Journal of clinical epidemiology
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To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake. ⋯ Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care.
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In randomized trials, the primary analysis should be consistent with the intention-to-treat (ITT) principle and should address missing data appropriately to draw valid inferences. This review focuses on current practices relating to the ITT principle and methods to handle missing data in the major musculoskeletal journals. ⋯ It appears that many trials reporting missing data are inappropriately analyzed and may therefore be prone to biased estimates and invalid inferences.
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Review
Lack of blinding of outcome assessors in animal model experiments implies risk of observer bias.
To examine the impact of not blinding outcome assessors on estimates of intervention effects in animal experiments modeling human clinical conditions. ⋯ Lack of blinding of outcome assessors in animal model experiments with subjective outcomes implies a considerable risk of observer bias.
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To investigate the nocebo effect using randomized acupuncture trials that include sham and no-treatment groups. ⋯ Our findings suggest that (1) the nocebo effect of acupuncture is clinically meaningful and (2) the rate of patients with any adverse event may be a more appropriate indicator of the nocebo effect.
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Expert guideline panelists are sometimes reluctant to offer weak/conditional/contingent recommendations. Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance warns against strong recommendations when confidence in effect estimates is low or very low, suggesting that such recommendations may seldom be justified. We aim to characterize the classification of strength of recommendations and confidence in estimates in World Health Organization (WHO) guidelines that used the GRADE approach and graded both strength and confidence (GRADEd). ⋯ Strong recommendations based on low or very low confidence estimates are very frequently made in WHO guidelines. Further study to determine the reasons for such high uncertainty recommendations is warranted.