How do you know what to believe when it comes to medical research studies? What sources of information should you trust? What about statistics? Is evidence based medicine the sollution?
Observational studies should be considered for inclusion in comparative effectiveness reviews to fill gaps in evidence from randomized controlled trials. Gaps may exist due to populations, interventions, comparators, outcomes, timing, or settings not covered by trials. Reviewers should assess whether observational studies can validly address review questions by considering potential biases, clinical context, and availability of comparison groups. While observational studies are generally not suitable for assessing benefits due to biases, they are important for evaluating harms since these are often inadequately assessed in randomized trials.
The document describes the topic refinement process used by the Agency for Healthcare Research and Quality (AHRQ) for systematic reviews. It involves identifying key questions about a topic through input from key informants and public comment to ensure the reviews address important uncertainties and stakeholder needs. Key questions guide the entire review process by defining the population, intervention, outcomes, and other elements.
Best strategies for successful recruitment and retentionTrialJoin
Best strategies for successful recruitment and retention for clinical research studies
Contact info@trialjoin.com for more information about patient recruitment help, obtaining new studies or help with site management.
This document discusses various topics related to outcomes research, including comparative effectiveness research, multilevel data analysis, investigating change over time, and estimating treatment effects from observational data. Comparative effectiveness research directly compares existing healthcare interventions to determine their benefits and harms. Multilevel analysis is helpful for comparing patient outcomes across hospitals while accounting for risk factors. Propensity score adjustment and other statistical techniques can be used to estimate causal treatment effects from observational data and reduce selection bias. Bayesian statistics are increasingly being used in areas like early-phase cancer trials.
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
Patients Recruitment Forecast in Clinical TrialsCognizant
Patient recruitment is a crucial but challenging part of clinical trials. Accurately forecasting patient enrollment is important to remain on schedule and budget. However, recruitment is often underestimated, leading to delays and costs. This is due to uncertainties like site investigator overestimations, patient dropout rates, and variability in recruitment across sites. The document discusses stochastic and non-stochastic approaches to more accurately model recruitment, using statistical techniques like Monte Carlo simulation to account for uncertainties. Accurately predicting enrollment can improve clinical trial success and reduce costs.
Results of an Online Survey of Stakeholders Regarding Barriers and Solutions ...John Reites
The survey found that the most significant barrier to clinical trial recruitment according to stakeholders was finding patients who meet eligibility criteria. The next most significant barriers were insufficient staff time for recruitment activities, followed by the length and complexity of consent forms, and protocol requirements other than eligibility criteria. Suggestions to overcome barriers included broadening eligibility criteria, improving planning, using effective recruitment methods and technology, simplifying processes, and improving staff support. Most stakeholders were optimistic that national recruitment rates would increase over the next 5-10 years if effective partnerships were formed between sectors like patient advocates, researchers, sponsors, and regulators.
This document discusses key concepts for using epidemiology to evaluate health services. Efficacy is measured in randomized trials, effectiveness in real-world settings, and efficiency with cost-benefit ratios. Outcome measures must be quantifiable, easy to define, and standardized. Studies evaluating health services compare outcomes between those receiving a service versus not, similar to etiology studies comparing exposed versus unexposed groups. Evaluation can use group or individual level data, with individual data allowing for comparison of comparable participant characteristics and measurement methods between service recipient groups. Randomized and nonrandomized designs like before-after, simultaneous, utilizers versus non-utilizers, and case-control studies can be used.
Observational studies should be considered for inclusion in comparative effectiveness reviews to fill gaps in evidence from randomized controlled trials. Gaps may exist due to populations, interventions, comparators, outcomes, timing, or settings not covered by trials. Reviewers should assess whether observational studies can validly address review questions by considering potential biases, clinical context, and availability of comparison groups. While observational studies are generally not suitable for assessing benefits due to biases, they are important for evaluating harms since these are often inadequately assessed in randomized trials.
The document describes the topic refinement process used by the Agency for Healthcare Research and Quality (AHRQ) for systematic reviews. It involves identifying key questions about a topic through input from key informants and public comment to ensure the reviews address important uncertainties and stakeholder needs. Key questions guide the entire review process by defining the population, intervention, outcomes, and other elements.
Best strategies for successful recruitment and retentionTrialJoin
Best strategies for successful recruitment and retention for clinical research studies
Contact info@trialjoin.com for more information about patient recruitment help, obtaining new studies or help with site management.
This document discusses various topics related to outcomes research, including comparative effectiveness research, multilevel data analysis, investigating change over time, and estimating treatment effects from observational data. Comparative effectiveness research directly compares existing healthcare interventions to determine their benefits and harms. Multilevel analysis is helpful for comparing patient outcomes across hospitals while accounting for risk factors. Propensity score adjustment and other statistical techniques can be used to estimate causal treatment effects from observational data and reduce selection bias. Bayesian statistics are increasingly being used in areas like early-phase cancer trials.
