Journal of clinical epidemiology
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Results from randomized trials can depend on the statistical analysis approach used. It is important to prespecify the analysis approach in the trial protocol to avoid selective reporting of analyses based on those which provide the most favourable results. We undertook a review of published trial protocols to assess how often the statistical analysis of the primary outcome was adequately prespecified. ⋯ The statistical analysis approach is rarely prespecified in published trial protocols. This may allow selective reporting of results based on different analyses.
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The minimum clinically important difference (MCID) is used to interpret the relevance of treatment effects, e.g., when developing clinical guidelines, evaluating trial results or planning sample sizes. There is currently no agreement on an appropriate MCID in chronic pain and little is known about which contextual factors cause variation. ⋯ MCID for chronic pain relief vary considerably. Baseline pain is strongly associated with absolute, but not relative, measures. To a much lesser degree, MCID is also influenced by the operational definition of relevant pain relief and possibly by clinical condition. Explicit and conscientious reflections on the choice of an MCID are required when classifying effect sizes as clinically important or trivial.
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Multicenter Study
Do clinicians want recommendations? A multicenter study comparing evidence summaries with and without GRADE recommendations.
Evidence-based clinical practice guidelines provide recommendations to assist clinicians in decision-making and to reduce the gap between best current research evidence and clinical practice. However, some argue that providing preappraised evidence summaries alone, rather than recommendations, is more appropriate. The objective of the study is to evaluate clinicians' preferences, and understanding of the evidence and intended course of action in response to evidence summaries with and without recommendations. ⋯ Evidence summaries alone are not enough to impact clinicians' course of action. Clinicians clearly prefer having recommendations accompanying evidence summaries in the context of low or very low certainty of evidence (Trial registration NCT02006017).
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Comparative Study
The M3 multimorbidity index outperformed both Charlson and Elixhauser indices when predicting adverse outcomes in people with diabetes.
Multimorbidity is common among those living with diabetes. The purpose of this manuscript was to assess the performance of the recently developed M3 multimorbidity index within a large, well-defined cohort of patients with diabetes. ⋯ These results give additional support for the utility of the M3 index in clinical populations, adding to previous observations regarding its performance in a general population setting.
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To apply component network meta-analysis (CNMA) models to an existing Cochrane review of psychological preparation interventions for adults undergoing surgery and to extend the models to account for covariates to identify the most effective components for improving postoperative outcomes. ⋯ The CNMA method allowed us to address questions about the effects of specific components that could not be answered using standard Cochrane methodology.