Research designs of publications in radiography professional journals - A modified bibliometric analysis.

INTRODUCTION: Evidence based practice relies on availability of research evidence mostly through peer-reviewed journal publications. No consensus currently exists on the best hierarchy of research evidence, often categorised by the adopted research designs. Analysing the prevalent research designs in radiography professional journals is one vital step in considering an evidence hierarchy specific to the radiography profession and this forms the aim of this study. METHODS: Bibliometric data of publications in three Radiography professional journals within a 10-year period were extracted. The Digital Object Identifier were used to locate papers on publishers' websites and obtain relevant data for analysis. Descriptive analysis using frequencies and percentages were used to represent data while Chi-square was used to analyse relationship between categorical variables. RESULTS: 1830 articles met the pre-set inclusion criteria. Quantitative descriptive studies were the most published design (26.6%) followed by non-RCT experimental studies (18.7%), while Randomised Controlled Trials (RCT) were the least published (1.0%). Systematic reviews (42.9%) showed the highest average percentage increase within the 10-year period, however RCTs showed no net increase. Single-centre studies predominated among experimental studies (RCT = 88.9%; Non-RCT = 95%). Author collaboration across all study designs was notable, with RCTs showing the most (100%). Quantitative and qualitative studies comparatively had similar number of citations when publication numbers were matched. Quantitative descriptive studies had the highest cumulative citations while RCTs had the least. CONCLUSION: There is a case to advocate for more study designs towards the peak of evidence hierarchies such as systematic reviews and RCT. Radiography research should be primarily designed to answer pertinent questions and improve the validity of the profession's evidence base. IMPLICATION FOR PRACTICE: The evidence presented can encourage the adoption of the research designs that enhances radiography profession's evidence base.

TFOS Lifestyle - Evidence quality report: Advancing the evaluation and synthesis of research evidence.

Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of predominantly low or very low certainty evidence across the eight systematic reviews highlights a need for further research to define the efficacy and/or safety of specific lifestyle interventions on the ocular surface, and to clarify relationships between certain lifestyle factors and ocular surface disease. To support the citation of reliable systematic review evidence in the narrative review sections of each report, the Evidence Quality Subcommittee curated topic-specific systematic review databases and relevant systematic reviews underwent standardized reliability assessment. Inconsistent methodological rigor was noted in the published systematic review literature, emphasizing the importance of internal validity assessment. Based on the experience of implementing the Evidence Quality Subcommittee, this report makes suggestions for incorporation of such initiatives in future international taskforces and working groups. Content areas broadly relevant to the activity of the Evidence Quality Subcommittee, including the critical appraisal of research, clinical evidence hierarchies (levels of evidence), and risk of bias assessment, are also outlined.

A Hierarchical Framework for Assessing Transmission Causality of Respiratory Viruses.

Systematic reviews of 591 primary studies of the modes of transmission for SARS-CoV-2 show significant methodological shortcomings and heterogeneity in the design, conduct, testing, and reporting of SARS-CoV-2 transmission. While this is partly understandable at the outset of a pandemic, evidence rules of proof for assessing the transmission of this virus are needed for present and future pandemics of viral respiratory pathogens. We review the history of causality assessment related to microbial etiologies with a focus on respiratory viruses and suggest a hierarchy of evidence to integrate clinical, epidemiologic, molecular, and laboratory perspectives on transmission. The hierarchy, if applied to future studies, should narrow the uncertainty over the twin concepts of causality and transmission of human respiratory viruses. We attempt to address the translational gap between the current research evidence and the assessment of causality in the transmission of respiratory viruses with a focus on SARS-CoV-2. Experimentation, consistency, and independent replication of research alongside our proposed framework provide a chain of evidence that can reduce the uncertainty over the transmission of respiratory viruses and increase the level of confidence in specific modes of transmission, informing the measures that should be undertaken to prevent transmission.

Translating Evidence to Optimize Patient Care Using GRADE.

Optimal evidence-based clinical practice requires systematic summaries of the best available evidence, including ratings of the quality of that evidence, and is facilitated by the availability of trustworthy guidelines. In this review, we describe the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to rating quality of evidence and moving from evidence to recommendations using examples from allergy-immunology. GRADE focuses on systematic summaries of the best evidence, systematic reviews and trustworthy guidelines, and emphasizes a structured approach to determining quality (certainty) of bodies of evidence, absolute magnitude of effects of desirable and undesirable consequences (benefits and harms), and use of evidence to develop clinical recommendations. Adopted by over 110 organizations worldwide, including the American Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters, GRADE is foundational to the optimal interpretation of research evidence and its application in clinical practice. This review supports the clinician's ability to find and use the information in GRADE guidelines to help care for patients in the clinic.

Ranking evidence in substance use and addiction.

Evidence-based medicine has consistently prized the epistemological value of randomized-controlled trials (RCTs) owing to their methodological advantages over alternative designs such as observational studies. However, there are limitations to RCTs that hinder their ability to study chronic and dynamic conditions such as substance use and addiction. For these conditions, observational studies may provide superior evidence based on methodological and practical strengths. Assuming epistemic superiority of RCTs has led to an inappropriate devaluation of other study designs and the findings they support, including support for harm reduction services, especially needle exchange programs and supervised injection facilities. The value offered by observational studies should be reflected in evidence-based medicine by allowing more flexibility in evidence hierarchies that presume methodological superiority of RCTs. Despite the popularity of evidence ranking systems and hierarchies, nothing should replace critical appraisal of study methodology and examining the suitability of applying a given study design to a specific research question.

