Transcript Slide 1
How can clinical trialists serve the needs of clinicians better? – experience on BMJ Clinical Evidence David Tovey, Editorial Director BMJ Knowledge What is BMJ Clinical Evidence? clinicalevidence.com Features • Systematic reviews covering 540 clinical questions and >3000 interventions • Presents what is known about benefits and harms • Annual updating cycle ensures currency of information • Now expanded to include guidance and emerging studies It’s not all problems, but… • Conduct • Reporting • The importance of the clinical question Population Intervention Comparison Outcomes The importance of getting the question right Viagra v placebo (yawn) Population • How much does the patient in the study resemble the person in front of me? • Co-morbidities e.g diabetes and heart failure Population: BMJ HIV study example • Population – MSM, IVDUs v heterosexual – Ethnicity • Co-morbidity – Malaria, TB, – Drug interactions • Health systems – Monitoring and follow up Population What can we presume? Population - exclusions Intervention • Interventions under-researched • Interventions poorly described Interventions under researched Interventions poorly described Comparison • Insufficient comparative trials • Few drug versus non drug comparisons Comparison – insufficient comparison trials Outcomes • How important to patients • Harms • “More research needed” Outcomes: how important to patients • “Antibiotic cures 98% of the bacteria that cause sinusitis” • Deferred prescription study: primary outcome – % that “filled” prescription Outcomes: Harms reporting inadequate “Needs further research!” Final slide – prescription for change • Identify the right question – what matters to patients and clinicians ( and don’t try to answer multiple questions ) • Identify or perform an SR – is your proposed research really necessary / clinically relevant? • Consider how representative is your population / setting • Concentrate on outcomes that have been shown to matter most to patients • Use the PICO structure to encourage focussed “further research” Thanks for listening [email protected] Problems of reporting • Setting the context - importance of SR in Introduction • Describing the intervention • Accurate reporting – how confident can I be? How can I translate it for the patient? • What is a clinically important difference: equivalence / non inferiority studies • “Needs further study” • Making core data available to subsequent reviewers Harms reporting inadequate Harms reporting inadequate