A presentation showcasing some of the patient recruitment challenges that I encountered as a recruitment manager as well as some of the strategies -- DIGITAL ADVERTISING -- I used to overcome them.
Patients Recruitment Forecast in Clinical TrialsCognizant
Patient recruitment is a crucial but challenging part of clinical trials. Accurately forecasting patient enrollment is important to remain on schedule and budget. However, recruitment is often underestimated, leading to delays and costs. This is due to uncertainties like site investigator overestimations, patient dropout rates, and variability in recruitment across sites. The document discusses stochastic and non-stochastic approaches to more accurately model recruitment, using statistical techniques like Monte Carlo simulation to account for uncertainties. Accurately predicting enrollment can improve clinical trial success and reduce costs.
Results of an Online Survey of Stakeholders Regarding Barriers and Solutions ...John Reites
The survey found that the most significant barrier to clinical trial recruitment according to stakeholders was finding patients who meet eligibility criteria. The next most significant barriers were insufficient staff time for recruitment activities, followed by the length and complexity of consent forms, and protocol requirements other than eligibility criteria. Suggestions to overcome barriers included broadening eligibility criteria, improving planning, using effective recruitment methods and technology, simplifying processes, and improving staff support. Most stakeholders were optimistic that national recruitment rates would increase over the next 5-10 years if effective partnerships were formed between sectors like patient advocates, researchers, sponsors, and regulators.
This document discusses key concepts for using epidemiology to evaluate health services. Efficacy is measured in randomized trials, effectiveness in real-world settings, and efficiency with cost-benefit ratios. Outcome measures must be quantifiable, easy to define, and standardized. Studies evaluating health services compare outcomes between those receiving a service versus not, similar to etiology studies comparing exposed versus unexposed groups. Evaluation can use group or individual level data, with individual data allowing for comparison of comparable participant characteristics and measurement methods between service recipient groups. Randomized and nonrandomized designs like before-after, simultaneous, utilizers versus non-utilizers, and case-control studies can be used.
This document provides guidance for consumers on how to effectively comment on Cochrane reviews and protocols. It outlines the importance of the consumer perspective in adding value and relevance. Consumer input can help identify priorities, clarify language, and ensure the review is meaningful. The document reviews the steps in producing a Cochrane review from registering the title to disseminating the final review. It addresses common concerns consumers may have and provides tips for submitting constructive feedback.
Our main involvement with your clinical research recruitment program concludes with processing the responses to your mailer. As our staff members direct the respondents to your site, you can begin conducting final interviews to complete the clinical trial recruitment process.
The document provides an overview of the Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care Program. It describes the program's goals of conducting comparative effectiveness research to inform healthcare decisions. It outlines the key players and their roles, including Evidence-based Practice Centers that conduct evidence syntheses, stakeholders that provide input, and dissemination of findings to patients and policymakers.
The document discusses several key issues regarding medical data:
1) Medicine lacks standardized vocabulary and terminology, creating problems for data retrieval and analysis across different observers and analysts.
2) Coding systems are used for health reporting but have limitations in clinical settings. Researchers developed the Unified Medical Language System (UMLS) to connect various vocabularies.
3) Physicians use a hypothetico-deductive approach in data collection and interpretation, generating hypotheses to guide sequential data collection and narrowing differential diagnoses.
Outcomes research measures the results of healthcare interventions on individuals and aims to provide scientific evidence to inform healthcare decisions while considering individual preferences. It is important to use appropriate tools to accurately measure outcomes, choose outcomes relevant to the patient population, and select qualified researchers. However, outcomes research can be flawed if the methods, conduct, or analysis are inadequate, which can lead to biased results. Other issues include poor reporting of study details, a lack of communication between researchers, and conclusions that exceed the available information or use limited outcome indicators.
Patient recruitment & retention is highlighted as the key factor in ensuring study success, the area of patient retention in clinical trials is often overlooked. Retention of patients throughout the life of a clinical trial is however extremely vital from scientific as well as economic point of view. Poor recruitment & retention negatively impacts on the overall evaluable data for regulatory submissions. Dropped participants must be replaced which incurs further expenditures and time delays. Subject dropout rates are estimated to range from 15-40% of enrolled participants in clinical trials.
This document discusses the value of personalized medicine and some key challenges in measuring and demonstrating its value. It provides two case studies of HER2 testing for breast cancer treatment with Herceptin and gene expression profiling tests for breast cancer recurrence risk. While these show promise for personalized medicine, challenges remain around ensuring access, accuracy of tests, linking tests to treatment and outcomes, and demonstrating cost-effectiveness. Overall, measuring the value of personalized medicine requires consideration of multiple stakeholder perspectives and building an evidence base around clinical utility, economic impacts, and real-world implementation.
