#GRADE’s primary focus in #SystematicReviews has been on rating certainty in evidence on interventions. But in this article GRADE also provides guidance for #CertaintyofEvidence in #prognosis in which #ObservationalStudies start as high certainty evidence. pubmed.ncbi.nlm.nih.gov/31982539/

At the recent #GuidelinesInternationalNetwork (GIN) meeting in Geneva I paid the price for my notoriety as folks cornered me, including this group lining up to have their photo taken with me.

At recent #GuidelinesInternationalNetwork (GIN) meeting with Thomas Agoritsas, Chair of the #MAGICEcosytemFoundation and international #GRADE methodology leader and our researcher Prashanti Eachempati, creator of the JUDGE instrument that will revolutionize GRADE education and practice.

The #ChronicRespiratoryQuestionnaire (CRQ) is the most responsive and valid #HealthStatusMeasurement instrument for disease-specific #QualityOfLife in patients with #COPD and other chronic respiratory conditions. This paper presents a self-report version. pubmed.ncbi.nlm.nih.gov/11713359/

Clinicians increasingly rely on #chatbots for advice in managing patients. But is this advice helpful or misleading? Researchers are trying to find out. A survey of 137 studies of bot performance demonstrates their methods leave a great deal to be desired. pubmed.ncbi.nlm.nih.gov/39903463/

I am keen that the Core #GRADE series - 7 articles in @bmj.com this spring - gets optimal use. I will therefore be available to address queries anyone has about using Core GRADE. Don’t hesitate to ask at [email protected]. pubmed.ncbi.nlm.nih.gov/40233981/

#TransActivists suggest our #SystematicReviews showing low certainty evidence for outcomes of #GenderAffirming care are “pseudoscientce”. The right attacks because we suggest that banning trans care is unconscionable. This newspaper article provides a balanced perspective. archive.ph/WsBIN

#GRADE provides guidance for rating #CertaintyofEvidence regarding accuracy of diagnostic tests. This informative paper provides details on assessing #inconsistency, #imprecision, #PublicationBias and other domains and for creating #SummaryofFindings tables. pubmed.ncbi.nlm.nih.gov/32058069/

Most #GRADE users are familiar with GRADE’s #EvidenceToDecision frameworks for interventions. Less so with EtD for tests. This excellent exposition provides guidance when creating or using a #DiagnosticTests and other tests (such as #screening) EtDs. pubmed.ncbi.nlm.nih.gov/26931285/

Our group posted: using our #GRADE #SR of #GenderAffirming care to justify denial of care is unconscionable. A #NationalPost piece decried our position. The author had been suspended by the BC College of Nursing for comments derogatory towards transgender people! nationalpost.com/opinion/fath...

As winner of the 2024 Canadian #Friesen prize, I toured 8 Canadian universities delivering Friesen lectures on the past and future of #EvidenceBasedMedicine. A booklet summarizing the lecture is now available. fchr.ca/books

This classic article looking at #DiagnosticTests for iron deficiency #anemia (showed #ferritin by far the best) remains the best example to teach students how to use #LikelihoodRatios in their clinical practice. pubmed.ncbi.nlm.nih.gov/2178409/

How the world has changed, how quickly we take for granted technological miracles that not so long ago would have been the stuff of #ScienceFiction. Only few years ago, a colleague called his research fellow over to view the miracle of his computer screen that showed six talking faces. And now…

#TransitionRatings (are you better; if so how much) is the most-used strategy for establishing #MinimalImportantDifferences in #PatientReportedOutcomeMeasures. But transition ratings must be valid. This seminal, essential paper shows how to test their validity. pubmed.ncbi.nlm.nih.gov/12393078/

Hanlon's Razor is a principle stating, "Never attribute to malice that which is adequately explained by incompetence". I’ve recently had an experience that put me in mind of these wise words – I suspected malevolence; explanation proved otherwise. fs.blog/mental-model...

We chose the term #MinimalClinicallyImportantDifference in an era of medical paternalism. We subsequently realized that we are considering patient-important outcomes and our language should align. This article presents the transition to #MinimallyImportantDifference pubmed.ncbi.nlm.nih.gov/15762909/

Legislators have unconscionably misused our #SystematicReviews of #GenderTransition interventions to deny #PatientsCare. Formerly, I thought my job ended with conducting and reporting high quality research. I now realize I have an additional responsibility to address how my work is used.

