McMaster researchers get evidence to practice

McMaster University researchers are playing a key role in an international project designed to get the latest medical evidence into practice.

The collaboration with medical journal The BMJ has already resulted in three practice-changing guidelines since September, including a strong recommendation Wednesday against the use of knee arthroscopy in nearly all patients with degenerative disease.

Three more guidelines are in the works with the aim to produce at least 10 a year so patients get the most up-to-date treatment.

“After a new study is published, it actually takes years before it’s included in guidelines and the practice changes,” said internist and McMaster PhD student Dr. Reed Siemieniuk. “We think that is way too long and it isn’t fair to patients.”

The project led by the University of Oslo watches for major randomized trials providing strong evidence that treatment needs to change. An international expert panel is convened including doctors, patients and other health-care workers. At the same time, a systematic review is done to compare the results to past studies. In the end, recommendations are made that are immediately available.

One unique aspect of the panels is that none of the experts can have a conflict of interest. “Part of this is also pushing the guideline community to become more transparent and more trustworthy,” said Siemieniuk. “Right now, guidelines are often marred by people who have serious conflicts of interest.”

The project has caught the attention of specialists who are trying it out in their fields. Hamilton’s Dr. Bram Rochwerg published rapid recommendations Thursday on critical care with more on the way.

“One of the biggest issues with clinical practice guidelines are they work on four- to six-year cycles,” said Rochwerg. “The whole process can take a year or two … So by the time you come out with the recommendations, the evidence is outdated. … There’s an appetite for providing guidance to stakeholders and clinicians immediately.”

One of the downsides is the risk of missing something important when working so quickly, said Dr. David Jevsevar, chair of the council of research and quality at the American Association of Orthopaedic Surgeons.

But the latest guideline shows the need for fast recommendations.

“In this case, patients have received years worth of unnecessary surgery,” said Siemieniuk.