GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework - PubMed GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework

Interpreting network #MetaAnalysis (NMA) to decide the best treatments is challenging. #GRADE’s guidance to deciding which are among the best, intermediate, and among the worst, in the @bmj.com, by far the best approach available.

pubmed.ncbi.nlm.nih.gov/33177059/

This study in @annalsofim.bsky.social highlights ethical problems in stopping trials early for benefit: seriously inflated overestimates of treatment effect violates ethical requirements of scientific validity and social value and leads to misguided patient choices.
pubmed.ncbi.nlm.nih.gov/17577007/

SPICE-GRADE: simultaneous processing of indirect causal evidence in complex pathways using GRADE - an exploratory case study - PubMed In this case study, we illustrate SPICE-GRADE as a structured way of mapping and assessing multiple causal links within the GRADE framework. Establishing SPICE-GRADE as a robust methodology for GRADE ...

Spice-GRADE: methodological breakthrough for #GRADE. New methods showing how indirect evidence from epidemiological investigations of mechanistic causal pathways can complement direct evidence.

pubmed.ncbi.nlm.nih.gov/41802581/

Evaluating agreement: conducting a reliability study - PubMed Instruments that are useful in clinical or research practice will, when the object of measurement is stable, yield similar results when applied at different times, in different situations, or by diffe...

Researchers sometimes interested in measuring agreement. Could be in physical examination, imaging evaluation, specimen evaluation or in measurement instruments such as risk of bias or guideline quality. This step-by-step guide to conducting such a study is THE BEST
pubmed.ncbi.nlm.nih.gov/19411507/

How to determine the optimal duration of anticoagulation for VTE: an evidence-based decision-analytical approach - PubMed When advising patients on the optimal duration of anticoagulation for venous thromboembolism (VTE), current management often relies on the intuition of treating physicians and guideline panels, an app...

#Guidelines often rely on the intuition of panels and can therefore remain opaque to outside observers. This paper demonstrates how a decision-analytical framework provides an explicit and transparent integration of the best available evidence on benefits and harms

pubmed.ncbi.nlm.nih.gov/41558032/

Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis - PubMed In this systematic review we looked for the long-term effects of childbirth on urinary leakage. We found that vaginal delivery is associated with an almost twofold increase in the risk of developing l...

Trade-offs in #vaginal vs #caesarian delivery: #SystematicReview vaginal delivery associated with almost twofold increase in the risk of developing leakage with exertion (Stress Incontinence), smaller increase on leakage in association with urgency.

pubmed.ncbi.nlm.nih.gov/26874810/

Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation - PubMed The purpose of this study was to compare the performance of measures of health-related quality of life in a randomized controlled trial of respiratory rehabilitation versus conventional community care...

Compelling evidence that if clinical trialists interested in the impact of treatment on health-related #qualityoflife include only generic measures & fail to include responsive & valid disease-specific measures in their #RCTs, they risk missing the crucial signal.
pubmed.ncbi.nlm.nih.gov/10210235/

Clarity CLARITY represents the formal alliance of a group of researchers who have enjoyed a long-standing and fruitful collaboration. Through formal collaboration, Clarity's clinical advances through research...

A crucial – though challenging – EBM concept is the distinction between baseline risk vs effect modification/subgroup analysis. After years struggling to teach, I discovered this exercise that succeeds brilliantly. Find it in the next to latest Core #GRADE FAQ.
www.clarityresearch.ca/frequently-a...

GRADE approach to rate the certainty from a network meta-analysis: avoiding spurious judgments of imprecision in sparse networks - PubMed When direct and indirect estimates of treatment effects are coherent, network meta-analysis (NMA) estimates should have increased precision (narrower confidence or credible intervals compared with relying on direct estimates alone), a benefit of NMA. We have, however, observed cases of sparse networ …

In network #MetaAnalysis (NMA) sparse networks sometimes yield bizarrely wide #ConfidenceIntervals. The solution we discovered after trying many alternatives perhaps surprising: switch from random effects to fixed effect.

pubmed.ncbi.nlm.nih.gov/30253217/

Adjusted Analyses in Studies Addressing Therapy and Harm: Users' Guides to the Medical Literature - PubMed Observational studies almost always have bias because prognostic factors are unequally distributed between patients exposed or not exposed to an intervention. The standard approach to dealing with this problem is adjusted or stratified analysis. Its principle is to use measurement of risk factors to …

