Journal of clinical epidemiology
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To assess how well do the black box warnings present and communicate evidence in a way that is consistent with evidence-based patient-centered practice, through evaluating the boxed warning on teriparatide-induced osteosarcoma. ⋯ Black box warning for teriparatide-associated osteosarcoma does not explicitly present the quality of evidence, and therefore, it could be of limited use in evidence-based practice. We propose that black box warnings should include an evidence profile and an implementation guide to be more useful in evidence-based patient-centered practice.
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This study assesses the extent to which the strength of a recommendation in a World Health Organization (WHO) guideline affects uptake of the recommendation in national guidelines. ⋯ Guideline developers should be confident that conditional recommendations are frequently adopted. The fact that strong recommendations are more frequently adopted than conditional recommendations underscores the importance of ensuring that such recommendations are justified.
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Meta Analysis Comparative Study
Adjustment for compliance behavior in trials of epidural analgesia in labor using instrumental variable meta-analysis.
Intention-to-treat (ITT) analysis of randomized controlled trials (RCTs) may cause bias when compliance is poor. Noncompliance describes failure to comply with allocation in the intervention arm, and contamination describes uptake of the intervention in the control arm. Instrumental variable (IV) analysis can be applied in addition to the primary ITT analysis to estimate the causal effect adjusted for noncompliance and contamination, assuming that noncompliers would have had the same treatment benefit as compliers. We aimed to compare ITT and IV meta-analysis of the association between epidural analgesia in labor and cesarean section. ⋯ ITT meta-analysis underestimates the effect of receiving epidural analgesia in labor on cesarean section compared with IV meta-analysis.
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Multi-item questionnaires are frequently used to measure outcomes in randomized controlled trials (RCTs) in patients with sciatica. Knowing the minimaly important change (MIC) values for these instruments will facilitate interpretation of change scores. MIC values have been shown to be dependent on baseline values. The question is whether they also depend on the type of intervention. To estimate the MIC of the Roland Morris Disability Questionnaire (modified 23 item version) (RMDQ) and of intensity of leg pain measured by a Visual Analogue Scale (VAS) in patients with sciatica and to assess to what extent MIC values depend on type of intervention and on baseline values. ⋯ The MIC values of the RMDQ-23 and VAS leg pain were found to be highly dependent on their baseline values, although the type of intervention appeared to influence the MIC value only slightly.
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To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake. ⋯ Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.