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| 2. |
- Howick, Jeremy, et al.
(författare)
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Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis
- 2018
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Ingår i: Journal of the Royal Society of Medicine. - : Sage Publications. - 0141-0768 .- 1758-1095. ; 111:7, s. 240-252
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPractitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised.ObjectiveTo estimate the effects of empathy and expectations interventions for any clinical condition.DesignSystematic review and meta-analysis of randomised trials.Data sourceSix databases from inception to August 2017.Study selectionRandomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older.Review methodsTwo reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis.ResultsWe identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference −0.43 [95% confidence interval −0.65 to −0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference −0.18 [95% confidence interval −0.32 to −0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons.ConclusionGreater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain.Protocol registrationCochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.
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| 3. |
- Howick, Jeremy, et al.
(författare)
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In search of justification for the unpredictability paradox
- 2014
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 15:480
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Tidskriftsartikel (refereegranskat)abstract
- A 2011 Cochrane Review found that adequately randomized trials sometimes revealed larger, sometimes smaller, and often similar effect sizes to inadequately randomized trials. However, they found no average statistically significant difference in effect sizes between the two study types. Yet instead of concluding that adequate randomization had no effect the review authors postulated the "unpredictability paradox", which states that randomized and non-randomized studies differ, but in an unpredictable direction. However, stipulating the unpredictability paradox is problematic for several reasons: 1) it makes the authors' conclusion that adequate randomization makes a difference unfalsifiable-if it turned out that adequately randomized trials had significantly different average results from inadequately randomized trials the authors could have pooled the results and concluded that adequate randomization protected against bias; 2) it leaves other authors of reviews with similar results confused about whether or not to pool results (and hence which conclusions to draw); 3) it discourages researchers from investigating the conditions under which adequate randomization over- or under-exaggerates apparent treatment benefits; and 4) it could obscure the relative importance of allocation concealment and blinding which may be more important than adequate randomization.
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| 4. |
- Howick, Jeremy, et al.
(författare)
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Philosophy of Evidence-Based Medicine
- 2015
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Ingår i: Oxford Bibliographies in Philosophy. - : Oxford University Press.
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Bokkapitel (refereegranskat)abstract
- Since its introduction just over two decades ago, evidence-based medicine (EBM) has come to dominate medical practice, teaching, and policy. There are a growing number of textbooks, journals, and websites dedicated to EBM research, teaching, and evidence dissemination. EBM was most recently defined as a method that integrates best research evidence with clinical expertise and patient values and circumstances in the treatment of patients. There have been debates throughout the early 21st century about what counts as good research evidence between EBM proponents and philosophical critics and even within the EBM community itself. Similar controversy arises about the relative worth of patient values and clinical expertise (and how these can be integrated). EBM has also evolved in ways that have come under scrutiny. Specifically, policymakers have used EBM research methodology to increase the relative importance of clinical guidelines that some clinicians have argued are tyrannical. Philosophers have addressed all of these controversies, and with very few exceptions have been critical of EBM. In addition most philosophical attention has been on the epistemic role of Randomization and evidence hierarchies, with relatively little attention being paid to the role of Diagnosis, expertise, patient values, and Systematic Reviews within EBM.
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| 5. |
- Howick, Jeremy, et al.
