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Evidence-Synthesis Tools to Inform Evidence-Based Physiatry

Patrick Engkasan J, Rizzo JR, Levack W, Annaswamy TM

Am J Phys Med Rehabil, 2020 11;99(11):1072-1073.
PMID: 32576745 DOI: 10.1097/PHM.0000000000001508
Matched MeSH terms: Evidence-Based Medicine/methods*
The process of evidence-based medicine and the search for meaning

Biswas R, Umakanth S, Strumberg J, Martin CM, Hande M, Nagra JS

J Eval Clin Pract, 2007 Aug;13(4):529-32.
PMID: 17683292 DOI: 10.1111/j.1365-2753.2007.00837.x

BACKGROUND AND RATIONALE: Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient. A systematic enquiry into the evolving paradigms in EBM is a need of the hour.
AIMS AND METHODS: A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning interpretable at individual levels.
RESULTS: Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn't believe to be statistically significant and perhaps here is an area that needs to be improved on - it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta-analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real 'uncontrolled' world of clinical practice with real people, their validity breaks down.
CONCLUSIONS: One needs to make the EBM standard model patient-individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient.

Matched MeSH terms: Evidence-Based Medicine/methods*
A systematic review of interventions by healthcare professionals on community-dwelling postmenopausal women with osteoporosis

Lai P, Chua SS, Chan SP

Osteoporos Int, 2010 Oct;21(10):1637-56.
PMID: 20379700 DOI: 10.1007/s00198-010-1199-0

A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women. Evidence available indicates that such interventions are effective in improving the quality of life, medication compliance, and calcium intake, but effect on other outcomes is less conclusive.

INTRODUCTION: The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women.

METHODS: Randomized controlled trials (RCTs) published in English between year 1990 and 2009 were identified. Types of patient outcome used as assessment included quality of life (QOL), bone mineral density (BMD), medication compliance and persistence, knowledge level, and lifestyle modification.

RESULTS: Twenty four RCTs met the inclusion criteria. Seven studies assessed interventions by physiotherapists, six by physicians, seven by nurses, three by multi-disciplinary teams and one by dietitians. Variability in the types and intensity of interventions made comparison between each study difficult. Collectively, these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD, medication persistence, knowledge, and other lifestyle modifications were less conclusive.

CONCLUSIONS: From this review, it was found that some outcome measures of such non-drug interventions still required further studies. Future studies should use validated instruments to assess the outcomes, with focus on common definitions of interventions and outcome measures, more intensive one-to-one interventions, appropriate control groups, adequate randomization procedures, and also provide information on effect size.

Matched MeSH terms: Evidence-Based Medicine/methods
Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management

Isayama H, Nakai Y, Rerknimitr R, Khor C, Lau J, Wang HP, et al.

J Gastroenterol Hepatol, 2016 Sep;31(9):1555-65.
PMID: 27042957 DOI: 10.1111/jgh.13398

Walled-off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.

Matched MeSH terms: Evidence-Based Medicine/methods
Fulltext Validity and reliability of the Noor Evidence-Based Medicine Questionnaire: A cross-sectional study

Norhayati MN, Nawi ZM

PLoS One, 2021;16(4):e0249660.
PMID: 33886615 DOI: 10.1371/journal.pone.0249660

BACKGROUND: Evidence-based medicine (EBM) is a widely accepted scientific advancement in clinical settings that helps achieve better, safer, and more cost-effective healthcare. However, presently, validated instruments to evaluate healthcare professionals' attitude and practices toward implementing EBM are not widely available. Therefore, the present study aimed to determine the validity and reliability of a newly developed knowledge, attitude, and practice (KAP) questionnaire on EBM for use among healthcare professionals.
METHODS: The Noor Evidence-Based Medicine Questionnaire was tested among physicians in a government hospital between July and August 2018. Exploratory factor analysis and internal consistency reliability-based Cronbach's alpha statistic were conducted.
RESULTS: The questionnaire was distributed among 94 physicians, and 90 responded (response rate of 95.7%). The initial number of items in the KAP domains of the Noor Evidence-Based Medicine Questionnaire were 15, 17, and 13, respectively; however, two items in the practice domain with communalities <0.25 and factor loadings <0.4 were removed. The factor structure accounted for 52.33%, 66.29%, and 55.39% of data variance in the KAP domains, respectively. Cronbach's alpha values were 0.81, 0.81, and 0.84 for KAP domains, respectively, indicating high reliability.
CONCLUSIONS: This questionnaire can be used to evaluate the knowledge, attitudes, and behaviour of healthcare professionals toward EBM. Future testing of this questionnaire among other medical personnel groups will help expand the scope of this tool.

Matched MeSH terms: Evidence-Based Medicine/methods*
Fulltext Development of a Search Strategy for an Evidence Based Retrieval Service

Ho GJ, Liew SM, Ng CJ, Hisham Shunmugam R, Glasziou P

PLoS One, 2016;11(12):e0167170.
PMID: 27935993 DOI: 10.1371/journal.pone.0167170

BACKGROUND: Physicians are often encouraged to locate answers for their clinical queries via an evidence-based literature search approach. The methods used are often not clearly specified. Inappropriate search strategies, time constraint and contradictory information complicate evidence retrieval.
AIMS: Our study aimed to develop a search strategy to answer clinical queries among physicians in a primary care setting.
METHODS: Six clinical questions of different medical conditions seen in primary care were formulated. A series of experimental searches to answer each question was conducted on 3 commonly advocated medical databases. We compared search results from a PICO (patients, intervention, comparison, outcome) framework for questions using different combinations of PICO elements. We also compared outcomes from doing searches using text words, Medical Subject Headings (MeSH), or a combination of both. All searches were documented using screenshots and saved search strategies.
RESULTS: Answers to all 6 questions using the PICO framework were found. A higher number of systematic reviews were obtained using a 2 PICO element search compared to a 4 element search. A more optimal choice of search is a combination of both text words and MeSH terms. Despite searching using the Systematic Review filter, many non-systematic reviews or narrative reviews were found in PubMed. There was poor overlap between outcomes of searches using different databases. The duration of search and screening for the 6 questions ranged from 1 to 4 hours.
CONCLUSION: This strategy has been shown to be feasible and can provide evidence to doctors' clinical questions. It has the potential to be incorporated into an interventional study to determine the impact of an online evidence retrieval system.

Matched MeSH terms: Evidence-Based Medicine/methods*