Evidence-based Medicine[JOURNAL]

The effectiveness of a continuing education programme in paediatric psychopharmacology designed for primary healthcare providers was objectively measured based on the assumption that training would lead to measurable cha... The effectiveness of a continuing education programme in paediatric psychopharmacology designed for primary healthcare providers was objectively measured based on the assumption that training would lead to measurable changes in referral patterns and established clinical measures of referred patients. Using established, valid and reliable measures of clinical urgency embedded in to a regional healthcare system since 2002, the referrals to child and adolescent psychiatric services of physicians who participated in the training (n=99) were compared pretraining and post-training, and to non-participating/untrained referring physicians (n=7753) making referrals over the same time period. Referrals were analysed for evidence of change based on frequencies and measures of clinical urgency. Participants of the training programme also completed standardised baseline and outcome self-evaluations. Congruent with participants self-reported evaluative reports of improved knowledge and practice, analysis of referral frequency and the clinical urgency of referrals to paediatric psychiatric services over the study period indicated that trained physicians made more appropriate referrals (clinically more severe) and reduced referrals to emergency services. Quantitative clinical differences as completed by intake clinicians blind to referrals from the study group designations were observed within the trained physician group pretraining and post-training, and between the trained physician group and the unexposed physician group. The results illustrate a novel model for objectively measuring change among physicians based on training in paediatric mental health management.

Free PDF PubMed ↗

Evidence based medicine manifesto for better healthcare: A response to systematic bias, wastage, error and fraud in research underpinning patient care.

Heneghan C, Mahtani KR, Goldacre B … +3 more , Godlee F, Macdonald H, Jarvies D

Evid Based Med · 2017 Aug · PMID 28720642 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Clinicians should assess the benefits and risks of using bezlotoxumab for reducing the risk of recurrent infection.

Hassouna H, Deshpande A

Evid Based Med · 2017 Aug · PMID 28716810 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Determining clinical decision thresholds for HIV-positive patients suspected of having tuberculosis.

Boyles T, Locatelli I, Senn N … +1 more , Ebell M

Evid Based Med · 2017 Aug · PMID 28716809 · Publisher ↗

Clinical decision thresholds may aid the evaluation of diagnostic tests but have rarely been determined for tuberculosis (TB). We presented clinicians with six web-based clinical scenarios, describing patients with HIV a... Clinical decision thresholds may aid the evaluation of diagnostic tests but have rarely been determined for tuberculosis (TB). We presented clinicians with six web-based clinical scenarios, describing patients with HIV and possible TB at various sites and with a range of clinical stability. The probability of disease was varied randomly and clinicians asked to make treatment decisions; threshold curves and therapeutic thresholds were calculated. Test and treatment thresholds were calculated using Bayes theorem and the diagnostic accuracy of Xpert MTB/RIF. We received 165 replies to our survey. Therapeutic thresholds vary depending on the clinical stability and site of suspected disease. For inpatients, it ranges from 3.4% in unstable to 79.6% in stable patients. For TB meningitis, it ranges from 0% in unstable to 51.4% in stable patients and for pulmonary TB in outpatients it ranges from 29.1% in unstable to 74.5% in the stable patients. Test and treatment thresholds vary in a similar way with test thresholds ranging from 0 in unstable patients with suspected meningitis to 8.2% for stable inpatients. Treatment thresholds vary from 0 for unstable patients with suspected meningitis to 97% for stable inpatients. Therapeutic thresholds for TB can be determined by presenting clinicians with patient scenarios with random probabilities of disease and can be used to calculate test and treatment thresholds using Bayes theorem. Thresholds are lower when patients are more clinically unstable and when the implications of inappropriately withholding therapy are more serious. These results can be used to improve use and evaluation of diagnostic tests.

Get PDF PubMed ↗

Second trimester levothyroxine treatment for subclinical hypothyroidism or hypothyroxinaemia of pregnancy does not improve cognitive outcomes of children.

Stagnaro-Green A

Evid Based Med · 2017 Aug · PMID 28716808 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Antenatal corticosteroid administration between 24 hours and 7 days before extremely preterm delivery is associated with the lowest rate of mortality.