This document discusses evidence-based practice and how to formulate clinical questions using the PICO framework. It emphasizes asking answerable clinical questions, acquiring the best evidence to answer those questions, critically appraising the evidence, and applying it to patient care. Examples are provided to demonstrate how to develop well-structured clinical questions using PICO components and identify the optimal study design to answer each type of question. Resources for self-education in evidence-based medicine are also highlighted.
P04.17. Adverse effects of homeopathy, what do we know? A systematic reviewhome
In order to prevent serious events as a consequence of
homeopathic treatment, the identification of an unwanted
adverse event is of critical importance. A differentiation of
adverse events and homeopathic aggravations, which is
accepted as a concept in homeopathy, should be a part of
a reporting system where risk and safety are assessed. This
is of particular significance in a treatment system like
homeopathy, which is in most European countries regulated
as an alternative treatment and as such not included
in the supervision system of health care.
Evidence Based Medicine involves integrating the best available research evidence with clinical expertise and patient values. It is a 5-step process: 1) framing a clinical question, 2) finding the best evidence, 3) critically appraising the evidence, 4) integrating the evidence into practice, and 5) evaluating the process. The hierarchy of evidence ranks randomized controlled trials highest, while expert opinion is lowest. Several sources can be used to find evidence, including PubMed, Cochrane Library, UptoDate, and clinical guidelines websites. Skill is required to perform efficient searches and appraise evidence critically.
ASSESSMENT OF BIOMEDICAL LITERATURE
Components of internal and external validity of controlled clinical trials
Internal validity — extent to which systematic error (bias) is minimized in clinical trials
Selection bias: biased allocation to comparison groups
Performance bias: unequal provision of care apart from treatment under evaluation
Detection bias: biased assessment of outcome
Attrition bias: biased occurrence and handling of deviations from protocol and loss to follow up
Requirements, needs
Planning, direction
Information collection
Information Assessment
- Evaluation for accuracy, correctness, relevance, usefulness
- Source reliability assessment (competency and past behavior based)
- Bias assessment (motivators, interests, funding, objectives)
- Conflicts of interest
- Sources of funding, important business relationships
- Grading of individual items (study, report, analysis, article)
Collation of information
- Exclusion of irrelevant, incorrect, and useless information
-Arrangement of information in a form which enables real-time analysis
- System for rapid retrieval of information
External validity — extent to which results of trials provide a correct basis for generalization to other circumstances
Patients: age, sex, severity of disease and risk factors, comorbidity
Treatment regimens: dosage, timing and route of administration, type of treatment within a class of treatments, concomitant treatments
Settings: level of care (primary to tertiary) and experience and specialization of care provider
Modalities of outcomes: type or definition of outcomes and duration of follow up
This document outlines the steps for critically appraising an article on a systematic review using the Sudan Evidence-Based Medicine Association template. It includes formulating a clinical question using PICO (Patient, Intervention, Comparison, Outcome), outlining the current practice and search strategy, selecting a research article, summarizing the results, and applying an appraisal scheme to assess the relevance, validity, results, and applicability of the study. The template provides guidance on assessing strengths and weaknesses, resolving the original clinical question, and making recommendations.
This document outlines the steps for critically appraising a journal article on therapy using the Sudan Evidence-Based Medicine Association template. It includes developing a well-built clinical question using PICO (Patient, Intervention, Comparison, Outcome), outlining the current practice and selecting a research article to appraise. The template guides the user through appraising the relevance, validity, results, and applicability of the selected article using the RVRA scheme. It also provides guidance on applying the findings to resolve the original clinical question and determining if changes to practice are warranted.
The document discusses factors that can affect the applicability of clinical trial results, such as trials with high exclusion rates pre-randomization, use of composite endpoints, and differences in study populations compared to general populations. It notes that grading strength of evidence and assessing applicability should be done separately, as studies may show superiority of an intervention but it may not be effective in actual practice. When assessing applicability, the initial step involves evaluating columns 1 through 5 of an evidence table, which relate to the PICOS (population, intervention, comparators, outcomes, setting) of each trial.
This document defines evidence-based medicine (EBM) and outlines its key aspects. EBM involves integrating the best available research evidence with clinical expertise and patient values. It teaches physicians to apply clinical and epidemiological research studies to patient care. EBM aims to make individual decision making more objective and evidence-based. Pharmacists can play an important role in EBM by facilitating systematic reviews, interpreting research findings, developing guidelines, and transferring evidence-based information to clinicians and patients.
