Identifying low-value clinical practices in critical care medicine: protocol for a scoping review

Niven, Daniel J.; McCormick, Thomas Jared; Straus, Sharon E.; Hemmelgarn, Brenda R.; Jeffs, Lianne; Stelfox, Henry T.

doi:10.1136/bmjopen-2015-008244

Cited by 5 publications

(5 citation statements)

References 42 publications

(56 reference statements)

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“…Results from the two sets of searches established the target ‘cohort’ of articles that was subsequently analyzed within a framework to describe reproducibility of experimental clinical research (Table 1 ). Our methods are outlined in a detailed, published protocol [ 25 ] and depicted within Additional file 1 : Figure S1. The published protocol indicates intention to include systematic reviews, systematic reviews with meta-analyses, and studies examining the clinical effects of diagnostic interventions within the target cohort of articles; however, at the request of the reviewers, these studies were removed from this manuscript.…”

Section: Methodsmentioning

confidence: 99%

“…Studies were excluded if (1) study participants were primarily admitted to coronary care units [ 28 ], (2) the clinical practice was provided exclusively in the pre-hospital setting, or (3) the study examined diagnostic accuracy or outcomes associated with the use of a diagnostic intervention. For the secondary searches, studies were retained if they fit the primary search eligibility criteria AND represented an ‘ original study’ OR a ‘ reproduction attempt ’ of a study identified in the primary search (Table 1 ) [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Reproducibility of clinical research in critical care: a scoping review

Niven

McCormick

Straus

et al. 2018

BMC Med

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BackgroundThe ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies.MethodsWe used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants.ResultsOverall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33–50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6–20.5% vs. 8.4%, 95% CI 6.0–10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42–68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19–52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt.ConclusionsA minority of critical care practices with research published in high-profile journals were evaluated for reproducibility; less than half had reproducible effects.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1018-6) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Reproducibility of clinical research in critical care: a scoping review

Niven

McCormick

Straus

et al. 2018

BMC Med

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“…Patients admitted to the Intensive Care Unit (ICU) are the sickest individuals in the hospital (Niven et al 2015). They are often physiologically unstable and require complex, invasive treatment to manage their care.…”

Section: Introductionmentioning

confidence: 99%

Understanding what matters to patients in critical care: An exploratory evaluation

Connelly

Jarvie

Daniel

et al. 2019

Nursing in Critical Care

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“…Few have undertaken a systematic approach to identifying candidates for de-adoption, although this has recently been proposed by a group of Canadian critical care researchers. 12 A systematic review published in 2007 examined variables affecting physicians' test-ordering tendencies. 13 They found that modifiable variables that affected testordering behaviours included perceived or real medicolegal concerns, personal beliefs on the usefulness of certain tests, individual risk-taking attitudes of the physicians, and financial incentives.…”

Section: "Waste" In the Ed: What Is It And Why Does It Exist?mentioning

confidence: 99%