The #GRADE evidence to decision (EtD) framework provides invaluable guidance in moving from evidence to recommendations. There are a number of variations for specific areas. This article explains EtD frameworks for #HealthSystem and policy decisions. pubmed.ncbi.nlm.nih.gov/29843743/

Recent BMJ: strong rapid recommendation against lucrative interventional #pain intervention. Practitioners pushed back, but this enlightened exception acknowledges industry influence, catchy branding ignoring science, hidden COI, low quality research. pmc.ncbi.nlm.nih.gov/articles/PMC...

As this article demonstrates, when one is creating a health status measurement #instrument for use in #Clinicaltrials, factor analysis has major limitations. Far preferable to pick items patients think are important than to choose on the basis of factor structure. pubmed.ncbi.nlm.nih.gov/9120521/

Explanatory or mechanistic #RCTs of physical or psychological interventions requires “placebo,” or “sham” comparators. This @bmj.com article presents recommendations for designing, and reporting comparator interventions as well as a reporting checklist. pubmed.ncbi.nlm.nih.gov/37230508/

Over-reliance on #SurrogateOutcomes remains a big problem in expert-driven recommendations. This #JAMA users guide shows how most surrogates are not valid: in #RCTs they fail to predict impact of interventions on patient-important outcomes pubmed.ncbi.nlm.nih.gov/10463714/

Introducing #CHART - reporting guidelines for studies evaluating evidence summaries and health advice from #genAI models like #ChatGPT. Authors may apply the CHART checklist ✅and methodological diagram 📈 when reporting their studies. Published in @bmj.com: pubmed.ncbi.nlm.nih.gov/40750271/

#GRADE uses optimal information size (number of patients in a power calculation of individual #RCTs to detect a modest effect), to decide on credibility of #MetaAnalyses showing large effects. This simulation study provides powerful support for GRADE’s OIS approach. pubmed.ncbi.nlm.nih.gov/22028777/

"Evidence itself never gives us the answer what to do. It's evidence in the context of values and preferences." Professor Gordon Guyatt talks to The BMJ about the challenges of evidence based medicine and introduces the Core GRADE system @guyattgh.bsky.social www.youtube.com/watch?v=433J...

#BMJ article documented disastrous performance of #RCT authors making inappropriate strong claims for #SubgroupEffects when application of appropriate criteria would have concluded low credibility. Fortunately, the #ICEMAN instrument now provides definitive guidance pubmed.ncbi.nlm.nih.gov/22422832/

0ur reviews impact of #TransitionInterventions in #GenderDysphoria: uncertainty remains. Used by National Post to justify Alberta government forbidding interventions. NP didn’t publish my letter: our work informs appropriate autonomous judgements by patients. Low integrity journalism.

#RealWorldData advocates facing challenges addressing sources of bias suggest causal modelling as a solution. Doesn’t work. Comparison of 19 modelling studies with #RCTs showed 42% differed in direction and 47% of confidence intervals didn’t include RCT estimate. pubmed.ncbi.nlm.nih.gov/31704350/

Randomized trials in individual patients – N of 1 #RCTs - remain underutilized. This #AnnInternMed paper describes our initial experience with 57 N of 1 RCTs. In 15, results prompted patients and clinicians to alter their treatment plans. pubmed.ncbi.nlm.nih.gov/2297206/

For clarity, simplicity, accessibility and user-friendliness the original #JAMA users guides – including this one addressing harm – remain the best for clinicians seeking guidance in how to interpret studies to guide their patient care. pubmed.ncbi.nlm.nih.gov/8182815/

In a previous post I noted that Guidelines International Network (GIN), in rejecting a workshop on Core GRADE, were underestimating the likely interest in the new #BMJ Core #GRADE series. We were thinking of conducting the workshop in an alternative venue but it has proved unfeasible. Too bad!

