scholarly journals Statistical competencies for medical research learners: What is fundamental?

2017 ◽  
Vol 1 (3) ◽  
pp. 146-152 ◽  
Author(s):  
Felicity T. Enders ◽  
Christopher J. Lindsell ◽  
Leah J. Welty ◽  
Emma K. T. Benn ◽  
Susan M. Perkins ◽  
...  
Keyword(s):  
Medical Research ◽  
Graduate Programs ◽  
Meta Analysis ◽  
Research Literature ◽  
Stopping Rules ◽  
Professional Organizations ◽  
The Past ◽  
Medical Researchers ◽  
Study Designs ◽  
Based Medicine

IntroductionIt is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.MethodsWe surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’ResultsThere were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).ConclusionWe have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.

Adoption of Evidence-Based Medicine in Clinical Laboratory Science: A Survey of the Prevalence of Systematic and Narrative Reviews

2018 ◽  
Vol 50 (3) ◽  
pp. 223-228
Author(s):  
Lauren N Pearson ◽  
Robert L Schmidt
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Laboratory ◽  
Meta Analysis ◽  
Critical Role ◽  
Publication Rate ◽  
Evidence Based ◽  
Clinical Laboratory Science ◽  
Laboratory Science ◽  
The Past ◽  
Based Medicine

Abstract Background Systematic reviews (SRs) play a critical role in evidence-based medicine. Objective To determine the publication trends of SRs in clinical laboratory science (CLS). Methods We searched Scopus to identify all reviews published in the top 20 CLS journals during the past 10 years (2008–2017). We determined year of publication, review type (systematic vs narrative), citations, and whether the review was accompanied by a meta-analysis (MA). Results We identified 2934 reviews. Of these, 2833 (96.6%) were narrative reviews, and 98 (3.3%) were SRs. A total of 67 (66.3%) of the SRs were accompanied by a MA. Three journals accounted for 68 of 98 (69.4%) SRs. The percentage of SRs (relative to all reviews) has increased during the past decade (P = .01). SRs were more frequently published in high-impact journals (P <.001). Conclusion The publication rate of SRs in CLS journals has increased during the past decade.

What historiography can tell us about evidence-based medicine and policy: A response to Pawson’s ‘The Realist Foundations of Evidence-based Medicine’

Evaluation ◽  
2018 ◽  
Vol 24 (3) ◽  
pp. 318-324
Author(s):  
Axel Kaehne
Keyword(s):  
Experimental Study ◽  
Medical Research ◽  
Evidence Based Medicine ◽  
Policy Impact ◽  
Evidence Based ◽  
Different Types ◽  
History Of ◽  
Study Designs ◽  
Based Medicine ◽  
History Of Cancer

In the battle between experimental study designs and realist approaches, Ray Pawson has fired the next shot. This time evidence based medicine is in his aim. He argues that evidence based medicine is becoming more appreciative of specific circumstances of interventions and hence medical research may be approximating realist evaluation’s approach. He illustrates his argument with the history of cancer where the disease increasingly looks like it is playing ‘cat and mouse’ with researchers. In the paper I try to disentangle the epistemological and methodological dimensions of Pawson’s claim. I argue that, what may look similar on a narrative level, may not be consequential for the different types of epistemologies that sustain medical and policy impact research.

scholarly journals The impact of selection criteria and study design on reported survival outcomes in extracorporeal oxygenation cardiopulmonary resuscitation (ECPR): a systematic review and meta-analysis

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Sameer Karve ◽  
Dominique Lahood ◽  
Arne Diehl ◽  
Aidan Burrell ◽  
David H. Tian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Prospective Studies ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Newcastle Ottawa Scale ◽  
Study Designs ◽  
Based Medicine ◽  
The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) during cardiac arrest (ECPR) has increased exponentially. However, reported outcomes vary considerably due to differing study designs and selection criteria. This review assessed the impact of pre-defined selection criteria on ECPR survival. Methods Systematic review applying PRISMA guidelines. We searched Medline, Embase, and Evidence-Based Medicine Reviews for RCTs and observational studies published from January 2000 to June 2021. Adult patients (> 12 years) receiving ECPR were included. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Outcomes included overall and neurologically favourable survival. Meta-analysis and meta-regression were performed. Results 67 studies were included: 14 prospective and 53 retrospective. No RCTs were identified at time of search. The number of inclusion criteria to select ECPR patients (p = 0.292) and study design (p = 0.962) was not associated with higher favourable neurological survival. However, amongst prospective studies, increased number of inclusion criteria was associated with improved outcomes in both OHCA and IHCA cohorts. (β = 0.12, p = 0.026) and arrest to ECMO flow time was predictive of survival. (β = -0.023, p < 0.001). Conclusions Prospective studies showed number of selection criteria and, in particular, arrest to ECMO time were associated with significant improved survival. Well-designed prospective studies assessing the relative importance of criteria as well as larger efficacy studies are required to ensure appropriate application of what is a costly intervention.

