Challenges in Developing Evidence-Based Recommendations Using the GRADE Approach: The Case of Mental, Neurological, and Substance Use Disorders

Corrado Barbui and colleagues describe their use and adaptation of the GRADE approach in developing the guidelines for the WHO mental health Gap Action Programme (mhGAP)

What kind of evidence is it that Evidence-Based Medicine advocates want health care providers and consumers to pay attention to?

BACKGROUND: In 1992, Evidence-Based Medicine advocates proclaimed a "new paradigm", in which evidence from health care research is the best basis for decisions for individual patients and health systems. Hailed in New York Times Magazine in 2001 as one of the most influential ideas of the year, this approach was initially and provocatively pitted against the traditional teaching of medicine, in which the key elements of knowing for clinical purposes are understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience. This paper reviews the origins, aspirations, philosophical limitations, and practical challenges of evidence-based medicine. DISCUSSION: EBM has long since evolved beyond its initial (mis)conception, that EBM might replace traditional medicine. EBM is now attempting to augment rather than replace individual clinical experience and understanding of basic disease mechanisms. EBM must continue to evolve, however, to address a number of issues including scientific underpinnings, moral stance and consequences, and practical matters of dissemination and application. For example, accelerating the transfer of research findings into clinical practice is often based on incomplete evidence from selected groups of people, who experience a marginal benefit from an expensive technology, raising issues of the generalizability of the findings, and increasing problems with how many and who can afford the new innovations in care. SUMMARY: Advocates of evidence-based medicine want clinicians and consumers to pay attention to the best findings from health care research that are both valid and ready for clinical application. Much remains to be done to reach this goal

Guidelines and Safety Practices for Improving Patient Safety

AbstractThis chapter explains why clinical practice guidelines are needed to improve patient safety and how further research into safety practices can successfully influence the guideline development process. There is a description of the structured process by which guidelines that aim to increase the likelihood of a higher score are created. Proposals are made relating to (a) the live updating of individual guideline recommendations and (b) tackling challenges related to the improvement of guidelines

Principles of Cancer Epidemiology

A clinical epidemiological study must address a research question, which can be explanatory or descriptive and which can be categorized as etiological, diagnostic, or prognostic. The main outcome measures of cancer epidemiology studies are prevalence, incidence, mortality, time to event, and quality of life. Surrogate endpoints are sometimes used instead of clinical endpoints but are controversial. There are many measures of association, which include relative risk, hazard ratio, odds ratio, differences in risk, and differences in mean score. The precision of estimates is described by p values and confidence intervals. Inaccuracies can be caused by various forms of bias, such as confounding, selection bias, and information bias. There are several research designs, which include case series, cross-sectional studies, cohort studies, randomized controlled trials, case-control studies, pilot studies, and systematic reviews

Journal Reading Habits of Internists

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72707/1/j.1525-1497.2000.00202.x.pd