PMC:1084246 / 7414-10428 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/1084246","sourcedb":"PMC","sourceid":"1084246","source_url":"http://www.ncbi.nlm.nih.gov/pmc/1084246","text":"Questions and judgements\nThe 12 examples were selected to include a variety of health care interventions, types of evidence and types of recommendations. The questions that were posed in the 12 examples were:\n• Should depressed patients in primary care be treated with SSRIs or tricyclics? [2]\n• Should patients with atrial fibrillation be treated with warfarin or aspirin for prevention of stroke? [3]\n• Should patients with pain believed to be due to degenerative arthritis be treated with non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol? [4]\n• Should patients who have had a myocardial infarction be given antiplatelet therapy to reduce all cause mortality? [5]\n• Should patients who have had a myocardial infarction be offered exercise rehabilitation? [5]\n• Should patients with deep venous thrombosis be treated with Low Molecular Weight Heparin (LMWH) or IV unfractionated heparin for prevention of pulmonary embolism? [6]\n• Should antibiotics be used to treat acute maxillary sinusitis? [7]\n• Should BCG vaccine be used to prevent tuberculosis? [8]\n• Should surgical discectomy be recommended for patients with sciatica due to lumbar disc prolapse? [9]\n• Should community water fluoridation be used to reduce dental caries? [10,11]\n• Should distribution of child safety seats and education programs be used to increase correct use of child safety seats? [12]\n• Should hormone replacement therapy be given to prevent cardiovascular heart disease in healthy post menopausal women? [13]\nFor each example each person made judgements about;\n• the quality of evidence for each outcome, scored as high, intermediate, low, or very low;\n• the relative importance of each outcome, scored as critical to the decision (7–9), important but not critical to the decision (4–6), or not important to the decision (1–3);\n• the overall quality of all the critical outcomes, scored as high, intermediate, low, or very low;\n• the balance between benefits and harms, scored as net benefit, trade offs, uncertain net benefit, or not net benefit; and\n• the recommendation, scored as do it, probably do it, toss up, probably don't do it, or don't do it.\nFor each example the judgements made by all 17 people were collected and summarised as illustrated in Table 3. Disagreements were discussed at a meeting attended by 15 of the 17 judges. Because of a lack of time, the last two examples were discussed at another meeting attended by six of the 17 judges, but all 17 raters provided judgements for all of the 12 examples. For each example the kappa agreement was calculated [14] for the 17 graders across the four levels for the quality of evidence across outcomes for each example (number of outcomes per example range from two to seven), across all outcomes (46) and for the judgements about overall quality of the evidence (12).\nTable 3 Summary of the judgements made by the 17 evaluators for Example 1 of the pilot study. 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