Common evidence gaps in point-of-care diagnostic test evaluation

The authors used Oxford Diagnostic Horizon Scan Programme reports to determine the sequence and timing of evidence for new point-of-care diagnostic tests and to identify common evidence gaps in this process | BMJ Open

We extracted data from 500 primary studies. Most diagnostic technologies underwent clinical performance (ie, ability to detect a clinical condition) assessment (71.2%), with very few progressing to comparative clinical effectiveness (10.0%) and a cost-effectiveness evaluation (8.6%), even in the more established and frequently reported clinical domains, such as cardiovascular disease. The median time to complete an evaluation cycle was 9 years (IQR 5.5–12.5 years). The sequence of evidence generation was typically haphazard and some diagnostic tests appear to be implemented in routine care without completing essential evaluation stages such as clinical effectiveness.

Evidence generation for new point-of-care diagnostic tests is slow and tends to focus on accuracy, and overlooks other test attributes such as impact, implementation and cost-effectiveness. Evaluation of this dynamic cycle and feeding back data from clinical effectiveness to refine analytical and clinical performance are key to improve the efficiency of point-of-care diagnostic test development and impact on clinically relevant outcomes. While the ‘road map’ for the steps needed to generate evidence are reasonably well delineated, we provide evidence on the complexity, length and variability of the actual process that many diagnostic technologies undergo.

Full reference: Verbakel, J.Y. T et al. (2017) Common evidence gaps in point-of-care diagnostic test evaluation: a review of horizon scan reports. BMJ Open 7:e015760.

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Podcast: The Evidence Manifesto – it’s time to fix the E in EBM

A response to systematic bias, wastage, error, and fraud in research underpinning patient care | BMJ

Informed decision making requires clinicians and patients to identify and integrate relevant evidence. But with the questionable integrity of much of today’s evidence, the lack of research answering questions that matter to patients, and the lack of evidence to inform shared decision how are they expected to do this?

Too many research studies are poorly designed or executed. Too much of the resulting research evidence is withheld or disseminated piecemeal. As the volume of clinical research activity has grown the quality of evidence has often worsened, which has compromised the ability of all health professionals to provide affordable, effective, high value care for patients.”

Carl Heneghan, director for the Centre for Evidence Based Medicine, and Fiona Godlee, editor in chief of The BMJ set out the 9 points of the Evidence manifesto, which tries to set a road map for strengthening the evidence base.

1) Expand the role of patients, health professionals and policy makers in research
2) Increase the systematic use of existing evidence
3) Make research evidence relevant, replicable and accessible to end users.
4) Reduce questionable research practices, bias, and conflicts of interests
5) Ensure drug and device regulation is robust, transparent and independent
6) Produce better usable clinical guidelines.
7) Support innovation, quality improvement, and safety through the better use of real world data.
8) Educate professionals, policy makers and the public in evidence-based healthcare to make informed choices.
9) Encourage the next generation of leaders in evidence-based medicine.

Alcohol abstention advice to pregnant women is wrong, say campaigners

Health officials and experts are wrong to tell women that they should completely abstain from drinking alcohol during pregnancy, according to campaigners | OnMedica

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Telling women that small quantities of alcohol in pregnancy can cause irreparable damage to a developing foetus has no basis in evidence and can cause needless anxiety, claimed academics and women’s advocates speaking at a conference in Canterbury, Kent.

The conference, Policing pregnancy: who should be a mother?, is a collaboration between the British Pregnancy Advisory Service (BPAS) charity, the Centre for Parenting Culture Studies (CPCS), maternal rights campaign group Birthrights, and engaging sociology.

Currently, pregnant women are warned that even light alcohol consumption can cause problems for them and long-term harm to their foetus, such as stunted growth, and eventual learning difficulties and behavioural problems. Warnings also include the possibility of liver damage to the baby and increased risk of the mother having a miscarriage.

Read the full overview here

Related news article by the Guardian available here

School nurse toolkit: Evaluation of behaviour change interventions

School nurses are key professionals in delivering evidence-based public health
programmes and interventions to support children and young people achieve best
health outcomes | Public Health England

Obesity - A Positive Lifestyle

Evidence suggests that although school nurse interventions result in a variety of positive
outcomes there is a lack of formal and robust evaluation activities. This toolkit is for school nurses who are undertaking interventions to support behaviour change in children or young people. It takes a realistic approach that can be integrated into practice. Whilst there is no single way of doing evaluation, and there is no ‘one size fits all’ approach to evaluation, this toolkit provides a guide to the processes and tools to use to evaluate the work you deliver.

View the full toolkit here

 

The role of evidence-based public health guidelines in local government

Kelly, M.P. et al. Journal of Public Health. Published online: 10 February 2017

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Background: In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites.

Conclusions: Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.

Read the full article here

A Million Decisions: evidence-based healthcare

Health Education England and the Chartered Institute of Library and Information Professionals have launched a joint campaign for decisions in the healthcare sector to be fully evidence-based. 

Every day more than a million decisions are made that have a profound and lasting impact on people’s lives and which influence the quality of healthcare and the cost of services.

The #milliondecisions campaign calls for everyone involved in policy making and care delivery to use the skills of librarians and knowledge specialists in meeting their obligations under the Health and Social Care Act 2012.

Additional links: Impact case studies | CILIP campaign information

PODCAST: Big Data – what effect is it going to have on EBM

In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK – whose mission is to deliver high-quality, cutting-edge research using ‘big data” | BMJ Talk Medicine

We know what the problems are – but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world – where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto.

Read the full over view here