scholarly journals Bipolar disorder: clinical uncertainty, evidence-based medicine and large-scale randomised trials

2001 ◽  
Vol 178 (S41) ◽  
pp. s191-s194 ◽  
Author(s):  
John Geddes ◽  
Guy Goodwin
Keyword(s):  
Bipolar Disorder ◽  
Evidence Based Medicine ◽  
Large Scale ◽  
Bipolar Affective Disorder ◽  
Research Literature ◽  
Evidence Based ◽  
Drug Treatments ◽  
Clinical Questions ◽  
Collaborative Ventures ◽  
Based Medicine

BackgroundThe increasing use of the methods of evidence-based medicine to keep up-to-date with the research literature highlights the absence of high-quality evidence in many areas in psychiatry.AimsTo outline current uncertainties in the maintenance treatment of bipolar disorder and to describe some of the decisions involved in designing a large simple trial.MethodWe describe some of the strategies of evidence-based medicine, and how they can be applied in practice, focusing specifically on the area of bipolar disorder.ResultsOne of the key clinical uncertainties in the treatment of bipolar disorder is the place of maintenance drug treatments and their relative efficacy. A large-scale study, the Bipolar Affective Disorder: Lithium Anticonvulsant Evaluation (BALANCE) trial, is proposed to compare the effectiveness of lithium, valproate and the combination of lithium and valproate.ConclusionsProviding reliable answers to key clinical questions in psychiatry will require new approaches to clinical trials. These will need to be far larger than previously appreciated and will therefore need to be collaborative ventures involving front-line clinicians.

scholarly journals Answering Clinical Questions with Knowledge-Based and Statistical Techniques

2007 ◽  
Vol 33 (1) ◽  
pp. 63-103 ◽  
Author(s):  
Dina Demner-Fushman ◽  
Jimmy Lin
Keyword(s):  
Evidence Based Medicine ◽  
Information Needs ◽  
Semantic Processing ◽  
Question Answering ◽  
Clinical Medicine ◽  
Statistical Techniques ◽  
Evidence Based ◽  
Knowledge Based ◽  
Clinical Questions ◽  
Based Medicine

The combination of recent developments in question-answering research and the availability of unparalleled resources developed specifically for automatic semantic processing of text in the medical domain provides a unique opportunity to explore complex question answering in the domain of clinical medicine. This article presents a system designed to satisfy the information needs of physicians practicing evidence-based medicine. We have developed a series of knowledge extractors, which employ a combination of knowledge-based and statistical techniques, for automatically identifying clinically relevant aspects of MEDLINE abstracts. These extracted elements serve as the input to an algorithm that scores the relevance of citations with respect to structured representations of information needs, in accordance with the principles of evidence-based medicine. Starting with an initial list of citations retrieved by PubMed, our system can bring relevant abstracts into higher ranking positions, and from these abstracts generate responses that directly answer physicians' questions. We describe three separate evaluations: one focused on the accuracy of the knowledge extractors, one conceptualized as a document reranking task, and finally, an evaluation of answers by two physicians. Experiments on a collection of real-world clinical questions show that our approach significantly outperforms the already competitive PubMed baseline.

scholarly journals Evidence-based medicine

1996 ◽  
Vol 20 (11) ◽  
pp. 673-675 ◽  
Author(s):  
Simon Gilbody
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Training ◽  
Journal Club ◽  
Critical Evaluation ◽  
Research Literature ◽  
Psychiatric Research ◽  
Evidence Based ◽  
Based Medicine ◽  
Clinical Problems

Evidence-based medicine is an approach to clinical training and practice that is increasing in popularity. When introduced into the journal club format, it provides an opportunity to integrate real clinical problems with critical evaluation of the psychiatric research literature. The principles of evidence-based medicine and the practicalities of its introduction into the Journal club format are described.

The Challenge of Evidence-Based Migraine Therapy

Cephalalgia ◽  
2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 1-4 ◽  
Author(s):  
WJ Becker
Keyword(s):  
Clinical Trials ◽  
Clinical Experience ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Academic Health ◽  
Migraine Therapy ◽  
Research Challenges ◽  
Health Centres ◽  
Clinical Questions ◽  
Based Medicine

It is important that physicians practise evidence-based medicine. Clinical experience is important, but there are a number of reasons why clinical experience can lead to the impression that ineffective treatments are effective. There are major educational and research challenges which must be met before clinicians can practice evidence-based migraine therapy more extensively than at present. Treating physicians will need to learn more about the principles of evidence-based medicine. Researchers will need to produce more and better clinical trials that address important clinical questions. The results of these trials will need to be reported clearly, and we need to improve the efficiency with which these results can be accessed. It is important that the pharmaceutical industry, clinicians, and academic health centres work together to meet these challenges.

scholarly journals Evidence-based Medicine (Dr. Gordon Guyatt)

The Meducator ◽  
2019 ◽  
Vol 1 (36) ◽  
pp. 26-28
Author(s):  
The Meducator ◽  
Daniel Rayner ◽  
Hargun Kaur
Keyword(s):  
Evidence Based Medicine ◽  
Large Scale ◽  
Research Evidence ◽  
Evidence Based ◽  
Assessment Development ◽  
Department Of Health ◽  
Study Methodology ◽  
Based Medicine ◽  
Grade Approach ◽  
Development And Evolution

Dr. Gordon Guyatt is a Distinguished Professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University, and is one of the founders of “evidence-based medicine.” He has played a significant role in over 30 major clinical studies, including large-scale observational and randomized trials and has extensive expertise in study methodology. As the co-founder and co-chair of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, he has been intimately involved in the development and evolution of the GRADE approach for evaluating research evidence.

