New evidence pyramid

Murad, M. Hassan; Asi, Noor; Alsawas, Mouaz; Alahdab, Fares

doi:10.1136/ebmed-2016-110401

Cited by 989 publications

(723 citation statements)

References 11 publications

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“…Evidence from healthcare settings is supported by the prominent tool known as the evidence pyramid (Murad et al, 2016). The case control design, represented by 61% of the total eligible studies, is known to have low quality of evidence (it is found at the base of the evidence pyramid).…”

Section: Discussionmentioning

confidence: 99%

Medication-related inpatient falls: a critical review

Ribeiro

Melo

Maia

et al. 2018

Braz. J. Pharm. Sci.

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Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.

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Section: Discussionmentioning

confidence: 99%

Medication-related inpatient falls: a critical review

Ribeiro

Melo

Maia

et al. 2018

Braz. J. Pharm. Sci.

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“…In parallel with the evidence-based medicine approach, various "hierarchy of evidence" stratifications have also emerged [1][2][3] . Overall, those stratifications attempt to characterize underlying bias (that is, validity) and emphasize the relative quality of different forms of evidence.…”

Section: Evidence In Medicine: Math Versus Biology!mentioning

confidence: 99%

“…Overall, those stratifications attempt to characterize underlying bias (that is, validity) and emphasize the relative quality of different forms of evidence. In a traditional pyramidal representation ( Figure 1) 2,3 , systematic reviews and meta-analyses of randomized clinical trials (rcts) represent the pinnacle of the pyramid, followed by individual rcts and observational studies (for example, case-control or cohort studies). Conversely, case reports and series, often called "anecdotal evidence," are placed at the bottom of the pyramid.…”

Section: Evidence In Medicine: Math Versus Biology!mentioning

confidence: 99%

Evidence in Medicine: Math Versus Biology!

2017

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The drive for optimal clinical decisions based on "best" evidence has gained significant momentum in the last few decades. In parallel with the evidence-based medicine approach, various "hierarchy of evidence" stratifications have also emerged 1-3 . Overall, those stratifications attempt to characterize underlying bias (that is, validity) and emphasize the relative quality of different forms of evidence. In a traditional pyramidal representation (Figure 1) 2,3 , systematic reviews and meta-analyses of randomized clinical trials (rcts) represent the pinnacle of the pyramid, followed by individual rcts and observational studies (for example, case-control or cohort studies). Conversely, case reports and series, often called "anecdotal evidence," are placed at the bottom of the pyramid. Notwithstanding a number of limitations and criticisms 4 , including an overreliance on systematic reviews and meta-analyses, clinical decision-making continues to be guided by such "hierarchies of evidence." Increasingly, however, the evidence-based medicine approach-and thus clinical decision-making-is coming to rely on mathematical or statistical characterizations of biologic processes (for example, disease progression or relapse, patient survival, and quality of life).The applications of math and statistics in clinical medicine are numerous and include characterizations of biologic observations and mathematical modelling of health outcomes 5 . As examples of the former, the biologic observations encountered in rcts (such as disease progression or relapse, patient survival, and quality of life) are often represented by bio-statistical measures that include estimates of effect size and the uncertainties involved (for example, type i and ii errors, p values, and 95% confidence intervals) 6,7 . As well, meta-analyses often use mathematical measures that extrapolate efficacy from individual rcts to compute compound measures of effect size and uncertainty. Not surprisingly, for clinicians who chose a science path driven by human biology, the underlying math and statistics are not infrequently perceived as complex. Nonetheless, a working knowledge of the underlying statistical methods is necessary for clinicians to properly interpret the current evidence. Furthermore, knowledge that is more in-depth is also often required to properly interpret the clinical evidence and avoid the pitfalls of mere binary interpretation of study outcomes as simply positive or negative 6,7 .Clinical evidence that stems from biologic observations cannot address all pertinent gaps in knowledge. As an

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“…With this in mind, I found the ‘New Evidence Pyramid’ proposed by Murad et al 3 to be ingenious. It is graphically simple while conveying that quality varies in primary studies, and that there are inherent difficulties in fully relying on systematic reviews and meta-analysis without understanding the strength of the primary evidence and the methodology of the analyses.…”

mentioning

confidence: 93%

Evidence pyramids

Kaufmann

2016

Evid Based Med

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New evidence pyramid

Cited by 989 publications

References 11 publications

Medication-related inpatient falls: a critical review

Medication-related inpatient falls: a critical review

Evidence in Medicine: Math Versus Biology!

Evidence pyramids

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