount of wasted resources in biomedical research. Whether already available or needed but unavailable, systematic reviews are a key element in prioritising questions for new research, and for informing the design of additional studies. One of the most important of Adrian Grant’s many contributions was to recognise this a decade before it began to become more widely accepted. In this sphere, as well as in many others, he was a real pioneer.
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Vaysbrot EE, Osani MC, Musetti MC, McAlindon TE, Bannuru RR. Are bisphosphonates efficacious in knee osteoarthritis? A meta-analysis of randomized controlled trials. Osteoarthritis Cartilage 2018; 26:154-164. [PMID: 29222056 DOI: 10.1016/j.joca.2017.11.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/25/2017] [Accepted: 11/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To clarify the effects of bisphosphonates in knee osteoarthritis (OA) using an up-to-date meta-analysis of randomized controlled trials (RCTs). DESIGN The protocol is registered in PROSPERO (CRD42017073449). We searched MEDLINE, EMBASE, Google Scholar, Web of Science, and Cochrane Database from inception until August 2017. We included only RCTs comparing any bisphosphonates vs placebo in knee OA patients and reporting validated pain and function scales, radiographic progression, and adverse events (AEs) outcomes. We excluded studies using active comparators or concomitant medications besides non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. We calculated standardized mean differences (SMDs) to account for variation in outcome scales. Random effects meta-analyses were performed. RESULTS We included seven RCTs (3013 patients, 69% female); most patients (N = 2767) received oral risedronate. No pain or function outcomes, regardless of dose, route, time point or measuring instrument, revealed statistically significant results (end of trial pain SMD = -0.16 [95% confidence interval (CI): -0.34, 0.02]). Similarly, we found no statistically significant effect on radiographic progression (risk ratio = 0.98 [95% CI: 0.77, 1.26]). One small RCT in patients with bone marrow lesions (BMLs) suggested a reduction in BML size at 6 months. Bisphosphonates displayed good tolerability, with no statistically significant differences in AE outcomes vs placebo. CONCLUSIONS Contrary to prior reviews, our analysis showed that bisphosphonates neither provide symptomatic relief nor defer radiographic progression in knee OA. However, these agents may still be beneficial in certain subsets of patients who display high rates of subchondral bone turnover. Future studies should be directed at defining such OA subsets and investigating the effects of bisphosphonates in those patients.
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Affiliation(s)
- E E Vaysbrot
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, 800 Washington Street, 02111 Boston, MA, USA
| | - M C Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, 800 Washington Street, 02111 Boston, MA, USA
| | - M-C Musetti
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, 800 Washington Street, 02111 Boston, MA, USA
| | - T E McAlindon
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, 800 Washington Street, 02111 Boston, MA, USA
| | - R R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, 800 Washington Street, 02111 Boston, MA, USA.
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Albarqouni L, Abu-Rmeileh NME, Elessi K, Obeidallah M, Bjertness E, Chalmers I. The quality of reports of medical and public health research from Palestinian institutions: a systematic review. BMJ Open 2017; 7:e016455. [PMID: 28601839 PMCID: PMC5726119 DOI: 10.1136/bmjopen-2017-016455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Over the past decade, there has been an increase in reports of health research from Palestine, but no assessment of their quality. We have assessed the quality of reports of Palestinian health research and factors associated with it. DESIGN This is a systematic review. INCLUSION CRITERIA We searched Medline and Scopus for reports of original research relevant to human health or healthcare authored by researchers affiliated with Palestinian institutions and published between January 2000 and August 2015 inclusive. OUTCOMES We used international guidelines to assess report quality, classifying as adequate those with ≥50% of items completely addressed. RESULTS Of 2383 reports identified, 497 met our inclusion criteria. Just over half (264; 55%) of these were published after 2010. 354 (71%) of first authors were affiliated with Palestinian institutions; 261 (53%) reports had coauthors from outside Palestine. The majority of the reports in our study were inadequately reported (342; 69%), and none had adequately reported all items. Of 439 observational studies, 11 (2.5%) reports provided adequate descriptions of eligibility criteria and selection procedures; 35 (8%) reported efforts to address potential sources of bias; 50 (11.4%) reported the basis for the study sample size; and funding sources were mentioned in 74 reports (17%). Higher reporting quality was associated with international affiliation of the first author (prevalence ratio (PR) 1.6 (95% CI 1.2 to 2.1)), international collaboration (PR 2.9 (95% CI 1.7 to 5.0)), international funding (PR 1.9 (95% CI1.5 to 2.5)), publication after 2005 (PR 3.9 (95% CI 1.8 to 8.5)) and four or more coauthors (PR 1.5 (95% CI 1.1 to 2.1)). CONCLUSION Although the quality of reports of Palestinian research has improved in recent years, it remains well below an acceptable standard. International reporting guidelines should be used to guide research design and improve the quality of reports of research. TRIAL REGISTRATION NUMBER The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) registery (registration number: CRD42015027553).