#GRADE evidence to decision (EtD) frameworks present a useful, transparent and comprehensive approach to moving from evidence to recommendations. This #BMJ paper focuses on EtD frameworks for clinical practice #guidelines. pubmed.ncbi.nlm.nih.gov/27365494/

Advocates suggest administrative #RealWorldData can substitute for #RCTs and offer propensity matching to reduce bias. But results often fail to correspond: #BMJ study showed direction of effect differed in 31% & CI failed to include RCT estimate in 56%. pubmed.ncbi.nlm.nih.gov/26858277/

Discontinued #RandomizedControlTrials (RCTs) a problem. This #JAMA article presents the prevalence (almost 25%), characteristics (most frequently due to poor recruitment), & publication status (odds ratio>3 of not being published) of discontinued RCTs. pubmed.ncbi.nlm.nih.gov/24618966/

On recent trip to Helsinki, biking in the nearby forest with KariTikkinen leading urological and surgical investigator and medicine overuse expert; GSCollins BMJ stats editor; and LauriLavikainen recent PhD grad who created AI Gordon.

Two fundamental strategies for establishing #MinimalImportantDifferences (MIDs) in #PatientReportedOutcomes (PROMs). The more popular is looking at changes within person over time. This paper provides an alternative: looking at differences between persons. pubmed.ncbi.nlm.nih.gov/8892486/

PhD candidate created “AI Gordon”, sent his thesis dominated by low certainty evidence, asked for advice how to defend. Presumably, LLM reviewed my writings, interviews, videos etc. Provided extraordinary response that even captured my voice. Wow, I’ve just achieved immortality!

This #BMJ paper provides a consensus view and a checklist on when and how to update #SystematicReviews pubmed.ncbi.nlm.nih.gov/27443385/

Participants and tutors at our recent Core #GRADE workshop, offering education on optimally using guidance presented in the 7 part #BMJ series published April to June this year. We are anticipating this #workshop as a yearly event.

#CompositeEndpoints in #RCTs: big problem. #BMJ survey of use in #cardiovascular trials: they make results look more important than they are through impression of benefits in death when only real effect in much less important outcomes (e.g. stent placement) pubmed.ncbi.nlm.nih.gov/17403713/

Just published commentary shows how expanding definitions of diseases such as #hypertension, gestational #diabetes, #osteoporosis, attention-deficit/hyperactivity disorder & social #anxiety disorder can result in harmful #medicalization & inefficient resource use. jamanetwork.com/journals/jam...

Incorporating cost/resource use into clinical practice #guidelines is tricky. This #BMJ paper designed for clinician users of #GRADE guidelines outlines GRADE’s approach to the problem. pubmed.ncbi.nlm.nih.gov/18497416/

Prof. @guyattgh.bsky.social, one of the founders of Evidence-Based Medicine #EBM, explains why #MAGICapp is a breakthrough for guideline development: multilayered, user-friendly, and built for trustworthy, living guidelines Ping @thomasagoritsas.bsky.social @chrischampion.bsky.social

Incorporating cost/resource use into clinical practice #guidelines is tricky. This #BMJ paper designed for clinician users of #GRADE guidelines outlines GRADE’s approach to the problem. www.bmj.com/content/336/...

Now complete: @bmj.com seven-part series presenting the Core #GRADE approach to rating certainty of evidence and moving from evidence to recommendations. Today, the final paper providing the Core approach to deciding on direction and strength of recommendations. bmj.com/content/389/...

Today in #BMJ, 6th in 7 part series on the essentials of #GRADE – Core GRADE: creating excellent Summary of Findings tables allowing clinicians and guideline developers to easily and comprehensively grasp evidence that will assist patients to make optimal decisions. pubmed.ncbi.nlm.nih.gov/40425239/

Core #GRADE guidance today in the #BMJ addresses the essentials of evaluating #indirectness with respect to patients (old vs young), interventions (fully versus partially adherent), comparators (placebo vs active) and outcomes (surrogate vs patient-important). www.bmj.com/content/389/...

A series of 7 papers, Core #GRADE, the essentials of GRADE providing all you need to rate #CertaintyofEvidence and move from evidence to recommendations, is currently appearing in the #BMJ. Today, dealing with #RiskofBias, publication bias, and large effects. www.bmj.com/content/389/...

The renaissance in #EBM and #GRADE continues: the third article in the #BMJ series presenting Core GRADE, the essentials of the GRADE approach to certainty of evidence and strength of recommendations. Today Core GRADE’s approach to addressing #inconsistency in results. www.bmj.com/content/389/...

The #EBM and #GRADE breakthrough continues. This one in the #BMJ the second in a series of 7 papers describing Core GRADE, the complete package of essentials for applying GRADE. This one choosing the target of certainty rating and addressing #imprecision. www.bmj.com/content/389/...