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Designing and Running a Clinical Trial
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
There is a hierarchy of evidence for clinical trials and studies. It is Systematic ReviewRandomised Controlled Trial (RCT)Non-Randomised Controlled TrialCohort StudyCase-control StudyCase Reports, Case SeriesExpert Opinion
Values in research: the case of nursing
Published in Stephen Pattison, Roisin Pill, Values in Professional Practice: lessons for health, social care and other professionals, 2020
The shortcomings of this approach are evident even within the relatively narrow realms of research into disease and pathology. To place such methods at the head of a hierarchy of evidence, as if quantitative research should be acknowledged as quite simply 'better' than any other way of knowing about anything, seems little short of folly. Writers such as Oakley (2000), Pickstone (2000) and Midgely (2001) have all argued that we need a far richer and more complex account of ways of knowing than can be offered by the natural sciences alone.
Difference-Making and mechanism
Published in Olaf Dammann, Etiological Explanations, 2020
The authors’ main point in applying the epistemic theory of causation to EBM has two parts. First, Russo and Williamson argue that the epistemic theory is the best, in fact the only fit for “causal assessment in medicine,” referring to the Hill guidelines (Russo and Williamson 2011a:570). They “argue that an epistemic interpretation of causality is required to underpin Hill's causal assessment” (p. 571). Second, they move on to the “evidence hierarchy” in EBM, where the highest level of evidential authority is given to meta-analyses of RCTs, while expert opinion is at the lowest level. They criticize this hierarchy as (1) not being a hierarchy of evidence but of techniques of evidence-generation and (2) ignoring mechanistic evidence by looking for difference-making evidence only (at least at higher levels). Their declared main point here is that [S]ince the evidence hierarchy only really includes evidence of difference making (except perhaps at the bottom level, level IV), it loses the generality of Bradford Hill's guidelines for causal assessment, which treat mechanistic and difference-making evidence on an equal footing. (p. 573)
Evaluation of conflicts of interest among systematic review authors on pharmacological therapies for alcohol use disorder: A cross-sectional study
Published in Substance Abuse, 2022
Matt Crow, Micah Hartwell, J. Michael Anderson, Daniel Tritz, Matt Vassar
Within the medical hierarchy of evidence, systematic reviews are often considered the gold standard,6 as such studies apply systematic methodologies to comprehensively locate all studies for a given topic and then collates the results from them. Supporting their position within the hierarchy, systematic reviews, when available, serve as high quality supporting evidence when formulating clinical practice guideline recommendations. One such example is the use of systematic reviews within the US Preventive Services Task Force (USPSTF) guidance to recommend screening adults 18 years or older for unhealthy alcohol use7. A clinicians’ care plan relies on evidence-based practice; therefore, the trust placed in systematic reviews is high. However, bias within systematic reviews may compromise the certainty or integrity of their results. Efforts should be made to mitigate and minimize such biases as much as possible.
A scoping review of studies into crisis resolution teams in community mental health services
Published in Nordic Journal of Psychiatry, 2022
Katrine Høyer Holgersen, Sindre Andre Pedersen, Heidi Brattland, Torfinn Hynnekleiv
This scoping review aimed to provide an overview and description of the total body of evidence related to CRTs. A detailed assessment of the quality of the individual studies falls outside the scope; however, there seems to be a clear trend that the quality of the research in this field is moving upwards in the hierarchy of evidence [52]. The early studies, mainly classified as Characteristics and Implementation in this review, utilized naturalistic, qualitative, and descriptive research designs. Although valuable for the in-depth understanding of clinical phenomena and the generation of hypotheses, generalizable conclusions about CRTs’ effects or mechanisms of action cannot be drawn based on these studies, this research provided knowledge of characteristics of individual CRTs and acute mental health care in general. In recent years, however, larger controlled and randomized controlled trials have been conducted [42,46,53]. Another example is an ongoing prospective RCT study in the Netherlands [54] comparing the effect of intensive home treatment to treatment at admission.
Comparing Aerobic Exercise with Yoga in Anxiety Reduction: An Integrative Review
Published in Issues in Mental Health Nursing, 2022
Amanda K. Cole, Tamera Pearson, Mary Knowlton
Of the 14 articles, there were three meta-analysis of randomized control trials (Hofmann et al., 2016; Vollbehr et al., 2018; Zoogman et al., 2019), one systematic review and qualitative analysis (Nguyen-Feng et al., 2019), seven randomized control trials (Davis et al., 2020; Falsafi, 2016; Kumar et al., 2016; Mehling et al., 2017; McIntyre et al., 2020; Vesa et al., 2016; Wipfli et al., 2011); two pilot studies (Shivakumar et al., 2017; Marshall et al., 2020), and one qualitative analysis (Mason et al., 2019). The hierarchy of evidence ranges from level I (evidence from a systematic review or meta-analysis of randomized control trials) to level VII (evidence from the opinion of authorities and/or reports of expert committees). Ten of the articles were either a level I or level II giving the highest level of evidence. Table 1 provides a summary of each article and the results of each study.