Evidence-based medicine in India

Prasad, Kameshwar

doi:10.1016/j.jclinepi.2012.07.006

Cited by 9 publications

(13 citation statements)

References 15 publications

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“…[ 4 , 23 ] Given the often large patient load among Indian physicians, clinicians have limited time and incentives to stay up-to-date with the latest breakthroughs and innovations; consequently, they may not always provide optimal care. [ 6 ]…”

Section: Objectivesmentioning

confidence: 99%

“…Failure to use evidence from research to make informed decisions is evident among healthcare providers, managers, and policy-makers, across all disciplines of care around the world. [ 6 , 8 – 10 ] The practice of EBM is further constrained in developing countries due to its inherent complexity, misperceptions, absence in medical curricula, and limited awareness among clinicians. [ 4 ] In resource-poor countries, there is limited access to databases/computers/Internet, limited literature relevant to local realities, and inadequate library facilities.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 ] In resource-poor countries, there is limited access to databases/computers/Internet, limited literature relevant to local realities, and inadequate library facilities. [ 7 , 11 – 18 ] In an effort to improve healthcare quality and physicians’ decision-making to promote optimal outcomes for patients, the use of EBM to inform healthcare practice has emerged as both a national [ 6 ] and international priority. [ 19 – 22 ]…”

Section: Introductionmentioning

confidence: 99%

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Daily versus weekly evidence reports for orthopaedic surgeons in India

Kheterpal¹,

Busse

Baxter³

et al. 2019

OTA International: The Open Access Journal of Orthopaedic Trauma

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Background: There is a dearth of research regarding the impact of evidence-based medicine (EBM) tools, such as evidence summaries, in developing countries. The goals of this study were to: investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery in India; explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports; and identify and explain the barriers and benefits of an online EBM resource in the Indian context. Methods: Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized into 2 groups—1 group received daily targeted evidence summaries while the other received general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated 2 questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons’ usage, perceptions, and impact of OE. Results: There were no observable differences in OE usage between groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups’ perceptions of the OE tool. semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature and limited incentive to keep up with current evidence. Conclusions: Neither frequency of delivery (daily versus weekly) nor targeted versus general content affected the use of evidence summaries. Facilitating uptake of current evidence into clinical practice among Indian orthopedic surgeons may require additional components beyond dissemination of evidence summaries.

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Section: Objectivesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Daily versus weekly evidence reports for orthopaedic surgeons in India

Kheterpal¹,

Busse

Baxter³

et al. 2019

OTA International: The Open Access Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

“…They still exist as a key component of evidence-based medicine. [3][4][5][6][7] However, single RCTs are not enough to address the demands of policy makers for conclusive results. In order to address this problem, systematic reviews with meta-analysis (SRMA) are being increasingly used to synthesize results of different clinical trials that evaluate same interventions/treatments for obtaining an overall estimate of the treatment effect with respect to a control (active comparator/placebo).…”

Section: Introductionmentioning

confidence: 99%

Methodological considerations in network meta-analysis

Hassan¹,

Ravishankar²,

Nair

2015

Int J Med Sci Public Health

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Network meta-analysis (NMA), multiple treatments meta-analysis (MTM), or mixed treatment comparison (MTC) provides a flexible and powerful generalization of pairwise meta-analysis traditionally used with SRMA [9] for comparison of multiple interventions simultaneously. As has been explained in numerous publications, [10,11] NMA allows for indirect comparisons of treatments that have not been studied in a head-to-head manner. For example, treatment effects from clinical trials comparing X with respect to Y (in XY trials) and trials comparing Z with respect to Y (in YZ trials) can be then pooled together in NMA to obtain an indirect estimate for indirect comparison between X and Z [12] by means of the common comparator Y. Even if direct evidences for X and Z (via XZ trials) exist, combining them with indirect estimates will strengthen the evidence base. [13] In the mid-1990s, the technique of "adjusted indirect comparisons" was used to compare multiple interventions. This technique was subjected to extension and periodical revisions, leading to the development of NMA. Higgins and Whitehead, [10] Bucher et al. (1998), Lumley (2002), Lu and Ades (2004) have made enormous contributions toward the development of NMA. Network plot is the pictorial representation of all comparisons to be made within a NMA. A well-designed network plot will foster the analysis and will be helpful in procuring reliable estimates. A network plot can either be Network meta-analysis (NMA) is an extension of pairwise meta-analysis that facilitates comparisons of multiple interventions over a single analysis. It is the method in which multiple interventions (that is, three or more) are compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator. NMA is methodologically complex compared to simple pairwise meta-analysis as it accounts for a broader evidence base. Results from NMA are more useful to policy makers, service commissioners, and providers when making choices between multiple alternatives than those from multiple, separate pairwise meta-analyses. It can be an ideal choice to be extended to compare complex interventions that are multifaceted. Apart from the numerous benefits the NMA offers, it is prone to methodological complications that need to be understood, implemented, and finally reported correctly. This article is meant to provide a primer to the various methodological issues pertaining to NMA. The NMA can be as valid as a standard pairwise meta-analysis if these methodological issues are taken care of.

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“…When evidence is weak, EBM empowers the patients, whereas when evidence is strong, EBM empowers the measures taken to improve the quality of care. [10]…”

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confidence: 99%

Editorial: Evidence-based dermatology in India: Problems and prospects

Panda¹

2014

Indian J Dermatol

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Evidence-based medicine in India

Cited by 9 publications

References 15 publications

Daily versus weekly evidence reports for orthopaedic surgeons in India

Daily versus weekly evidence reports for orthopaedic surgeons in India

Methodological considerations in network meta-analysis

Editorial: Evidence-based dermatology in India: Problems and prospects

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