The #JAMA Users’ Guide to the Medical Literature is the best existing tutorial on adjusted analysis taking the learner from the basic principles to regression and contrasting with propensity matching, highlighting the (limited) advantages of propensity.

pubmed.ncbi.nlm.nih.gov/28241362/

Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat - PubMed Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat

This wonderful educational plan describes how to teach learners new to #EBM to understand relative risk reductions and to differentiate them from absolute risk reduction as well as number needed to treat.

pubmed.ncbi.nlm.nih.gov/15313996/

A decision algorithm for assessing indirectness in core GRADE - PubMed A decision algorithm for assessing indirectness in core GRADE

Most useful innovation in #BMJ Core #GRADE series are algoritms to take your though #riskofbias, #imprecision, and #inconsistency. But #indirectness – nothing until publication last month of an indirectness algorithm we developed after publication of the series.

pubmed.ncbi.nlm.nih.gov/41386580/

GRADE approach to rate the certainty from a network meta-analysis: addressing incoherence - PubMed This article presents official guidance from the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) working group on how to address incoherence when assessing the certainty in the evidence from network meta-analysis. Incoherence represents important differences between direc …

Assessing #incoherence – differences between direct and indirect estimates in a network #MetaAnalysis (NMA) can be challenging. This lucid article describes the #GRADE approach to addressing the issue

pubmed.ncbi.nlm.nih.gov/30529648/

A few months ago – 48 years after graduation from medical school - I did my last clinical rotation in hospital-based general internal medicine and hung up my stethoscope. Now, more time for research, graduate student supervision, research, and local and international #EBM teaching.

Specific instructions for estimating unclearly reported blinding status in randomized trials were reliable and valid - PubMed With the possible exception of blinding of data analysts, use of "probably yes" and "probably no" instead of "unclear" may enhance the assessment of blinding in trials.

Looking at an #RCT to decide who among #patients, #clinicians, data collectors, et al is #blinded and it’s not clear and explicit? Happens often. Fortunately, almost always enough clues that if you follow instructions in this paper you will make the right inference.
pubmed.ncbi.nlm.nih.gov/22200346/

Clarity CLARITY represents the formal alliance of a group of researchers who have enjoyed a long-standing and fruitful collaboration. Through formal collaboration, Clarity's clinical advances through research...

Latest frequently asked question regarding Core #GRADE: What should a #guideline panel do when they suspect baseline difference in risk warrant different #recommendations in two groups, but no review of #prognosis available? If you have a question, email me.

www.clarityresearch.ca/frequently-a...

GRADE approach to rate the certainty from a network meta-analysis: addressing incoherence - PubMed This article presents official guidance from the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) working group on how to address incoherence when assessing the certainty in the evidence from network meta-analysis. Incoherence represents important differences between direc …

#Incoherence in a network #MetaAnalysis occurs when direct and indirect estimates of the effect of an intervention differ substantially: what to do, and how to use #GRADE to rate the #CertaintyofEvidence? This paper answers the questions.

pubmed.ncbi.nlm.nih.gov/30529648/

Key study of Grail’s cancer detection test fails in setback for company Grail's blood test for detecting cancer early failed to meet its main goal in a giant study being conducted with England’s NHS, the company said.

Company, new #tests for early #CancerDetection to decrease late-stage #cancer and #mortality sold 185k in 2025 at $1k a crack. Problem: just completed #RCT no benefit either outcome. Latest evidence cancer screening limitations, need to wait for evidence of benefit.

www.statnews.com/2026/02/19/g...

A comparison of seven-point and visual analogue scales. Data from a randomized trial - PubMed Many controlled trials rely on subjective measures of symptoms or quality of life as primary outcomes. The relative merits of different response options for these instruments is an important issue. Therefore, we compared the responsiveness and validity of seven-point versus visual analogue scales (V …

Compelling evidence from a #RandomizedTrial (RCT) looking at #PatientImportantOutcomes (PROMS): 7-point scales and #VisualAnalogueScales (VAS) show similar validity and responsiveness (sensitivity to change) to detect intervention effects. Either choice is fine.

pubmed.ncbi.nlm.nih.gov/2157581/

Is 'shared decision-making' being hijacked by U.S. health officials to sow doubt about vaccines? Experts worry that health officials' use of 'shared decision-making' in new vaccine guidance distorts the concept's meaning and disregards the importance of evidence.

