Journal of evaluation in clinical practice
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As the recent literature has growing concerns about research replicability and the misuse and misconception of P-values, the fragility index (FI) has been an attractive measure to assess the robustness (or fragility) of clinical study results with binary outcomes. It is defined as the minimum number of event status modifications that can alter a study result's statistical significance (or non-significance). Owing to its intuitive concept, the FI has been applied to assess the fragility of clinical studies of various specialties. However, the FI may be limited in certain settings. As a relatively new measure, more work is needed to examine its properties. ⋯ Our findings may help clinicians properly use the FI and appraise the reliability of a study's conclusion.
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Assessing the performance of diagnostic tests requires evaluation of the amount of diagnostic uncertainty a test reduces. Statistical measures, such as sensitivity and specificity, currently dominating the evidence-based medicine (EBM) and related fields, cannot explicitly measure this reduction in diagnostic uncertainty. Mutual information (MI), an information theory statistic, explicitly quantifies diagnostic uncertainty by measuring information gain before vs after diagnostic testing. In this paper, we propose the use of MI as a single measure to express diagnostic test performance and demonstrate how it can be used in the meta-analysis of diagnostic test studies. ⋯ We have demonstrated the suitability of MI in assessing the performance of diagnostic tests, which can facilitate easier interpretation of the true utility of diagnostic tests. Similarly, to the guidance for interpretation of effect size of treatment interventions, we also propose the guidelines for interpretation of the utility of diagnostic tests based on the magnitude of reduction in diagnostic uncertainty.
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Three-dimensional (3D) medical images are shown to patients during clinical consultations about certain health conditions. However, little is known about patients' experience of viewing them. The aim of this qualitative study was to explore the impact of sharing 3D medical images with patients during a clinical consultation about hip surgery, from the perspective of patients, health care professionals, and lay representatives. ⋯ When shown to patients during an orthopaedic clinical consultation, 3D medical images may be an empowering resource. However, in this study, patients and focus group participants perceived medical images as factual and believed they could provide evidence of a diagnoses. This perception could result in overreliance in imaging tests or disregard for other forms of information.
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The FallProof Balance and Mobility Program is a multifactorial fall prevention intervention that targets intrinsic risk factors such as muscle strength, balance, gait, and posture. Using mixed methods, we evaluated the implementation of the program for older adults at high risk of falling in the community. ⋯ Findings provided insights into pragmatic issues of implementing a balance and mobility program for older adults at risk of falling. The FallProof program was found to be feasible and acceptable in a small cohort of older adults from the community.
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Qualitative research has been promoted as an important component of the evaluation of complex interventions to support the scale up and spread of health service interventions, but is currently not being maximized in practice. We aim to identify and explore the sociocultural and structural factors that impact the uses (and misuses) of qualitative research in the evaluation of complex health services interventions. ⋯ Based on these findings we encourage ongoing engagement of qualitative researchers in evaluation programmes to begin to refine our methodological understanding, while also suggesting changes to medical education and evaluation funding models to create fertile environments for interdisciplinary collaborations.