This document discusses methods for exploring between-study heterogeneity in meta-analyses, including subgroup analyses, meta-regression, and control-rate meta-regression. It provides examples of how these techniques can help identify sources of variability in treatment effects across studies and generate hypotheses. However, it also cautions that subgroup analyses and meta-regressions on patient-level covariates are prone to spurious findings due to multiple testing and ecological fallacy.
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
This document discusses the history and principles of evidence-based medicine (EBM). It notes that while EBM has ancient origins, the modern concept was popularized in the 1970s by Archie Cochrane. EBM involves applying the best available evidence from scientific research to medical practice and decision making. Evidence is ranked based on the strength of the research design. Guidelines help regulate practice based on evidence, while individual decision making focuses on practitioners building their decisions from evidence. Randomized controlled trials provide the strongest evidence, while observational studies and descriptive research provide weaker evidence. Rigorous research requires strength, consistency and adherence to proper methodology.
This document provides guidance for consumers on how to effectively comment on Cochrane reviews and protocols. It outlines the importance of the consumer perspective in adding value and relevance. Consumer input can help identify priorities, clarify language, and ensure the review is meaningful. The document reviews the steps in producing a Cochrane review from registering the title to disseminating the final review. It addresses common concerns consumers may have and provides tips for submitting constructive feedback.
Our main involvement with your clinical research recruitment program concludes with processing the responses to your mailer. As our staff members direct the respondents to your site, you can begin conducting final interviews to complete the clinical trial recruitment process.
The document provides an overview of the Agency for Healthcare Research and Quality's (AHRQ) Effective Health Care Program. It describes the program's goals of conducting comparative effectiveness research to inform healthcare decisions. It outlines the key players and their roles, including Evidence-based Practice Centers that conduct evidence syntheses, stakeholders that provide input, and dissemination of findings to patients and policymakers.
The document discusses several key issues regarding medical data:
1) Medicine lacks standardized vocabulary and terminology, creating problems for data retrieval and analysis across different observers and analysts.
2) Coding systems are used for health reporting but have limitations in clinical settings. Researchers developed the Unified Medical Language System (UMLS) to connect various vocabularies.
3) Physicians use a hypothetico-deductive approach in data collection and interpretation, generating hypotheses to guide sequential data collection and narrowing differential diagnoses.
Outcomes research measures the results of healthcare interventions on individuals and aims to provide scientific evidence to inform healthcare decisions while considering individual preferences. It is important to use appropriate tools to accurately measure outcomes, choose outcomes relevant to the patient population, and select qualified researchers. However, outcomes research can be flawed if the methods, conduct, or analysis are inadequate, which can lead to biased results. Other issues include poor reporting of study details, a lack of communication between researchers, and conclusions that exceed the available information or use limited outcome indicators.
Patient recruitment & retention is highlighted as the key factor in ensuring study success, the area of patient retention in clinical trials is often overlooked. Retention of patients throughout the life of a clinical trial is however extremely vital from scientific as well as economic point of view. Poor recruitment & retention negatively impacts on the overall evaluable data for regulatory submissions. Dropped participants must be replaced which incurs further expenditures and time delays. Subject dropout rates are estimated to range from 15-40% of enrolled participants in clinical trials.
This document discusses the value of personalized medicine and some key challenges in measuring and demonstrating its value. It provides two case studies of HER2 testing for breast cancer treatment with Herceptin and gene expression profiling tests for breast cancer recurrence risk. While these show promise for personalized medicine, challenges remain around ensuring access, accuracy of tests, linking tests to treatment and outcomes, and demonstrating cost-effectiveness. Overall, measuring the value of personalized medicine requires consideration of multiple stakeholder perspectives and building an evidence base around clinical utility, economic impacts, and real-world implementation.
This document discusses evidence-based practice and how to formulate clinical questions using the PICO framework. It emphasizes asking answerable clinical questions, acquiring the best evidence to answer those questions, critically appraising the evidence, and applying it to patient care. Examples are provided to demonstrate how to develop well-structured clinical questions using PICO components and identify the optimal study design to answer each type of question. Resources for self-education in evidence-based medicine are also highlighted.
P04.17. Adverse effects of homeopathy, what do we know? A systematic reviewhome
In order to prevent serious events as a consequence of
homeopathic treatment, the identification of an unwanted
adverse event is of critical importance. A differentiation of
adverse events and homeopathic aggravations, which is
accepted as a concept in homeopathy, should be a part of
a reporting system where risk and safety are assessed. This
is of particular significance in a treatment system like
homeopathy, which is in most European countries regulated
as an alternative treatment and as such not included
in the supervision system of health care.
