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Hôpital-Camfrout, France

Watine J.,Laboratoire Of Biologie Polyvalente | Augereau C.,Hopital Europeen Georges Pompidou | Oosterhuis W.P.,Atrium Medical
Immuno-Analyse et Biologie Specialisee | Year: 2012

The proliferation and the success of Clinical practice guidelines (CPG) are accompanied by misconceptions about them. In this letter, the three ideas below are discussed with the help of examples. Many of the CPG available are formulated in a way that may lead the reader to believe that: 1) Opinions (including those of expert) have a lower value than the evidence; 2) Situations where we do not have any evidence are quite frequent in medicine; 3) It is acceptable that CPG do not apply to questions that are framed according to Patient, Intervention, Comparator, Outcome (PICOs), and without any indication about the medico-socio-economical setting where the recommendations are supposed to be implemented. These three ideas are mistaken and can lead to recommendations which can annihilate the very principles of CPG. © 2012 Elsevier Masson SAS. Source

Aakre K.M.,University of Bergen | Watine J.,Laboratoire Of Biologie Polyvalente | Bunting P.S.,Ottawa Hospital | Sandberg S.,University of Bergen | Oosterhuis W.P.,Atrium Medical
Diabetic Medicine | Year: 2012

Aims To evaluate if clinical practice guideline recommendations regarding self-monitoring of blood glucose in patients with diabetes not using insulin follow the principles of evidence-based medicine. Methods After a search from 1999 to 2011, 18 clinical practice guidelines were included. Recommendations regarding self-monitoring of blood glucose were graded on a scale from one (strongly against self-monitoring) to four (strongly in favour of self-monitoring) and compared with the similarly graded conclusions of systematic reviews that were cited by the clinical practice guidelines. We also investigated how clinical practice guideline characteristics, for example funding sources, and quality of references cited could be related to the guideline recommendations. Results The clinical practice guidelines cited in total 15 systematic reviews, 14 randomized controlled trials, 33 non-randomized controlled trials papers and 18 clinical practice guidelines or position statements. The clinical practice guideline recommendations had an average grade of 3.4 (range 2.0-4.0). Higher grades were seen for clinical practice guidelines that acknowledged industry funding (mean value 4.0) or were issued by organizations depending on private funding (mean value 3.6 vs. 3.0 for governmental funding). The conclusions of the 15 systematic reviews had a mean grade of 2.2 (range 1.0-3.8). Systematic reviews with low grades were less cited. In total, 21 randomized controlled trials were included in the systematic reviews. Approximately half of these evaluated an educational intervention where the effect of self-monitoring of blood glucose could not be clearly isolated. Conclusions Clinical practice guidelines were more in favour of self-monitoring use than the systematic reviews that were cited. The citation practice was non-systematic and industry funding seemingly led to a more positive attitude towards use of self-monitoring of blood glucose. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK. Source

Watine J.,Laboratoire Of Biologie Polyvalente | Watine J.,Paris Observatory | Wils J.,Paris Observatory | Wils J.,University of Rouen | And 2 more authors.
Journal of Clinical Epidemiology | Year: 2014

Objective To challenge the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group to address the potential misconceptions about their approach to grading the strength of recommendations in clinical practice guidelines. Study Design and Setting Based on our own expertise of health care professionals trying to think in depth about, and using, guidelines, we have identified four such misconceptions. Results These potential misconceptions are: (1) evidence in medicine means factual or scientific evidence; (2) opinions are a subcategory of evidence; (3) the most important evidence is related to clinical benefits and harms; (4) being virtuous, and principled, does not particularly help in developing the best possible guidelines. Conclusion We call on the GRADE leadership to address all the above-mentioned misconceptions. These need explicit answers in their manuscript series. © 2014 Elsevier Inc. All rights reserved. Source

Aakre K.M.,University of Bergen | Aakre K.M.,European Federation of Clinical Chemistry and Laboratory Medicine | Langlois M.R.,European Federation of Clinical Chemistry and Laboratory Medicine | Barth J.H.,European Federation of Clinical Chemistry and Laboratory Medicine | And 6 more authors.
Clinica Chimica Acta | Year: 2014

Objective: The European Federation of Laboratory Medicine (EFLM) and the Union of European Medical Specialists (UEMS) joint Working Group on guidelines recently proposed a checklist to help standardize the description of laboratory investigations in clinical practice guidelines (CPG). Methods: Nine CPGs or consensus documents published from 2011 to 2013 describing the investigation of chest pain, diagnosis of acute coronary syndrome, or myocardial infarction were evaluated against the published checklist. Results: Clinical use of troponin analysis are commonly dealt with but the publications present variable, vague and sometimes conflicting information regarding this laboratory test being very much relied on upon making a diagnosis of acute coronary syndrome. Most of the laboratory related checklist items are not considered or need to be updated e.g. suggested analytical quality goals are not applicable for the high sensitive assays and important interferences that may lead to false positive or negative diagnoses are commonly not mentioned. Conclusion: The current paper sums up important analytical and biological issues related to troponin assays and gives suggestions for analytical quality goals that could be included in CPG's. © 2014 Elsevier B.V. Source

Watine J.,Laboratoire Of Biologie Polyvalente
Journal of Medical Ethics | Year: 2011

The concept of evidence-based medicine (EBM) has been invented by physicians mostly from English Canada, mostly from McMaster University, Ontario, Canada. The term EBM first appeared in the biomedical literature in 1991 in an article written by a prominent member of this group-Gordon Guyatt from McMaster University. The inventors of EBM have also created the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group, which is a prominent international organisation whose main purpose is to develop evidence-based clinical practice guidelines (CPGs). CPGs that are based on the GRADE approach are becoming increasingly adopted worldwide, in particular by many professional or governmental organisations. This group of thinkers being thus identified, we have retrieved and read many of their publications in order to try and understand how they intend to incorporate bioethical values into their concept. The author of this little essay did also spend a few years on the internet as an active member of the GRADE group discussion list. The observations thus gathered suggest that although some of the inventors of EBM, at least Gordon Guyatt, wish to incorporate core principles of biomedical ethics into their concept (ie, non-malevolence, beneficence and maybe to a lesser extent respect for autonomy, and justice), some clarifications are still necessary in order to better understand how they intend to more explicitly incorporate bioethical values into their concept and, perhaps more importantly, into evidence-based CPGs. Source

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