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David Tovey, Editorial Director BMJ Knowledge

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

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David Tovey, Editorial Director BMJ Knowledge

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  1. How can clinical trialists serve the needs of clinicians better? – experience on BMJ Clinical Evidence David Tovey, Editorial DirectorBMJ Knowledge

  2. 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

  3. It’s not all problems, but… • Conduct • Reporting • The importance of the clinical question Population Intervention Comparison Outcomes

  4. The importance of getting the question right

  5. Viagra v placebo (yawn)

  6. Population • How much does the patient in the study resemble the person in front of me? • Co-morbidities e.g diabetes and heart failure

  7. Population: BMJ HIV study example • Population • MSM, IVDUs v heterosexual • Ethnicity • Co-morbidity • Malaria, TB, • Drug interactions • Health systems • Monitoring and follow up

  8. Population What can we presume?

  9. Population - exclusions

  10. Intervention • Interventions under-researched • Interventions poorly described

  11. Interventions under researched

  12. Interventions poorly described

  13. Comparison • Insufficient comparative trials • Few drug versus non drug comparisons

  14. Comparison – insufficient comparison trials

  15. Outcomes • How important to patients • Harms • “More research needed”

  16. Outcomes: how important to patients • “Antibiotic cures 98% of the bacteria that cause sinusitis” • Deferred prescription study: primary outcome – % that “filled” prescription

  17. Outcomes: Harms reporting inadequate

  18. “Needs further research!”

  19. 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”

  20. Thanks for listeningdtovey@bmjgroup.com

  21. 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

  22. Harms reporting inadequate

  23. Harms reporting inadequate

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