Evidence Based Medicine involves integrating the best available research evidence with clinical expertise and patient values. It is a 5-step process: 1) framing a clinical question, 2) finding the best evidence, 3) critically appraising the evidence, 4) integrating the evidence into practice, and 5) evaluating the process. The hierarchy of evidence ranks randomized controlled trials highest, while expert opinion is lowest. Several sources can be used to find evidence, including PubMed, Cochrane Library, UptoDate, and clinical guidelines websites. Skill is required to perform efficient searches and appraise evidence critically.
ASSESSMENT OF BIOMEDICAL LITERATURE
Components of internal and external validity of controlled clinical trials
Internal validity — extent to which systematic error (bias) is minimized in clinical trials
Selection bias: biased allocation to comparison groups
Performance bias: unequal provision of care apart from treatment under evaluation
Detection bias: biased assessment of outcome
Attrition bias: biased occurrence and handling of deviations from protocol and loss to follow up
Requirements, needs
Planning, direction
Information collection
Information Assessment
- Evaluation for accuracy, correctness, relevance, usefulness
- Source reliability assessment (competency and past behavior based)
- Bias assessment (motivators, interests, funding, objectives)
- Conflicts of interest
- Sources of funding, important business relationships
- Grading of individual items (study, report, analysis, article)
Collation of information
- Exclusion of irrelevant, incorrect, and useless information
-Arrangement of information in a form which enables real-time analysis
- System for rapid retrieval of information
External validity — extent to which results of trials provide a correct basis for generalization to other circumstances
Patients: age, sex, severity of disease and risk factors, comorbidity
Treatment regimens: dosage, timing and route of administration, type of treatment within a class of treatments, concomitant treatments
Settings: level of care (primary to tertiary) and experience and specialization of care provider
Modalities of outcomes: type or definition of outcomes and duration of follow up
This document outlines the steps for critically appraising an article on a systematic review using the Sudan Evidence-Based Medicine Association template. It includes formulating a clinical question using PICO (Patient, Intervention, Comparison, Outcome), outlining the current practice and search strategy, selecting a research article, summarizing the results, and applying an appraisal scheme to assess the relevance, validity, results, and applicability of the study. The template provides guidance on assessing strengths and weaknesses, resolving the original clinical question, and making recommendations.
This document outlines the steps for critically appraising a journal article on therapy using the Sudan Evidence-Based Medicine Association template. It includes developing a well-built clinical question using PICO (Patient, Intervention, Comparison, Outcome), outlining the current practice and selecting a research article to appraise. The template guides the user through appraising the relevance, validity, results, and applicability of the selected article using the RVRA scheme. It also provides guidance on applying the findings to resolve the original clinical question and determining if changes to practice are warranted.
The document discusses factors that can affect the applicability of clinical trial results, such as trials with high exclusion rates pre-randomization, use of composite endpoints, and differences in study populations compared to general populations. It notes that grading strength of evidence and assessing applicability should be done separately, as studies may show superiority of an intervention but it may not be effective in actual practice. When assessing applicability, the initial step involves evaluating columns 1 through 5 of an evidence table, which relate to the PICOS (population, intervention, comparators, outcomes, setting) of each trial.
This document defines evidence-based medicine (EBM) and outlines its key aspects. EBM involves integrating the best available research evidence with clinical expertise and patient values. It teaches physicians to apply clinical and epidemiological research studies to patient care. EBM aims to make individual decision making more objective and evidence-based. Pharmacists can play an important role in EBM by facilitating systematic reviews, interpreting research findings, developing guidelines, and transferring evidence-based information to clinicians and patients.
This document discusses methods for exploring between-study heterogeneity in meta-analyses, including subgroup analyses, meta-regression, and control-rate meta-regression. It provides examples of how these techniques can help identify sources of variability in treatment effects across studies and generate hypotheses. However, it also cautions that subgroup analyses and meta-regressions on patient-level covariates are prone to spurious findings due to multiple testing and ecological fallacy.
April 18, 2018
Decision aids can be highly-effective tools to promote shared decision making and support patients in becoming engaged participants in their healthcare. Join us for the first-ever convening with leaders behind a Washington experiment in certifying decision aids, as state officials, health systems, and on-the-ground implementation experts share lessons learned and discuss policy recommendations for national or statewide approaches to decision aid certification.
For more information, visit our website at: http://petrieflom.law.harvard.edu/events/details/decision-aids-for-patients-with-serious-illness
This document discusses the history and principles of evidence-based medicine (EBM). It notes that while EBM has ancient origins, the modern concept was popularized in the 1970s by Archie Cochrane. EBM involves applying the best available evidence from scientific research to medical practice and decision making. Evidence is ranked based on the strength of the research design. Guidelines help regulate practice based on evidence, while individual decision making focuses on practitioners building their decisions from evidence. Randomized controlled trials provide the strongest evidence, while observational studies and descriptive research provide weaker evidence. Rigorous research requires strength, consistency and adherence to proper methodology.