The Application of an Evidence Framework for Obesity Prevention at the Population-Level.

PURPOSE OF REVIEW: To review existing frameworks for assessing the evidence of effectiveness of obesity prevention interventions, and discuss the application of a custom-developed evidence framework to inform an obesity prevention priority-setting study in Australia. RECENT FINDINGS: There are a wide range of frameworks for grading evidence. However, most frameworks are not well suited to assess the effectiveness of obesity prevention interventions because they do not include processes to synthesise evidence from multiple study designs and outcome measures. The key features of the Obesity Prevention Evidence Assessment (OPEA) Framework are: [1] separately assessed weight-, diet- and physical activity-related outcomes; [2] consideration of the balance of evidence from multiple study types; and [3] a summary indication of the degree of certainty of intervention effectiveness. Evidence frameworks that recognise the complexities of obesity prevention research can support decision-makers in prioritising actions to address obesity alongside broader priority-setting considerations.

Participatory simulation modelling to inform public health policy and practice: Rethinking the evidence hierarchies.

Drawing on the long tradition of evidence-based medicine that aims to improve the efficiency and effectiveness of clinical practice, the field of public health has sought to apply 'hierarchies of evidence' to appraise and synthesise public health research. Various critiques of this approach led to the development of synthesis methods that include broader evidence typologies and more 'fit for purpose' privileging of methodological designs. While such adaptations offer great utility for evidence-informed public health policy and practice, this paper offers an alternative perspective on the synthesis of evidence that necessitates a yet more egalitarian approach. Dynamic simulation modelling is increasingly recognised as a valuable evidence synthesis tool to inform public health policy and programme planning for complex problems. The development of simulation models draws on and privileges a wide range of evidence typologies, thus challenging the traditional use of 'hierarchies of evidence' to support decisions on complex dynamic problems.

Negotiating concepts of evidence-based practice in the provision of good service for nursing and allied health professionals.

OBJECTIVE: The principles of evidence-based medicine have been critiqued by the 'caring' professions, such as nursing and social work, and evidence-informed medicine has been proposed as a more client-centred, integrative approach to practice. The purpose of this study was to explore how Canadian health science librarians who serve nurses and allied health professionals define good service and how they negotiate evidence-based principles in their searching strategies. METHOD: Twenty-two librarians completed a 30 minute, semi-structured phone interview about strategies for providing good service and supporting evidence-based services. Participants were also asked to respond to three challenging search scenarios. Analysis of results used grounded theory methods. RESULTS: Participants' definitions of good service and strategies for supporting evidence-based practice involved discussions about types of services provided, aspects of the librarian providing the service and aspects of the information provided during the service. Analysis of search scenarios revealed four justifications librarians rely upon when providing evidence that is in opposition to what their patron hopes to receive (evidentiary, ethical, practice-based and boundaries of the profession). CONCLUSION: The findings of this study suggest that health science librarians are both constrained and enabled by the principles of evidence-based medicine and especially by understandings of 'best evidence'.

Organisation of evidence-based knowledge production: evidence hierarchies and evidence typologies.

The evidence movement and the idea of systematically synthesising results from primary studies has gained support in recent years. As the movement has moved into still more policy fields, from medical treatment to, for example, public health, social welfare, and education, review practice has also been developed. The initial evidence hierarchy based standard given priority to randomised controlled trials and meta-analysis advocated by the Cochrane and Campbell collaborations has become supplemented with evidence typologies and review practice paradigms stressing the importance of contextual factors as explanations of differences in effects. In addition to analysing and discussing this development, the article discusses the organisation of dissemination of evidence. This topic is interesting because it is part of the self-perception of the evidence movement that evidence should be brought to use in both practice and policy making.

An Exploratory Analysis of Levels of Evidence for Articles Published in Indian Journal of Palliative Care in the years 2010-2011.

CONTEXT: Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making. AIMS: To analyze the levels of evidence of articles published in IJPC in the years 2010-2011. SETTINGS AND DESIGN: Systematic review of palliative care journals. MATERIALS AND METHODS: Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication. STATISTICAL ANALYSIS USED: All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL). RESULTS: There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05). CONCLUSIONS: The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.

The evidence that evidence-based medicine omits.

According to current hierarchies of evidence for EBM, evidence of correlation (e.g., from RCTs) is always more important than evidence of mechanisms when evaluating and establishing causal claims. We argue that evidence of mechanisms needs to be treated alongside evidence of correlation. This is for three reasons. First, correlation is always a fallible indicator of causation, subject in particular to the problem of confounding; evidence of mechanisms can in some cases be more important than evidence of correlation when assessing a causal claim. Second, evidence of mechanisms is often required in order to obtain evidence of correlation (for example, in order to set up and evaluate RCTs). Third, evidence of mechanisms is often required in order to generalise and apply causal claims. While the EBM movement has been enormously successful in making explicit and critically examining one aspect of our evidential practice, i.e., evidence of correlation, we wish to extend this line of work to make explicit and critically examine a second aspect of our evidential practices: evidence of mechanisms.