(författare)
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Positive "framing" as a powerful medication for pain : A meta-analysis of randomized trials
- 2016
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Ingår i: European Journal of Integrative Medicine. - : Elsevier. - 1876-3820 .- 1876-3839. ; 8, s. 57-59
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A growing body of evidence suggests that positive framing–inducing positive expectations about the outcome of treatments can reduce pain symptoms. However there is no pooled estimate of the effect size of positive framing for treating pain. Such an estimate is useful to understand the extent to which positive expectations can enhance usual care.Methods: We extracted data from a recent systematic review of interventions that modified all "context factors" (including but not limited to) inducing positive expectations) in adults suffering from pain. The systematic review concluded that positive expectations were effective, but did not pool the results so no effect size was provided. Two authors independently extracted data from the studies and conducted the analysis. Our primary outcome was patient self-reported pain.Results: 10 randomized trials were eligible for meta-analysis. In the trials with continuous outcomes the standardized effect size was −0.39 (95% confidence interval −0.68 to −0.10, p = 0.009, I2 = 79%), suggesting reduced pain on average in groups in which positive expectations were induced. The effect size was similar in magnitude but was not statistically significant when we excluded studies deemed to have a high risk of bias (standard effect size −0.31, 95% CI −0.65 to 0.02, p = 0.07, I2 = 77%).Conclusion: The effect of inducing positive expectations is comparable to the effects of some pharmacological drugs. However many of the studies had a high risk of bias, and heterogeneity was significant. Future research is warranted including investigating ways to implement this evidence into patient care in an ethical way.
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| 6. |
- Howick, Jeremy, et al.
(författare)
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Randomized trials and observational studies : the current philosophical controversy
- 2016
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Ingår i: Handbook of the Philosophy of Medicine. - Dordrecht : Springer. - 9789401786874 ; , s. 873-886
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Bokkapitel (refereegranskat)abstract
- The supposed superiority of randomized over non-randomized studies is used to justify claims about therapeutic effectiveness of medical interventions and also inclusion criteria for many systematic reviews of therapeutic interventions. However, the view that randomized trials provide better evidence has been challenged by philosophers of science. In addition, empirical evidence for average differences between randomized trials and observational studies (which we would expect if one method were superior) has proven difficult to find. This chapter reviews the controversy surrounding the relative merits of randomized trials and observational studies. It is concluded that while (well-conducted) observational can often provide the same level of evidential support as randomized trials, merits of (well-conducted) randomized trials warrant claims about their superiority, especially where results from the two methods are contradictory.
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| 7. |
- Howick, Virginia M., et al.
(författare)
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The Malaria Cell Atlas : Single parasite transcriptomes across the complete Plasmodium life cycle
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science. - 0036-8075 .- 1095-9203. ; 365:6455
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Tidskriftsartikel (refereegranskat)abstract
- Malaria parasites adopt a remarkable variety of morphological life stages as they transition through multiple mammalian host and mosquito vector environments. We profiled the single-cell transcriptomes of thousands of individual parasites, deriving the first high-resolution transcriptional atlas of the entire Plasmodium berghei life cycle. We then used our atlas to precisely define developmental stages of single cells from three different human malaria parasite species, including parasites isolated directly from infected individuals. The Malaria Cell Atlas provides both a comprehensive view of gene usage in a eukaryotic parasite and an open-access reference dataset for the study of malaria parasites.
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| 8. |
- Mebius, Alexander
(författare)
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Philosophical controversies in the evaluation of medical treatments : With a focus on the evidential roles of randomization and mechanisms in Evidence-Based Medicine
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies.
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| 9. |
- Mebius, Alexander, et al.
(författare)
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Research gaps in the philosophy of evidence-based medicine
- 2016
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Ingår i: Philosophy Compass. - : John Wiley & Sons. - 1747-9991. ; 11:11, s. 757-771
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Tidskriftsartikel (refereegranskat)abstract
- Increasing philosophical attention is being directed to the rapidly growing discipline of evidence-based medicine (EBM). Philosophical discussions of EBM, however, remain narrowly focused on randomization, mechanisms, and the sociology of EBM. Other aspects of EBM have been all but ignored, including (a) the nature of clinical reasoning and the question of whether it can be standardized; (b) the application of EBM principles to the logic, value, and ethics of diagnosis and prognosis; (c) evidence synthesis (systematic reviews and meta-analyses); and (d) the nature and ethics of placebo controls. Philosophical analysis in each of these areas has the potential to enhance the discussion of EBM methodology and practice.
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