Bill Elrick's presentation from the GNA/ACT Expo webinar on February 19, 2014. Bill gives an overview of hydrogen stations in California, commonly used equipment, and codes and standards information.
This document contains an English language practice test with multiple choice questions and fill-in-the-blank exercises about travel-related vocabulary, grammar, and passages. The questions cover topics like accommodations, camping equipment, directions, schedules, and accidents involving GPS navigation systems.
The document discusses the evolution of HR transformation in healthcare. It outlines challenges faced such as change, decision making delays, and complex structures. It argues HR must shift from administrative tasks to strategic roles like strategic partner and change partner. This involves developing a human capital strategy aligned with organizational goals and helping facilitate change. The HR function needs analysis and prioritization through an "HR scan" to identify opportunities and a phased transformation approach to optimize processes and support the organization's objectives.
Social media provides recognizable brands with the means to connect with consumers outside of traditional advertising. However, the reach of these social media initiatives creates additional risk for businesses online.
With web users often leaving a site if it doesn't load in less than three seconds, having a slow blog not only harms your traffic, but it can have a detrimental effect on your business too.
This presentation shows you three simple steps to optimize your blog's load time, to ensure you not only keep new visitors happy, but ensure they join your existing community and keep coming back.
This session will cover data-driven roadmaps for in-house SEOs, technical SEO priorities for 2016, tools that will support your efforts and strategies SEOs need as the search engines continue to mutate in the coming year.
Dit is een artikel van mijn hand in M&O 2012/4
Veranderen is mijn vak. Theorieën en modellen helpen me als adviseur om de complexe werkelijkheid in kaart te brengen. Maar helaas schie- ten ze ook tekort, omdat ze de werkelijkheid net iets te simpel voor- stellen. Ik geef daarom de voorkeur aan managementboeken die het veranderen van organisaties en mensen niet eenvoudig, lineair en planmatig benaderen, maar de nadruk leggen op de complexiteit en weerbarstigheid. In dit artikel beschrijf ik het doen-en-denkenproces. Niet bedoeld als een prescriptief leermodel, maar als een heuristisch hulpmiddel. Het bevat bekende zaken, maar het wijkt ook af. Bijvoor- beeld door de ingebouwde frictie tussen doen en denken als de drijf- veer van verandering; het is een reactief model, geen doelzoekend model. Centraal staat dat denken en doen gestapelde deelprocessen zijn: dat denken niet kan zonder doen, maar doen wel zonder denken. De crux is niet het kiezen wanneer te doen of wanneer te denken, maar hoe deze twee processen goed te laten samenlopen.
Heart disease and stroke are forms of cardiovascular disease that are generally caused by atherosclerosis, a buildup of plaque in the arteries over many years. This plaque buildup can restrict blood flow and cause heart attacks, strokes, or gangrene depending on the location. Risk factors for cardiovascular disease include smoking, diabetes, high blood pressure, high cholesterol, obesity, poor diet, lack of exercise, and exposure to pollution. Early warning signs can include numbness, tingling, cold fingers/toes, and swelling. Coconut oil is a healthy fat that may help maintain cholesterol levels and immunity while promoting proper digestion.
This document is an application pack for clubs and societies at RMIT University to apply for affiliation or re-affiliation for 2012. It contains forms and checklists for the application process. Clubs must have a minimum of 10 members including executive officers. The application process requires filling out forms with contact details of members and officers, descriptions of the club, and signing bank account authorization forms.
This document provides an introduction to biostatistics. It discusses key concepts including descriptive statistics, inferential statistics, hypothesis testing, and sampling techniques. It outlines the role of biostatistics in various areas like clinical medicine, preventive medicine, health planning and evaluation, and medical research. Biostatistics helps manage uncertainties in medicine by providing statistical methods to analyze data, evaluate treatments and programs, and make inferences about populations. It is important for designing valid research studies and interpreting medical literature.
Knowledge transfer, and evidence informed health policy-minster's meetingDr Ghaiath Hussein
This document discusses knowledge transfer between researchers and policymakers. It begins with an overview of the knowledge cycle and evidence-based healthcare. It notes that while researchers seek truth and policymakers seek compromise, their common goal is improving public health. The document recommends establishing units to facilitate knowledge transfer and decision support. It also suggests training policymakers to identify how research can help and accessing evidence to inform decisions. The overall message is that researchers and policymakers must understand each other and work together toward their shared goal of improving health outcomes.
