A Comparison of Results of Meta-analyses of Randomized Control Trials and Recommendations of Clinical Experts

Antman, Elliott M.; Lau, Joseph; Kupelnick, Bruce; Mosteller, Frederick; Chalmers, Thomas C.

doi:10.1001/jama.1992.03490020088036

Cited by 1,215 publications

(309 citation statements)

References 45 publications

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“…No one nowadays would countenance ignoring the robust evidence on, say, management of acute myocardial infarction, yet there was a 13-year delay between the demonstration of effectiveness (by meta-analysis of trials) of thrombolysis in myocardial infarction and its general acceptance into clinical practice. 8 Are we now going to learn from our history, or repeat it, by failing to put into practice the evidence from different disciplines on how to support adoption of clinical evidence into practice?…”

Section: Resultsmentioning

confidence: 99%

Evidence‐based medicine: still not flowing into practice

Hutchinson¹

2012

Prescriber

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Section: Resultsmentioning

confidence: 99%

Evidence‐based medicine: still not flowing into practice

Hutchinson¹

2012

Prescriber

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“…Furthermore, the problem is not confined to primary care physicians since hospital specialists also fail to adopt evidence based interventions rapidly. 17 Most studies have also indicated that identifying barriers to change in physician behaviour is a further important prerequisite to adoption of evidence based practice. In the case of angiotensin converting enzyme (ACE) inhibition in heart failure this is probably a major issue, since data 8 18 suggest that primary care physicians, while being aware of the evidence for treatment benefits with ACE inhibitors in heart failure, have exaggerated concerns over the safety and tolerability of these agent in their patients.…”

Section: Current Practice In the Diagnosis Of Heart Failure And Consementioning

confidence: 99%

Keeping the culture alive: the laboratory technician in mid-twentieth-century British medical research

Tansey

2008

Notes Rec. R. Soc.

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Heart 2002;88(Suppl II):ii9-ii11 H eart failure and left ventricular systolic dysfunction (LVSD) are major diseases, with existing high prevalence (around 2% each), 1 2 and prevalence that is on the increase.3 Based on the ECHOES (echocardiographic heart of England screening) study, 1 which probably provides the most precise estimates on heart failure prevalence to date, 2.3% of adults in England over the age of 45 years suffer all cause heart failure, which rises to 3.1% if adults who are symptomatic with borderline abnormal ejection fractions (40-50%) are added. The latter suffer a significantly worse prognosis than people with an ejection fraction above 50%. In addition, 1.8% of adults suffer LVSD, of whom 1% also suffer symptoms and are therefore included within the rates quote for heart failure.As if this burden of disease was not significant enough, heart failure will get more common, for two main reasons. The first is that despite rates of myocardial infarction declining, infarction remains very common and rates of survival are increasing. Heart failure is an inevitable sequel in a high proportion of survivors (25% over 10 years). Secondly, heart failure is essentially a disease of the elderly with a prevalence of 3% in those aged 65-74 years, 7% in those ages 75-84, and 15% in those over 85.

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“…thrombolytic drugs) much earlier (i.e. 15 years earlier for thrombolytic drugs), thereby saving several hundreds of thousands of lives [41].…”

Section: Hierarchies Of Research Evidencementioning

confidence: 99%

The evolution of the randomized controlled trial and its role in evidence‐based decision making

Devereaux

Yusuf

2003

Journal of Internal Medicine

125

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The randomized controlled trial has been used in medical research for a little over half a century. This manuscript provides an overview of some of the history and evolution of the randomized controlled trial during this period. There exists hierarchies of evidence for therapeutic, diagnostic and prognostic questions, and the randomized controlled trial is at the top of the therapeutic hierarchy. Despite being at the top of the therapeutic hierarchy randomization in itself does not guarantee the trial results approximate the true effect. Issues that result in systematic and nonsystematic deviations from the truth in randomized controlled trials must also be considered. We present a model for evidence-based decision making that includes the following components: the clinical state, patient preferences, research evidence from a range of studies and clinical expertise. We discuss the role of the randomized controlled trial within evidencebased decision making.

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A Comparison of Results of Meta-analyses of Randomized Control Trials and Recommendations of Clinical Experts

Cited by 1,215 publications

References 45 publications

Evidence‐based medicine: still not flowing into practice

Evidence‐based medicine: still not flowing into practice

Keeping the culture alive: the laboratory technician in mid-twentieth-century British medical research

The evolution of the randomized controlled trial and its role in evidence‐based decision making

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