Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent.
Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent.
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DOI：
10.1136/bmjebm-2022-111952
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发表时间：
2022-07-19
影响因子：
5.8
通讯作者：
Macintyre, Chandini Raina
中科院分区：
文献类型：
--
作者：
Greenhalgh, Trisha;Fisman, David;Cane, Danielle J.;Oliver, Matthew;Macintyre, Chandini Raina
循证医学 (EBM) 传统方法，尤其是随机对照试验 (RCT) 和荟萃分析，以及偏倚风险工具和清单，对 COVID-19 的科学做出了重大贡献。但这些方法和工具的设计主要是为了在稳定的背景下回答简单、有针对性的问题，在这种背景下，昨天的研究或多或少可以毫无问题地映射到今天的临床和政策问题。当扩展到有关在快速变化的全球背景下在多个部门造成混乱的新型病原体的复杂问题时，它们具有显着的局限性。结合了物质制品、人类行为、组织指令、职业健康和安全以及建筑环境的非药物干预措施就是一个很好的例子：循证医学的实验性、以干预为重点、清单驱动、以效果大小为导向和演绎的方法有时会引起混乱，而不是有根据的辩论。虽然随机对照试验很重要，但在需要快速决策以拯救生命和保护健康的情况下，排除其他研究设计和证据来源尤其成问题。现在是时候引入更广泛的证据和更多元化的方法来定义什么才是“高质量”证据。我们介绍了来自各个领域的一些概念工具和质量框架，涉及所谓的机械研究，包括复杂性科学、工程和社会科学。我们建议，机械证据的工具和框架（有时被称为“EBM+”）与传统的 EBM 相结合，可用于开发和评估使我们摆脱这场旷日持久的流行病所需的跨学科证据基础。本系列的其他文章将运用多元方法来解决具体的研究问题。
Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s research can be mapped more or less unproblematically onto today’s clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM’s experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate. While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as ‘high-quality’ evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions.
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DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
影响因子：
2.3
作者：
Fedak KM;Bernal A;Capshaw ZA;Gross S
通讯作者：
Gross S
DOI：
10.1001/jama.1992.03490170092032
发表时间：
1992-11-04
影响因子：
120.7
作者：
GUYATT, G
通讯作者：
GUYATT, G
影响因子：
17.1
作者：
Konda, Abhiteja;Prakash, Abhinav;Guha, Supratik
通讯作者：
Guha, Supratik
十个科学原因支持SARS-COV-2的机载传播。
DOI：
10.1016/s0140-6736(21)00869-2
发表时间：
2021-05-01
期刊：
Lancet (London, England)
影响因子：
--
作者：
Greenhalgh T;Jimenez JL;Prather KA;Tufekci Z;Fisman D;Schooley R
通讯作者：
Schooley R