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Affiliation(s)
- Loai Albarqouni
- Centre for Research in Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Niveen ME Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Ramallah, Occupied Palestinian Territory
| | - Khamis Elessi
- Faculty of Medicine, Evidence-Based Medicine Unit, Islamic University, Gaza, Occupied Palestinian Territory
| | - Mohammad Obeidallah
- Institute of Community and Public Health, Birzeit University, Ramallah, Occupied Palestinian Territory
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Cheung CYL, Ikram MK, Chen C, Wong TY. Imaging retina to study dementia and stroke. Prog Retin Eye Res 2017; 57:89-107. [PMID: 28057562 DOI: 10.1016/j.preteyeres.2017.01.001] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 01/01/2017] [Indexed: 02/07/2023]
Abstract
With increase in life expectancy, the number of persons suffering from common age-related brain diseases, including neurodegenerative (e.g., dementia) and cerebrovascular (e.g., stroke) disease is expected to rise substantially. As current neuro-imaging modalities such as magnetic resonance imaging may not be able to detect subtle subclinical changes (resolution <100-500 μm) in dementia and stroke, there is an urgent need for other complementary techniques to probe the pathophysiology of these diseases. The retina - due to its anatomical, embryological and physiological similarities with the brain - offers a unique and accessible "window" to study correlates and consequences of subclinical pathology in the brain. Retinal components such as the microvasculature and retinal ganglion cell axons can now be visualized non-invasively using different retinal imaging techniques e.g., ocular fundus photography and optical coherence tomography. Advances in retinal imaging may provide new and potentially important insights into cerebrovascular neurodegenerative processes in addition to what is currently possible with neuro-imaging. In this review, we present an overview of the current literature on the application of retinal imaging in the study of dementia and stroke. We discuss clinical implications of these studies, novel state-of-the-art retinal imaging techniques and future directions aimed at evaluating whether retinal imaging can be an additional investigation tool in the study of dementia and stroke.
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Affiliation(s)
- Carol Yim-Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - M Kamran Ikram
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Departments of Neurology & Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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Aagaard T, Lund H, Juhl C. Optimizing literature search in systematic reviews - are MEDLINE, EMBASE and CENTRAL enough for identifying effect studies within the area of musculoskeletal disorders? BMC Med Res Methodol 2016; 16:161. [PMID: 27875992 PMCID: PMC5120411 DOI: 10.1186/s12874-016-0264-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/14/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND When conducting systematic reviews, it is essential to perform a comprehensive literature search to identify all published studies relevant to the specific research question. The Cochrane Collaborations Methodological Expectations of Cochrane Intervention Reviews (MECIR) guidelines state that searching MEDLINE, EMBASE and CENTRAL should be considered mandatory. The aim of this study was to evaluate the MECIR recommendations to use MEDLINE, EMBASE and CENTRAL combined, and examine the yield of using these to find randomized controlled trials (RCTs) within the area of musculoskeletal disorders. METHODS Data sources were systematic reviews published by the Cochrane Musculoskeletal Review Group, including at least five RCTs, reporting a search history, searching MEDLINE, EMBASE, CENTRAL, and adding reference- and hand-searching. Additional databases were deemed eligible if they indexed RCTs, were in English and used in more than three of the systematic reviews. Relative recall was calculated as the number of studies identified by the literature search divided by the number of eligible studies i.e. included studies in the individual systematic reviews. Finally, cumulative median recall was calculated for MEDLINE, EMBASE and CENTRAL combined followed by the databases yielding additional studies. RESULTS Deemed eligible was twenty-three systematic reviews and the databases included other than MEDLINE, EMBASE and CENTRAL was AMED, CINAHL, HealthSTAR, MANTIS, OT-Seeker, PEDro, PsychINFO, SCOPUS, SportDISCUS and Web of Science. Cumulative median recall for combined searching in MEDLINE, EMBASE and CENTRAL was 88.9% and increased to 90.9% when adding 10 additional databases. CONCLUSION Searching MEDLINE, EMBASE and CENTRAL was not sufficient for identifying all effect studies on musculoskeletal disorders, but additional ten databases did only increase the median recall by 2%. It is possible that searching databases is not sufficient to identify all relevant references, and that reviewers must rely upon additional sources in their literature search. However further research is needed.
