Martin Mayer

Objectives: To update previous GRADE guidance addressing inconsistency and interpreting subgroup analyses. Study design and setting: Using an iterative process, we consulted with members of the GRADE working group through multiple rounds of written feedback and discussions at GRADE working group meetings. Results: The guidance complements prev...

Objective To provide updated guidance on when GRADE users should consider rating down more than one level for imprecision using a minimally contextualized approach. Study design and setting Based on the first GRADE guidance addressing imprecision rating in 2011, a project group within the GRADE Working Group conducted iterative discussions and pre...

Introduction GRADE guidance to rate the certainty domain of imprecision is presently not fully operationalized for rating down by two levels and when different or uncertainty in baseline risks are considered. In addition, there are scenarios in which lowering the certainty of evidence by three levels for imprecision is more appropriate than lowerin...

The Fracture Risk Assessment Tool (FRAX®) is widely used to estimate the 10-year risk of hip fracture and major osteoporotic fracture (MOF, defined as a hip, humerus, wrist, or clinical vertebral fracture). In 2015, McCloskey and colleagues published an adjustment to FRAX® based on the trabecular bone score (TBS). In 2017, the adjustment was update...

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Background and methods People with atrial fibrillation face an increased risk of thromboembolic events, and deciding on an antithromboembolic strategy in non-valvular atrial fibrillation is a prime opportunity for shared decision making. Therefore, tools facilitating this process are highly desirable. The American College of Cardiology strives for...

Importance: Hypertension is very common, but guideline recommendations for hypertension have been controversial, are of increasing interest, and have profound implications. Objective: To systematically assess the consistency of recommendations regarding hypertension management across clinical practice guidelines (CPGs). Design, Setting, and P...

Jüni and colleagues replied to my previous correspondence about their Cochrane reviews. However, although they agree with my observations and commit to using the approach I suggest going forward, a considerable portion of their responses are incorrect, so I submitted further correspondence with the hope of reaching resolution. An abridged comment i...

Many patient-relevant outcomes, particularly quality of life measures such as pain or function, are routinely measured on a continuous scale. However, the interpretation of continuous outcomes is difficult, particularly when considering application to clinical practice and shared decision-making. Making matters worse is the frequent existence of mu...

Objectives To discuss how continuous outcome measures are commonly used to measure patient-relevant outcomes, the obstacles in employing these measures clinically, and methods available to facilitate use of bodies of evidence comprised of continuous outcomes. Method Many patient-relevant outcomes, particularly quality of life measures such as pain...

Objectives To systematically assess the consistency of recommendations regarding hypertension management across clinical practice guidelines (CPGs) and electronic point-of-care (POC) resources Method We identified hypertension management recommendations from eight CPGs and two POC resources in April 2018. We described discrete and unambiguous spec...

Objectives Evidence-based practice requires the use of research results to inform care. Computers can add capacity for evidence-based practice by making the information from research results, appraisals, and summarizations searchable and re-usable without labor-intensive manual screening and repetition of data entry. Such interoperability can be ac...

There are methods available to estimate dichotomous measures, such as the odds ratio, from continuous measures, such as the standardized mean difference. da Costa and colleagues employ these methods in their Cochrane review ‘Oral or transdermal opioids for osteoarthritis of the knee or hip’, but certain aspects of the review are unclear or warrant...

There are methods available to estimate dichotomous measures, such as the odds ratio, from continuous measures, such as the standardized mean difference. Jüni and colleagues employ these methods in their Cochrane review ‘Intra-articular corticosteroid for knee osteoarthritis’, but certain aspects of the review are unclear or warrant further conside...

Evidence-based medicine is arguably among the most important innovations of the modern era, but publication bias and inadequate research transparency are serious issues affecting the very foundation of evidence-based practice. Despite this truth, these crucial issues have gone largely unaddressed or inadequately addressed for a distressingly long p...

Although authors Emily Webster, MPAS, PA-C, and Michael Gil, MPAS, PA-C, seek to provide a helpful overview of advances in anticoagulant therapy in their recent article (“Advances in anticoagulation therapy,” February 2018), I was troubled by several important oversights or errors in their detailing of the direct oral anticoagulants (DOACs, also ca...

Aim: A crucial element of evidence-based healthcare is the sound understanding and use of statistics. As part of instilling sound statistical knowledge and practice, it seems useful to highlight instances of unsound statistical reasoning or practice, not merely in captious or vitriolic spirit, but rather, to use such error as a springboard for edi...

Background: The most recent joint guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) are a result of a substantial and considered undertaking, and those involved deserve much recognition for their efforts. However, the handling of a...

To the Editor Dr Goroll argued that the term “provider” should be eliminated, as it might lead to problems in the primary care arena.¹ However, although “professional” seems like a desirable alternative, Goroll advanced his argument with false assumptions. His writing suggests a poor understanding of the physician assistant and nurse practitioner p...

In what became a highly-publicised move, the American Heart Association (AHA) and American College of Cardiology (ACC) effectively dropped low-density lipoprotein cholesterol (LDL-C) goals from their most recent guidelines pertaining to the matter. However, due to developments since the AHA and ACC released their current guidelines, some have calle...

Lumacaftor-ivacaftor (Orkambi) was recently approved by the Food and Drug Administration (FDA) in the USA to treat patients at least 12 years old who have cystic fibrosis due to two copies of the F508del (Phe508del) mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Lumacaftor-ivacaftor has been designated a 'breakthro...

Think about all the information you process while driving. Now, imagine only being able to process 50% of that information and having no control over what 50% is available. Most people would shudder at the thought of driving with this limitation and would be right to question the sensibility of anyone who was completely fine with driving under thes...

The most recent joint guidelines from the American Heart Association and American College of Cardiology on the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) represent the culmination of a considerable undertaking to synthesize a large body of evidence, and the efforts of those involved are to be applauded. However, the handling...

When patients seek medical care, they assume the treatment or advice they receive is based on a strong understanding of the human body and its processes. They also typically assume the care they receive is based on a strong understanding of the research literature pertaining to their well-being and any ailments for which they might seek care. Howev...

The paradigm of evidence-based medicine has made impressive advancements since its conception and implementation, but publication bias and issues with inadequate research transparency have remained persistent and pestilent problems. These closely-related issues have markedly detrimental effects on the evidence base from which researchers operate an...