The role of patients and healthcare providers in translational medicinejangeissler
The role of patients and healthcare providers in translational medicine, presented by Jan Geissler at the European Commission's Personalized Medicine Conference 2016 on 1 June 2016 in Brussels
Introduction to Evidence Based Medicine (EBM)Elsayed Salih
This document provides an overview of evidence-based medicine (EBM), including its definition, importance, and process. It defines EBM as the conscientious use of the best available evidence in making decisions about patient care. The key steps in EBM are asking a clear clinical question using the PICO framework, acquiring evidence through a literature search, appraising the evidence for validity and applicability, and applying the evidence to the individual patient. Examples of question types and appropriate study designs are also discussed.
Matching the Research Design to the Study QuestionAcademyHealth
This document discusses matching research designs to study questions in comparative effectiveness research (CER). It notes that the appropriate research design depends on factors like who is asking the question, the amount of existing evidence, and whether the focus is on individual outcomes or system-level decisions. Both experimental and non-experimental designs have important roles to play in CER. An ideal CER enterprise would support a variety of study designs, methods research, data infrastructure, and efforts to translate evidence into practice.
The document discusses barriers and facilitators to policymakers using research evidence in decision making. It finds that the primary facilitator is personal contact between researchers and policymakers, while the main barrier is the lack of such contact. It also lists other factors that can encourage or discourage the use of evidence in policy, and strategies for bridging the gap between researchers and policymakers such as jointly setting agendas and facilitating interaction.
This document discusses evidence-based medicine (EBM), including its definition, history, classifications of evidence, and criticisms. EBM aims to apply scientific methods and best evidence from research to medical practice. While randomized controlled trials are considered the gold standard, critics note limitations like ethical issues conducting some trials, lack of diversity in research, and potential for bias from funding sources influencing results. The document advocates for conducting rigorous randomized trials, being transparent about funding sources and roles, and using systematic reviews and meta-analyses to help address biases.
Outcomes research examines the end results of healthcare provided to patients and uses this information to provide scientific evidence to help clinicians and patients make informed healthcare decisions. It aims to include subjective patient-reported outcomes like quality of life that were previously excluded from traditional clinical research. Two key organizations that conduct outcomes research are the Patient-Centered Outcomes Research Institute (PCORI), which funds research to help patients make healthcare choices based on desired outcomes, and the Agency for Healthcare Research and Quality (AHRQ), which develops knowledge and measures to improve patient safety and healthcare quality. While outcomes research provides important patient-centered data, limitations include potential reluctance to share private information and variability in how patients perceive symptoms and treatment impact.
This document discusses evidence-based laboratory medicine (EBLM) and its key components. It explains that EBLM involves the conscientious, explicit and judicious use of current best evidence in making well-informed decisions in laboratory medicine. The main components of EBLM are individual expertise, best external evidence, and patient values and expectations. It also discusses how to practice EBLM by asking questions, acquiring evidence, critically appraising the evidence, and applying the information while evaluating the process.
The drug effectiveness review project: governments collaborating to use syste...cmaverga
The document summarizes the Drug Effectiveness Review Project, which is a collaboration of organizations that systematically review evidence on the effectiveness and safety of drug classes. It aims to support policymakers by providing reviews of comparative drug effectiveness. The collaboration includes government agencies and non-profits. It produces reviews and updates on many drug classes. Results from reviews have found both differences and no differences between drugs. The project also discusses lessons learned, such as the importance of transparency and maintaining researcher independence.
Personalized Medicine: Current and Future Perspectives Personalized Medicin...MedicineAndHealth
The document discusses personalized medicine, including its definitions, current state, and future perspectives. It provides examples of personalized medicine like warfarin dosing and breast cancer risk assessment. It outlines key issues for stakeholders like payers, providers, developers, government, and consumers regarding pharmacogenomics testing, costs, access, and emerging ethical and policy concerns around privacy, informed consent, and potential for discrimination.
The document proposes a novel structure called a Patient-Centered Research Management Group (PCRMG) that would specialize in comparative effectiveness research. Key aspects are that it would incorporate significant patient input into study design and would facilitate collaboration between healthcare systems, pharmaceutical companies, patients, and other stakeholders. The goal is for research to better represent real-world clinical practice and patient preferences. Some benefits mentioned include exploring off-label drug uses, targeting medicines based on patient profiles, increased data sharing, and lower study costs. Pharmaceutical company involvement is argued to help develop personalized medicine and target drug development based on patient priorities.
This document discusses evidence-based decision making in healthcare. It explains that over the past decade, healthcare workers have increasingly used scientific research evidence to guide clinical practice. While the concept of evidence-based healthcare has been adopted into healthcare systems, its implementation is uneven in actual practice. The paper aims to explore the methods used to make evidence-based decisions in healthcare, and their application to clinical practice. These methods include systematic reviews, clinical practice guidelines, and qualitative studies to measure outcomes. Evidence-based healthcare aims to ensure patients and practitioners are guided by the strongest available research evidence.