Travers CP, Carlo WA

Evid Based Med · 2017 Oct · PMID 28716807 · Full text

Abstract loading — click title to view on PubMed.

Free PDF PubMed ↗

The Cochrane Collaboration withdraws a review on methylphenidate for adults with attention deficit hyperactivity disorder.

Boesen K, Saiz LC, Erviti J … +4 more , Storebø OJ, Gluud C, Gøtzsche PC, Jørgensen KJ

Evid Based Med · 2017 Aug · PMID 28705922 · Full text

A Cochrane systematic review on immediate-release methylphenidate for adults with attention deficit hyperactivity disorder (ADHD) was withdrawn from the Cochrane Library on 26 May 2016 after substantial criticism of its... A Cochrane systematic review on immediate-release methylphenidate for adults with attention deficit hyperactivity disorder (ADHD) was withdrawn from the Cochrane Library on 26 May 2016 after substantial criticism of its methods and flawed conclusions. Retraction of scientific papers on this basis is unusual but can be necessary. We provide a summary of the criticism that led to the withdrawal. We detail the methodological flaws of the withdrawn Cochrane systematic review and general issues of bias and shortcomings of the included ADHD trials: cross-over designs compared with parallel-group designs, exclusion of participants with psychiatric comorbidity, absence of 'functional outcomes' and use of clinical outcomes with limited relevance, short trial duration and small trial populations, broken blinding caused by easily recognisable side effects, combining outcome assessments by trial investigators and participants, outcome reporting bias, poor evaluation of cardiovascular and psychiatric harms and conflicts of interest of trialists and systematic reviewers. The withdrawal of the Cochrane systematic review signals recognition of previous unreliable clinical ADHD research. We conclude that clinical trials of immediate-release methylphenidate in adults with ADHD are of very low quality. We urgently need well-conducted long-term trials free of bias to assess the benefits and harms of central stimulant treatment in adult ADHD.

Free PDF PubMed ↗

Apixaban may have lower risk of GI bleeding compared with dabigatran and rivaroxaban in patients with atrial fibrillation.

Rivera-Caravaca JM, Lip GYH

Evid Based Med · 2017 Aug · PMID 28705921 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Antibiotic utilisation in very low birth weight infants without sepsis or necrotising enterocolitis is associated with multiple adverse outcomes.

Roberts JL, Patel RM

Evid Based Med · 2017 Oct · PMID 28701373 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Guidelines for reporting meta-epidemiological methodology research.

Murad MH, Wang Z

Evid Based Med · 2017 Aug · PMID 28701372 · Full text

Published research should be reported to evidence users with clarity and transparency that facilitate optimal appraisal and use of evidence and allow replication by other researchers. Guidelines for such reporting are av... Published research should be reported to evidence users with clarity and transparency that facilitate optimal appraisal and use of evidence and allow replication by other researchers. Guidelines for such reporting are available for several types of studies but not for meta-epidemiological methodology studies. Meta-epidemiological studies adopt a systematic review or meta-analysis approach to examine the impact of certain characteristics of clinical studies on the observed effect and provide empirical evidence for hypothesised associations. The unit of analysis in meta-epidemiological studies is a study, not a patient. The outcomes of meta-epidemiological studies are usually not clinical outcomes. In this guideline, we adapt items from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to fit the context of meta-epidemiological studies.

Free PDF PubMed ↗

Percutaneous coronary intervention has similar 5-year survival rates to coronary bypass grafting surgery for patients with unprotected left main artery disease.

Collet C, Serruys PW

Evid Based Med · 2017 Aug · PMID 28684430 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Use of the M-CHAT follow-up interview (M-CHAT/F) by paediatricians during well-child care visits is feasible, valid and reliable.

Dumont-Mathieu T

Evid Based Med · 2017 Aug · PMID 28663203 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Induction of labour at 37 weeks for suspected fetal macrosomia may reduce birth trauma.

Walker K, Thornton J

Evid Based Med · 2017 Aug · PMID 28646127 · Publisher ↗

Abstract loading — click title to view on PubMed.

Get PDF PubMed ↗

Evidence-based Medicine[JOURNAL]

About