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Affiliation(s)
- Thomas Aagaard
- Department of Physiotherapy, Holbaek University Hospital, Holbaek, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Center for Evidence-based practice, Bergen University College, Bergen, Norway
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Rehabilitation, Copenhagen University Hospital, Herlev, Gentofte, Denmark
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6
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Exploring reasons for the observed inconsistent trial reports on intra-articular injections with hyaluronic acid in the treatment of osteoarthritis: Meta-regression analyses of randomized trials. Semin Arthritis Rheum 2016; 46:34-48. [DOI: 10.1016/j.semarthrit.2016.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 01/20/2023]
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Newson AJ, Lipworth W. Why should ethics approval be required prior to publication of health promotion research? Health Promot J Austr 2016; 26:170-175. [PMID: 26548539 DOI: 10.1071/he15034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/01/2015] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED Most academic journals that publish studies involving human participants require evidence that the research has been approved by a human research ethics committee (HREC). Yet journals continue to receive submissions from authors who have failed to obtain such approval. In this paper, we provide an ethical justification of why journals should not, in general, publish articles describing research that has no ethics approval, with particular attention to the health promotion context. METHODS Using theoretical bioethical reasoning and drawing on a case study, we first rebut some potential criticisms of the need for research ethics approval. We then outline four positive claims to justify a presumption that research should, in most instances, be published only if it has been undertaken with HREC approval. RESULTS We present four justifications for requiring ethics approval before publication: (1) HREC approval adds legitimacy to the research; (2) the process of obtaining HREC approval can improve the quality of an intervention being investigated; (3) obtaining HREC approval can help mitigate harm; and (4) obtaining HREC approval demonstrates respect for persons. CONCLUSION This paper provides a systematic and comprehensive assessment of why research ethics approval should generally be obtained before publishing in the health promotion context. So what? Journals such as the Health Promotion Journal of Australia have recently begun to require research ethics approval for publishing research. Health promotion researchers will be interested in learning the ethical justification for this change.
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Affiliation(s)
- Ainsley J Newson
- Centre for Values, Ethics and the Law in Medicine, Level 1, Medical Foundation Building K25, 92-4 Parramatta Road, University of Sydney, NSW 2006, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, Level 1, Medical Foundation Building K25, 92-4 Parramatta Road, University of Sydney, NSW 2006, Australia
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Moher D, Glasziou P, Chalmers I, Nasser M, Bossuyt PMM, Korevaar DA, Graham ID, Ravaud P, Boutron I. Increasing value and reducing waste in biomedical research: who's listening? Lancet 2016; 387:1573-1586. [PMID: 26423180 DOI: 10.1016/s0140-6736(15)00307-4] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The biomedical research complex has been estimated to consume almost a quarter of a trillion US dollars every year. Unfortunately, evidence suggests that a high proportion of this sum is avoidably wasted. In 2014, The Lancet published a series of five reviews showing how dividends from the investment in research might be increased from the relevance and priorities of the questions being asked, to how the research is designed, conducted, and reported. 17 recommendations were addressed to five main stakeholders-funders, regulators, journals, academic institutions, and researchers. This Review provides some initial observations on the possible effects of the Series, which seems to have provoked several important discussions and is on the agendas of several key players. Some examples of individual initiatives show ways to reduce waste and increase value in biomedical research. This momentum will probably move strongly across stakeholder groups, if collaborative relationships evolve between key players; further important work is needed to increase research value. A forthcoming meeting in Edinburgh, UK, will provide an initial forum within which to foster the collaboration needed.