This document outlines the key concepts of evidence-based medicine and its application in clinical pharmacy practice. It defines evidence-based medicine as the conscientious use of current best evidence from clinical research in medical decision making. The sources of knowledge are discussed, including scientific research. Research is defined as a systematic process to develop conclusions. Different levels of evidence are stratified from high to low. The PICO process for framing clinical questions is explained. Applying evidence-based medicine to clinical settings, evaluating evidence, and addressing biases are also covered. The roles and skills required of pharmacists are stated. A case study example is provided to demonstrate how evidence-based resources can be used to answer a patient's clinical question. Barriers to evidence
The document discusses the importance of including information on harmful effects when conducting systematic reviews in order to properly assess the balance of benefits and harms of interventions. It notes that data on adverse effects is often incomplete and of lower quality than data on effectiveness, and provides suggestions for how to search for, analyze, and synthesize this information to provide a more comprehensive assessment of medical treatments. Gaps and weaknesses in current data on adverse effects are identified, and guidance is provided on prioritizing reviews to fill these evidence gaps.
Critical Appraisal Of Research Essay Example Paper.docxstudywriters
1) Four peer-reviewed articles on racism and health were critically appraised using an evaluation table.
2) Based on the appraisal, the best practice that emerged was reducing racism in healthcare settings to improve health outcomes and promote equal access to quality care.
3) Stronger measures are needed to eliminate racism through increasing cultural competency training and ensuring non-discriminatory, equitable treatment for all patients.
Critical Appraisal Of Research Essay Example Paper.docxstudywriters
1) Four peer-reviewed articles on racism and health were critically appraised using an evaluation table.
2) Based on the appraisal, the best practice that emerged was reducing racism in healthcare settings to improve health outcomes and promote equal access to quality care.
3) Stronger measures are needed to eliminate racism through improving cultural competency and ensuring all patients receive equitable treatment.
The document discusses evidence-based periodontology. It defines evidence-based practice and outlines the stages in evidence-based practice, including framing clinical questions and searching for evidence through systematic reviews. Critical appraisal of evidence is important to determine internal and external validity. The best available evidence was searched for various periodontal therapies and procedures, finding that mechanical debridement remains the foundation treatment, while some adjunctive therapies provide modest benefits. A review found reduced pocket depth reduction in smokers compared to non-smokers following nonsurgical periodontal therapy.
Level of Evidence- Dina Hudiya Nadana Lubis.pptxdina410715
This document provides an overview of different types of evidence and study designs used to assess levels of evidence in healthcare research. It defines level of evidence as a hierarchical system used to assess the quality and strength of research findings. Randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies are described as primary sources of evidence, while systematic reviews and meta-analyses are secondary sources. The advantages and disadvantages of each study design are summarized in a table. Systematic reviews synthesize existing evidence through a structured process, while meta-analyses conduct quantitative analyses to derive summary effect sizes. Expert opinion is also discussed as a source of evidence.
1. How to Evaluate New Medical Treatments Mark Perloe, M.D. www.ivf.com
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Editor's Notes
The costs of medical care are rising sharply, yet we know that not all common or expensive procedures are necessary, and some may be harmful. Wide variations in the outcomes of medical care have been observed between different centres and different individual clinicians. Patients and their advocates are becoming more informed, more aware that they have (or should have) choices, and more vocal in seeking to make informed choices. Clinicians, health care managers, and, increasingly, lawyers, acknowledge that decision making in health care should involve the patient and be based on best evidence of effectiveness and harm. Comprehensive lists of published research papers, indexed electronically and accessible via standard search techniques, have become available at little or no cost over the internet. Statistical tools, especially those of meta-analysis, are better understood and more widely used. Hence, precise and cumulative estimates of effectiveness and harm tend now to be published soon after the relevant trials are complete. The discipline of critical appraisal (evaluating research papers for their validity and relevance) has evolved and become both more rigorous and more accessible to the non-expert through the publication of basic guides and structured checklists.
Assignment of individuals is randomized RCT: Individuals similar at the beginning RCOT: Prospective analytical, susceptible to bias if carry over effects occur Observational: allocation or assignement is not under investigator control; weaker potential evidence; potential for large confounding variables Cohort: prospective, follow-up period to determine effect of exposure and outcome, stronger than case-control but more expensive Case-Control: retrospective, secondary data from chart review, useful for rare conditions, inexpensive, many forms of bias Cross-Sectional: descriptive study of relationship between factors at one point in time Case-Series: series of cases, lack of comparability, source of hypothesis, most common study type Case-Report: anecdotal evidence,
Scientific enquiry has never been, and never will be, independent of prevailing political, ideological, economic and technological forces