Medical Search Engines

2008 ◽  
pp. 873-881
Author(s):  
Bob Badgett ◽  
Suresh Chalasani ◽  
Rajendra V. Boppana ◽  
Jacqueline A. Pugh
Keyword(s):  
Biomedical Research ◽  
Evidence Based Medicine ◽  
Clinical Care ◽  
National Institutes Of Health ◽  
Research Articles ◽  
The Internet ◽  
Free Access ◽  
Evidence Based ◽  
Clinical Questions ◽  
Based Medicine

Twenty years ago, researchers identified the difficulties physicians have in answering the clinical questions that arise during medical care (Covell, Uman, & Manning, 1985). Fifteen years ago, the “Evidence-based medicine” movement arose (Cohen, 2001) and exhorted clinicians to use computers to look up the answers to questions as they arise during clinical care. Fortuitously for the proponents of evidence-based medicine the Internet matured in the 1990s{Hersh 1996 #3370}, epitomized by the launching of PubMed by Al Gore in June, 1997. PubMed, developed by the National Institutes of Health, provided the first free access to millions of biomedical research articles at MEDLINE. Unfortunately, the Internet has not fulfilled its potential to assist physicians in answering clinical questions. A recent study found that physicians obtain answers to only 40% of questions that arise during patient care (Ely, Osheroff, Chambliss, Ebell, & Rosenbaum, 2004); this rate is not much different than the rate of 30% reported 20 years ago (Covell et al., 1985).

scholarly journals The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 2

2013 ◽  
Vol 40 (4) ◽  
pp. 475-481 ◽  
Author(s):  
Shashi S. Seshia ◽  
G. Bryan Young
Keyword(s):  
Cognitive Processes ◽  
Emerging Economies ◽  
Evidence Based Medicine ◽  
Statistical Tests ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Core Elements ◽  
Literature Evidence ◽  
Clinical Questions ◽  
Based Medicine

AbstractIn Part 2, we discuss the challenges of keeping up with the ‘literature,’ evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the ‘measurements’ for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.

scholarly journals Appraisal of meta-analysis

1998 ◽  
Vol 22 (11) ◽  
pp. 698-701
Author(s):  
Apu Chakraborty ◽  
James P. Warner ◽  
Robert Blizard
Keyword(s):  
Mood Disorders ◽  
Evidence Based Medicine ◽  
Journal Club ◽  
Meta Analysis ◽  
Clinical Implications ◽  
Evidence Based ◽  
Clinical Question ◽  
Ventricular Size ◽  
Clinical Questions ◽  
Based Medicine

Aims and methodPrompted by a clinical question, we critically appraised a meta-analysis of neuroimaging in our evidence-based journal club.ResultsThe results of the meta-analysis suggested differences in ventricular size and sulcal width between controls and people with schizophrenia and mood disorders. However, we were unable to answer the question that prompted this exercise.Clinical implicationsAlthough the evidence-based medicine approach facilitates appraisal of complex articles, some clinical questions are not yet answerable.

scholarly journals Peering into the “rabbit hole” of publication bias and inadequate research transparency: Adding tangibility to the abstract

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 609 ◽  
Author(s):  
Martin Mayer
Keyword(s):  
Publication Bias ◽  
Human Body ◽  
Evidence Based Medicine ◽  
Case Series ◽  
Well Being ◽  
Research Literature ◽  
Evidence Based ◽  
Medical Providers ◽  
Research Transparency ◽  
Based Medicine

When patients seek medical care, they assume the treatment or advice they receive is based on a strong understanding of the human body and its processes. They also typically assume the care they receive is based on a strong understanding of the research literature pertaining to their well-being and any ailments for which they might seek care. However, publication bias and inadequate research transparency greatly threaten medical providers’ ability to practice evidence-based medicine in its truest form, and this in turn puts patients at unnecessary risk. The evidence of these issues existing is unequivocal. However, systematic reviews and other studies that present overviews of these issues – although certainly incredibly important in establishing the undeniable presence and pervasiveness of these issues – may inadvertently obfuscate the concreteness of these closely-related processes in action. Therefore, this article presents a “case series” of these detrimental issues in action in an effort to emphasize the tangibility of these issues and thereby help make their importance unmistakably clear.

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