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Affiliation(s)
- David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Ottawa, Canada.
| | - Paul Glasziou
- Centre for Research in Evidence Based Practice, Bond University, Robina, QLD, Australia
| | | | - Mona Nasser
- Peninsula Dental School, Plymouth University, Plymouth, UK
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Daniël A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Ottawa, Canada
| | - Philippe Ravaud
- METHODS Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, UMR 1153, Institut National de la Santé et de la Recherche Médicale, University Paris Descartes, Paris, France
| | - Isabelle Boutron
- METHODS Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, UMR 1153, Institut National de la Santé et de la Recherche Médicale, University Paris Descartes, Paris, France
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9
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Affiliation(s)
- Hans Lund
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, 5230 Odense, Denmark; Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway.
| | - Carsten Juhl
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, 5230 Odense, Denmark; Department of Rehabilitation, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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10
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Biased and inadequate citation of prior research in reports of cardiovascular trials is a continuing source of waste in research. J Clin Epidemiol 2016; 69:174-8. [DOI: 10.1016/j.jclinepi.2015.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 01/10/2023]
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Jeal N, Macleod J, Turner K, Salisbury C. Systematic review of interventions to reduce illicit drug use in female drug-dependent street sex workers. BMJ Open 2015; 5:e009238. [PMID: 26582403 PMCID: PMC4654393 DOI: 10.1136/bmjopen-2015-009238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/03/2015] [Accepted: 09/11/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Most female street-based sex workers (SSWs) are drug users and this group experience particularly poor outcomes in achieving and maintaining abstinence. In 2010 the UK adopted a recovery-orientated Drug Strategy. This strategy did not specifically highlight the complex drug treatment needs of SSWs. Therefore we sought to synthesise and critically appraise existing evidence of interventions to reduce illicit drug use in this group, in order to guide service change toward better provision for the drug treatment needs of SSWs. METHODS A systematic review of evidence on the effectiveness of interventions to reduce illicit drug use in female SSWs. Following the PRISMA guidelines, a structured search strategy was used. Searches included databases, organisational and government websites to identify published and grey literature, as well as contacting experts in the field, and hand-searching reference lists and journals. RESULTS Six studies, one experimental and five observational, were identified which met review inclusion criteria. Intervention approaches evaluated included substitute prescribing, educational sessions and motivational interviewing. All studies reported a positive intervention effect but the five observational studies were all subject to a relatively high risk of bias. By contrast, the experimental study provided little or no evidence of positive effect (OR for reduction of illicit drug in intervention compared to controls 1.17 95%CI 0.84-1.66 at 3 months and 1.14 (95% CI 0.8 to 1.61) at 6 months follow-up). All six studies described challenges and solutions to study recruitment, retention and follow-up, which were influenced by issues affecting SSWs' health and social stability. CONCLUSIONS There is currently no strong evidence for effectiveness of interventions to reduce illicit drug use in female SSWs with problematic drug use. Thus, the development and robust evaluation of effective interventions should be a priority if recovery-orientated goals are to become more achievable for this group.
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Affiliation(s)
- Nikki Jeal
- Centre for Academic Primary Care School of Social & Community medicine, University of Bristol, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care School of Social & Community medicine, University of Bristol, Bristol, UK
| | - Katrina Turner
- Centre for Academic Primary Care School of Social & Community medicine, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Centre for Academic Primary Care School of Social & Community medicine, University of Bristol, Bristol, UK
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Chalmers I, Fox DM. Increasing the Incidence and Influence of Systematic Reviews on Health Policy and Practice. Am J Public Health 2015; 106:11-3. [PMID: 26562111 DOI: 10.2105/ajph.2015.302915] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Iain Chalmers
- Iain Chalmers is a co-founder of the Cochrane Collaboration ( www.cochrane.org ) and the James Lind Initiative, Oxford, UK. Daniel Fox is president emeritus of the Milbank Memorial Fund, New York, NY
| | - Daniel M Fox
- Iain Chalmers is a co-founder of the Cochrane Collaboration ( www.cochrane.org ) and the James Lind Initiative, Oxford, UK. Daniel Fox is president emeritus of the Milbank Memorial Fund, New York, NY
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13
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Jamtvedt G, Klemp M, Mørland B, Nylenna M. Responsibility and accountability for well informed health-care decisions: a global challenge. Lancet 2015; 386:826-8. [PMID: 26085031 DOI: 10.1016/s0140-6736(15)60855-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gro Jamtvedt