scholarly journals Learning gaps among statistical competencies for clinical and translational science learners

2020 ◽  
pp. 1-11
Author(s):  
Robert A. Oster ◽  
Katrina L. Devick ◽  
Sally W. Thurston ◽  
Joseph J. Larson ◽  
Leah J. Welty ◽  
...  
Keyword(s):  
Statistical Methods ◽  
Meta Analysis ◽  
Stopping Rules ◽  
Professional Organizations ◽  
Master's Level ◽  
Translational Science ◽  
Graduate Courses ◽  
Statistical Literacy ◽  
Doctoral Level ◽  
Graduate Curricula

Abstract Introduction: Statistical literacy is essential in clinical and translational science (CTS). Statistical competencies have been published to guide coursework design and selection for graduate students in CTS. Here, we describe common elements of graduate curricula for CTS and identify gaps in the statistical competencies. Methods: We surveyed statistics educators using e-mail solicitation sent through four professional organizations. Respondents rated the degree to which 24 educational statistical competencies were included in required and elective coursework in doctoral-level and master’s-level programs for CTS learners. We report competency results from institutions with Clinical and Translational Science Awards (CTSAs), reflecting institutions that have invested in CTS training. Results: There were 24 CTSA-funded respondents representing 13 doctoral-level programs and 23 master’s-level programs. For doctoral-level programs, competencies covered extensively in required coursework for all doctoral-level programs were basic principles of probability and hypothesis testing, understanding the implications of selecting appropriate statistical methods, and computing appropriate descriptive statistics. The only competency extensively covered in required coursework for all master’s-level programs was understanding the implications of selecting appropriate statistical methods. The least covered competencies included understanding the purpose of meta-analysis and the uses of early stopping rules in clinical trials. Competencies considered to be less fundamental and more specialized tended to be covered less frequently in graduate courses. Conclusion: While graduate courses in CTS tend to cover many statistical fundamentals, learning gaps exist, particularly for more specialized competencies. Educational material to fill these gaps is necessary for learners pursuing these activities.

The Ego Could Be Depleted, Providing Initial Exertion Is Depleting

2017 ◽  
Vol 48 (4) ◽  
pp. 242-245 ◽  
Author(s):  
Junhua Dang ◽  
Ying Liu ◽  
Xiaoping Liu ◽  
Lihua Mao
Keyword(s):  
Stroop Task ◽  
Meta Analysis ◽  
Ego Depletion ◽  
Current Experiment ◽  
The Past ◽  
Depletion Effect

Abstract. The ego depletion effect has been examined by over 300 independent studies during the past two decades. Despite its pervasive influence, recently this effect has been severely challenged and asserted to be a fake. Based on an up-to-date meta-analysis that examined the effectiveness of each frequently used depleting task, we preregistered the current experiment with the aim to examine whether there would be an ego depletion effect when the Stroop task is used as the depleting task. The results demonstrated a significant ego depletion effect. The current research highlights the importance of the depleting task’s effectiveness. That is to say, the “ego” could be “depleted,” but only when initial exertion is “depleting.”

Advances In Asthma Care

2003 ◽  
Vol 1 (1) ◽  
pp. 87-90 ◽  
Author(s):  
Chris Garvey
Keyword(s):  
Healthcare Costs ◽  
Professional Organizations ◽  
Current Status ◽  
Asthma Care ◽  
Advanced Level ◽  
Clinical Criteria ◽  
Asthma Knowledge ◽  
The Past ◽  
The Us ◽  
Examination Process

Asthma rates in the US have risen during the past 25 years, as have asthma-related morbidity and healthcare costs. Professional organizations involved in asthma care have identified the need to assure that an advanced level of asthma knowledge and skill is available to patients with asthma, their families, and insurers. This need led to development of the certification for asthma educators. The Certified Asthma Educator (AE-C) must meet specific clinical criteria and pass a standardized examination designed to evaluate knowledge and skill for providing competent asthma education and coordination. The development and current status of the Certified Asthma Educator examination process and content are discussed, as are goals of the certification

