Tessera

Just published: How we should be educating clinicians in #EBM concepts in 2026. Includes guidance to put much less emphasis on critical appraisal and much more on understanding magnitudes of effect and quality of evidence, and use of #AI in education. ebm.bmj.com/content/earl...

Educating health professionals in evidence-based practice in 2026

Early formulations of evidence-based medicine and healthcare emphasised the ability of health professionals to formulate questions, search for and critically appraise individual studies to inform thei...

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Frequently, at meetings, two participants start talking about an issue of very limited interest to the others. Frustrated, I interrupt, asking them to finish this part of the conversation separately. In planning agendas I make sure topics of interest to all; separate meetings for topics that are not

#Microsimulation modelling often an extremely useful alternative to traditional #DecisionAnalysis modelling for estimating the impact of interventions on patient-important outcomes. Here, great example from alternative #ColonCancer #screening strategies. pubmed.ncbi.nlm.nih.gov/31578177/

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study - PubMed

Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a...

pubmed.ncbi.nlm.nih.gov

#Lancet Commission report in the first #Trump administration presaged events in the second: adverse impact of income inequality on health; increasing coverage barriers, increased #uninsured; environmental rollbacks increased pollution-related #mortality. pubmed.ncbi.nlm.nih.gov/33581802/

Public policy and health in the Trump era - PubMed

Public policy and health in the Trump era

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As an educator, patience is crucial. Sometimes students grasp concepts quickly, others, not so much. Recently after an hour on a concept the student understood and commented on my patience. From whence comes my patience? Metaphor: when the lights go on, the world gets brighter

#RCT evidence supporting optimal presentation of #GRADE summary of finding tables: present risk in control, risk in intervention, difference between with confidence interval, include reasons for rating down in table rather than footnotes, and plain language summary. pubmed.ncbi.nlm.nih.gov/26791430/

Improving GRADE evidence tables part 1: a randomized trial shows improved understanding of content in summary of findings tables with a new format - PubMed

While providing at least similar levels of understanding for some items and increased understanding for others, users prefer the new format of SoF tables.

pubmed.ncbi.nlm.nih.gov

Breakthrough original concept in #BMJ: #Guideline recommendations should consider time needed to treat. Useless or marginally beneficial #screening and advising #patients on #lifestyle can eat up huge portion of primary doc’s time, divert from useful activities. pubmed.ncbi.nlm.nih.gov/36596571/

Guidelines should consider clinicians' time needed to treat - PubMed

Guidelines should consider clinicians' time needed to treat

pubmed.ncbi.nlm.nih.gov

My daughter Claire finishing a psychology Masters submitted her first major paper. A reviewer wants a propensity analysis. Claire asks: what do I do if analysis goes badly. My answer: worry about that when it happens. Lots of our suffering results from worrying about what may never happen.

Just published, brilliant observation enhances understanding of the utility of #ClinicalPrediction rules. The closer the threshold for action (e.g. treat/don’t treat) to the population prevalence of the CPR target (e.g. likelihood of stroke), the more useful the CPR pubmed.ncbi.nlm.nih.gov/42044720/

Discriminating clinical prediction models: how outcome incidence and decision thresholds shape clinical utility and apt AUROC values - PubMed

Whether a clinical prediction model's AUROC is "good" cannot be judged in isolation. Clinical usefulness arises from the joint relationship between discrimination, outcome incidence, and decision thre...

pubmed.ncbi.nlm.nih.gov

With former student, now dear friend and colleague Luis Colunga, on my deck at home after vigorous bike ride in the woods. Our latest collaboration highlighted what is new in Core #GRADE. pubmed.ncbi.nlm.nih.gov/41207400/

In classic paper I argue direct linguistic translation of patient-reported outcome measure (PROMs) enshrines biases, fails to capture cross-cultural differences. Solution: strong conceptual definition of what you want to measure, flexibility in translation/adaptation pubmed.ncbi.nlm.nih.gov/8161980/

The philosophy of health-related quality of life translation - PubMed

Conventional translation strategies are limited because they enshrine deficiencies of the original questionnaire and do not permit modifications that reflect differences in culture and values. An alte...

pubmed.ncbi.nlm.nih.gov

Common misguided definition of #IntentionToTreat requires attributing outcomes to every randomized patient and requires making up data for those lost to follow-up. Better: #ITT analyzes patients followed in groups to which they are randomized. pubmed.ncbi.nlm.nih.gov/23166608/

Inconsistent definitions for intention-to-treat in relation to missing outcome data: systematic review of the methods literature - PubMed

We found that there is no consensus on the definition of ITT in relation to MOD. For conceptual clarity, we suggest that both reports of randomized trials and systematic reviews separately consider an...

pubmed.ncbi.nlm.nih.gov

Central principles for meeting minutes: As succinct as possible, include only what you need for reviewing if want to check what happened. So unproductive discussion with no clear decision or action: no need to include the item in the minutes.

