McMaster re­searchers get ev­i­dence to prac­tice

The Hamilton Spectator - - LOCAL - JOANNA FRKETICH jfr­ketich@thes­pec.com 905-526-3349 | @Jfr­ketic

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.

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