A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies

2020 ◽  
Vol 133 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Anthony T. Lee ◽  
John F. Burke ◽  
Pranathi Chunduru ◽  
Annette M. Molinaro ◽  
Robert Knowlton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Meta Analysis ◽  
Small Sample ◽  
Seizure Freedom ◽  
Level I ◽  
Study Designs ◽  
Medically Refractory Epilepsy

OBJECTIVERecent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions.METHODSThe authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012–April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort.RESULTSThe overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2< 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93–29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni’s multiple comparison test).CONCLUSIONSThe overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.

scholarly journals Levels of Evidence in Rhinology and Skull Base Surgery Research

2021 ◽  
pp. 019459982098713
Author(s):  
Jennifer A. Silver ◽  
Marco Mascarella ◽  
George Tali ◽  
Rickul Varshney ◽  
Marc A. Tewfik ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Absolute Number ◽  
High Quality ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
The Past ◽  
Significant Difference ◽  
Surgery Research ◽  
Based Medicine

Objective The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade. Study Design Review article. Setting We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals. Methods The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2. Results In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 ( P < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant ( P < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ2 = 3.1, P = .077). Conclusion The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.

scholarly journals Does Neonatal Imitation Exist? Insights From a Meta-Analysis of 336 Effect Sizes

2021 ◽  
pp. 174569162095983
Author(s):  
Jacqueline Davis ◽  
Jonathan Redshaw ◽  
Thomas Suddendorf ◽  
Mark Nielsen ◽  
Siobhan Kennedy-Costantini ◽  
...  
Keyword(s):  
Social Behavior ◽  
Positive Result ◽  
Human Development ◽  
Degrees Of Freedom ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Significant Evidence ◽  
The Past ◽  
Substantial Heterogeneity

Neonatal imitation is a cornerstone in many theoretical accounts of human development and social behavior, yet its existence has been debated for the past 40 years. To examine possible explanations for the inconsistent findings in this body of research, we conducted a multilevel meta-analysis synthesizing 336 effect sizes from 33 independent samples of human newborns, reported in 26 articles. The meta-analysis found significant evidence for neonatal imitation ( d = 0.68, 95% CI = [0.39, 0.96], p < .001) but substantial heterogeneity between study estimates. This heterogeneity was not explained by any of 13 methodological moderators identified by previous reviews, but it was associated with researcher affiliation, test of moderators ( QM) (15) = 57.09, p < .001. There are at least two possible explanations for these results: (a) Neonatal imitation exists and its detection varies as a function of uncaptured methodological factors common to a limited set of studies, and (2) neonatal imitation does not exist and the overall positive result is an artifact of high researcher degrees of freedom.

scholarly journals 165 A Review of The Current Literature on LMWH Administered at Different Times in Relation to MOS (Major Orthopaedic Surgery): Assessment of The Safety and Efficacy of The Different Proposed Strategies

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Placella ◽  
V Pace ◽  
P Antinolfi ◽  
V Salini
Keyword(s):  
Meta Analysis ◽  
Convincing Evidence ◽  
Just In Time ◽  
Medical Complications ◽  
Randomized Controlled ◽  
The Past ◽  
Cochrane Database ◽  
Major Orthopedic Surgery ◽  
Major Orthopaedic Surgery ◽  
The One

Abstract Nowadays venous VTE represents an important perioperative and postoperative complication in patients undergoing elective Major Orthopedic Surgery (MOS). There are significant discrepancies between clinical practice, international recommendations, and published guidelines. Although thromboembolic events may be less common these days than in the past, they can still lead to serious medical complications. Therefore, most patients undergoing MOS procedures are provided with one of the thromboprophylactic treatments. The optimum timing of LMWH administrations remains debated. Customized structured electronic searches in PubMed and Cochrane database. Meta-Analysis, Randomized Controlled Trials, Systematic Reviews on different strategies of the use of LMWH for MOS. Studies on prophylactic regimens showed that subcutaneous LMWH plays a key role in the management of thromboprophylaxis in MOS. However, some controversies still stand. Among those most relevant, it remains unclear whether to start thromboprophylaxis before or after MOS to better balance the risks of clotting and bleeding. With regards to different times of LMWH administration, there is no convincing evidence that starting prophylaxis 12 hours preoperatively is associated with lower risks of VTE compared to prophylaxis started 12 to 24 hours postoperatively. Furthermore, it seems that the most safe and efficient LMWH regimen is the one called “Just-in-time” (LMWH started 6 hours post-op).

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