Pooling #PROs: some studies report risk differences, some continuous. Solution: convert continuous to risk differences. Pivotal study: when conversion applied to papers reporting both continuous and dichotomous for same outcomes, conversion worked well. Hurray! pubmed.ncbi.nlm.nih.gov/23045205/

Methods to convert continuous outcomes into odds ratios of treatment response and numbers needed to treat: meta-epidemiological study - PubMed

The methods by HH, CS, FU and SU are suitable to convert summary treatment effects calculated from continuous outcomes into odds ratios of treatment response and NNTs, whereas the method by KK is unsu...

pubmed.ncbi.nlm.nih.gov

Unsolicited feedback on #BMJ Core GRADE from Aye Paing, #NICE Senior Analyst. “The series is clear, practical, and far more straightforward than many of the approaches in the #GRADE Book. The way Core GRADE distils the essential concepts without losing rigour is incredibly helpful."

This article provides optimal strategies for reporting #pain in #RCTs and #SystematicReviews. pubmed.ncbi.nlm.nih.gov/25979719/

Optimal Strategies for Reporting Pain in Clinical Trials and Systematic Reviews: Recommendations from an OMERACT 12 Workshop - PubMed

Presentation of relative effects regarding pain will facilitate interpretation of treatment effects.

pubmed.ncbi.nlm.nih.gov

#SystematicReview authors often face the challenge that authors of primary studies sometimes present effects as continuous outcomes, sometimes relative effects. One would like to pool them together. Solution: change continuous to binary. pubmed.ncbi.nlm.nih.gov/23045205/

Methods to convert continuous outcomes into odds ratios of treatment response and numbers needed to treat: meta-epidemiological study - PubMed

pubmed.ncbi.nlm.nih.gov

Question at meeting: limitations of #GRADE? My answer: For eminent individuals with their own perceptions of the evidence and with strong views about how clinicians should best treat their patients, GRADE hierarchy of evidence and emphasis on patient values can be unpleasantly constraining.

Optimizing the integration of #RandomizedTrial #RCT and observational studies of interventions in #SystematicReviews and health #guidelines can be challenging. This #GRADE guidance tells you how. pubmed.ncbi.nlm.nih.gov/34800676/

GRADE guidance 24 optimizing the integration of randomized and non-randomized studies of interventions in evidence syntheses and health guidelines - PubMed

This work aims to help methodologists in review teams, technology assessors, guideline panelists, and anyone conducting evidence syntheses using GRADE.

pubmed.ncbi.nlm.nih.gov

This outstanding #BMJ recently published paper provides a lucid, pragmatic step-by-step guide to applying #GRADE to Network #MetaAnalysis. Already justifiably widely cited. pubmed.ncbi.nlm.nih.gov/37369385/

A guide and pragmatic considerations for applying GRADE to network meta-analysis - PubMed

A guide and pragmatic considerations for applying GRADE to network meta-analysis

pubmed.ncbi.nlm.nih.gov

Student has insight into one’s strengths and appreciates. This one about highly respected colleague: Dr. Meade challenged me more than any other mentor. Only those who are truly invested in your growth will hold you to such a high standard, and for that I am deeply grateful.

From a remarkable three-part Users Guide series in #JAMA regarding #genetic association studies that clarifies and simplifies concepts like no other guide. This one addressed validity of genetic association studies. pubmed.ncbi.nlm.nih.gov/19141767/

How to use an article about genetic association: B: Are the results of the study valid? - PubMed

In the first article of this series, we reviewed the basic genetics concepts necessary to understand genetic association studies. In this second article, we enumerate the major issues in judging the v...

pubmed.ncbi.nlm.nih.gov

This paper from a series of tips for learners of evidence-based medicine #EBM provides a lucid step by step to decipher heterogeneity in #MetaAnalysis. pubmed.ncbi.nlm.nih.gov/15738493/

Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results - PubMed

Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results

pubmed.ncbi.nlm.nih.gov

I seldom recommend protocols for potential scrutiny. However, for those interested in measurement of patient values & preferences, in particular patient MID crucial for #GRADE and #guideline development, this just published highly original ground-breaking work. pubmed.ncbi.nlm.nih.gov/41969831/

Exploring methodology for investigating Chinese coronary artery disease patient values and preferences: A methodological study protocol - PubMed

This study will develop standard materials for surveying patient values and determining MIDs in Chinese CAD patients. The resulting methodology will support future investigations into patient-importan...

pubmed.ncbi.nlm.nih.gov

Many clinical practice #guidelines claim to follow #GRADE, yet adherence poor. Just published paper identifies 11 checklists assessing adherence, all with serious limitations. Definitive GRADE-Check under development, upcoming presentation at GIN conference. pubmed.ncbi.nlm.nih.gov/41722827/

Evaluation of grading of recommendations assessment, development, and evaluation approach adherence in clinical practice guidelines: a systematic survey of criteria and their applications - PubMed

Many medical guidelines say that they use a trusted scientific method called GRADE to make their advice reliable. But we neither know if they actually follow it correctly nor were there good tools to ...

pubmed.ncbi.nlm.nih.gov

This classic @jama.com Users’ Guide to the medical literature lucidly tells you what you need to know to understand and a apply a #guideline and recommendation regarding a #screening intervention. pubmed.ncbi.nlm.nih.gov/10359392/

Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group - PubMed

Users' guides to the medical literature: XVII. How to use guidelines and recommendations about screening. Evidence-Based Medicine Working Group

pubmed.ncbi.nlm.nih.gov