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
| | - Marianne Klemp
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Berit Mørland
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Magne Nylenna
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
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Chevance A, Schuster T, Steele R, Ternès N, Platt RW. Contour plot assessment of existing meta-analyses confirms robust association of statin use and acute kidney injury risk. J Clin Epidemiol 2015; 68:1138-43. [PMID: 26092287 DOI: 10.1016/j.jclinepi.2015.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 04/20/2015] [Accepted: 05/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Robustness of an existing meta-analysis can justify decisions on whether to conduct an additional study addressing the same research question. We illustrate the graphical assessment of the potential impact of an additional study on an existing meta-analysis using published data on statin use and the risk of acute kidney injury. STUDY DESIGN AND SETTING A previously proposed graphical augmentation approach is used to assess the sensitivity of the current test and heterogeneity statistics extracted from existing meta-analysis data. In addition, we extended the graphical augmentation approach to assess potential changes in the pooled effect estimate after updating a current meta-analysis and applied the three graphical contour definitions to data from meta-analyses on statin use and acute kidney injury risk. RESULTS In the considered example data, the pooled effect estimates and heterogeneity indices demonstrated to be considerably robust to the addition of a future study. Supportingly, for some previously inconclusive meta-analyses, a study update might yield statistically significant kidney injury risk increase associated with higher statin exposure. CONCLUSIONS The illustrated contour approach should become a standard tool for the assessment of the robustness of meta-analyses. It can guide decisions on whether to conduct additional studies addressing a relevant research question.
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Affiliation(s)
- Aurélie Chevance
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave W., Montreal, Quebec, Canada H3A 1A2
| | - Tibor Schuster
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave W., Montreal, Quebec, Canada H3A 1A2.
| | - Russell Steele
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine, H-461, Montreal, Quebec, Canada H3T 1E2; Department of Mathematics and Statistics, McGill University, Burnside Hall, 805 Sherbrooke Street West, Montreal, Quebec, Canada H3A 0B9
| | - Nils Ternès
- Service de biostatistique et d'épidémiologie, Gustave Roussy, 39 rue Camille Desmoulins, Villejuif, France; CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Sud University, 12 avenue Paul Vaillant Couturier, Villejuif, France
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Ave W., Montreal, Quebec, Canada H3A 1A2; Department of Pediatrics, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1
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15
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Chalmers I. Commentary for history special issue of Research Synthesis Methods. Res Synth Methods 2015; 6:268-71. [PMID: 26097220 DOI: 10.1002/jrsm.1144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/10/2022]
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16
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Treweek S, Altman DG, Bower P, Campbell M, Chalmers I, Cotton S, Craig P, Crosby D, Davidson P, Devane D, Duley L, Dunn J, Elbourne D, Farrell B, Gamble C, Gillies K, Hood K, Lang T, Littleford R, Loudon K, McDonald A, McPherson G, Nelson A, Norrie J, Ramsay C, Sandercock P, Shanahan DR, Summerskill W, Sydes M, Williamson P, Clarke M. Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform. Trials 2015; 16:261. [PMID: 26044814 PMCID: PMC4475334 DOI: 10.1186/s13063-015-0776-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge ( www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - David Crosby
- Medical Research Council, Methodology Research Programme (MRC MRP), London, UK.
| | - Peter Davidson
- Consultant in Public Health and Head of Health Technology Assessment, National Institute for Health Research, Evaluation, Trials, and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK.
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Lelia Duley
- Nottingham Clinical Trials Unit (NCTU), Nottingham Health Science Partners, C Floor, South Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Janet Dunn
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Carrol Gamble
- North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kerry Hood
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Cardiff, UK.
| | - Trudie Lang
- The Global Health Network, Oxford University Centre for Tropical Medicine, University of Oxford, Oxford, UK.
| | | | - Kirsty Loudon
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Gladys McPherson
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, CF14 4YS, UK.
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Sandercock
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
| | | | | | - Matt Sydes
- Medical Research Council, Clinical Trials Unit (MRC CTU), London, UK.
| | - Paula Williamson
- North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building Daulby Street, Liverpool, L69 3GA, UK.
| | - Mike Clarke
- Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
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