Disturbing article about how U.S. health officials have hijacked shared decision making to follow the Kennedy line to encourage vaccine hesitancy.

www.statnews.com/2026/01/20/s...

GRADE: assessing the quality of evidence for diagnostic recommendations - PubMed GRADE: assessing the quality of evidence for diagnostic recommendations

Applying GRADE to #DiagnosticTests remains challenging. Here, a summary of the #GRADE approach from the days when we succeeded in being as simple and straightforward as possible.

pubmed.ncbi.nlm.nih.gov/19043023/

An imputation study shows that missing outcome data can substantially bias pooled estimates in systematic reviews of patient-reported outcomes - PubMed When studies included in a systematic review have missing outcome data, the study results may be biased and therefore misleading. If there is not much missing data, this is not a problem. If there is lots of missing data, it can be a big problem. Researchers have suggested ways of highlighting how m …

Newly published #ImputationStudy demonstrates that #MissingData can often bias pooled estimates in #SystematicReviews (SR) of #PatientReportedOutcomes(#PROs)

pubmed.ncbi.nlm.nih.gov/41461360/

GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making - PubMed This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for a …

Addressing the #CertaintyofEvidence for #ModellingStudies is a tough nut to crack. Here, a #GRADE overview of the issues in a health context.

pubmed.ncbi.nlm.nih.gov/32980429/

Trans health care "skeptics" lost a key ally—now they're having a meltdown The godfather of evidence-based medicine on rejecting anti-trans "misuse" of his work.

Superb article addressing the controversy regarding our #EBM research – #SystematicReviews of the #evidence regarding #GenderAffirming care in #adolescence and early #adulthood – probably the best yet. Great commentary on my views versus those of #SEGM.
www.motherjones.com/politics/202...

An observational study found that authors of randomized controlled trials frequently use concealment of randomization and blinding, despite the failure to report these methods - PubMed Readers should not assume that bias-reducing procedures not reported in an RCT did not occur.

Authors of #RCTs who actually apply concealed #randomization and #blinding failed to report transparently in their articles. Making correct deductions requires inferences from clues in the study, contacting authors to get definitive information.

pubmed.ncbi.nlm.nih.gov/15617948/

Clarity CLARITY represents the formal alliance of a group of researchers who have enjoyed a long-standing and fruitful collaboration. Through formal collaboration, Clarity's clinical advances through research...

Latest frequently asked question about #BMJ Core #GRADE series, all you need to apply GRADE to treatment studies: how to deal with uncertainty around #PublicationBias, joins applying GRADE to single study, a prior hypotheses, rating down for #imprecision.

www.clarityresearch.ca/frequently-a...

GRADE Guidance 34: update on rating imprecision using a minimally contextualized approach - PubMed GRADE provides updated guidance for imprecision rating in a minimally contextualized approach, with a focus on the circumstances in which one should seriously consider rating down two or three levels for imprecision.

Brilliant explication of #GRADE framework when to rate down once or twice for #imprecision complements and provides additional informative examples to what you’ll find in the #BMJ 2025 GRADE series’ second article.

pubmed.ncbi.nlm.nih.gov/35934265/

I’ll be speaking at world’s best #EBM conference, 22nd to 24th October 2026, focus on EBM and AI . In #Taormina, renowned, picturesque hilltop town on #Sicily 's east coast, famous for its breathtaking views of the #IonianSea and active #MountEtna

www.ebhcconference.org/home.en-GB.h...

Methodologic discussions for using and interpreting composite endpoints are limited, but still identify major concerns - PubMed Methodologists have given limited attention to CEPs and their views are sometimes contradictory. Further work is needed to establish the role of CEPs in research and in guiding clinical practice.

#CompositeEndpoints frequently mislead by overestimating benefits: #death, #MyocardialInfarction (dominated), and #revascularization. Worse, add #stroke to these three and goes in opposite direction to revascularization and composite favors the wrong intervention!

pubmed.ncbi.nlm.nih.gov/17573977/

All you need to know about EBM: A founder's guide to evidence, guidelines & getting back to the core YouTube video by EBM One Platform

My favorite interview-based brief introduction to #EBM, the interviewer being my dear friend Jaeschke. Comment on the interview from the individual who organized ”It is well paced, illustrative and easy to follow – just the kind of conversation we were hoping for”

www.youtube.com/watch?v=I7ou...