Introduction to BMJ Rapid Recommendations

[RogerBlack]

http://www.bmj.com/content/354/bmj.i5191

Find a committee. Add evidence, opinion, politics, and money in varying measures, and a murky set of recommendations can emerge. To those on the outside, guideline production may seem like a black box, and, unless it is carefully and transparently managed, loss of trust, patient suffering, waste, and over and under treatment can occur. ...

An initiative from the MAGIC non-profit research and innovation programme—representing patients, front-line clinicians, researchers, and guideline experts www.magicproject.org has resulted in a collaboration with The BMJ. We aim to promptly translate emerging research to user friendly and trustworthy recommendations, evidence summaries, and decision aids.

During the hiatus between new evidence and guideline publication, many patients receive outdated care; it can take years for evidence to filter …

This seems almost tailor-made for the emerging problems with PACE and its impact on guidelines.
Both the Cochrane collaboration, US and UK guidelines are (to varying strengths) heavily reliant on PACE and the subsequent first data release.

Highlighting the fact that severe CFS patients will suffer would be nice, but I don't think there is robust evidence for that yet.
PACE - even on the authors own recent reanalysis is a much smaller effect size for CBT over standard care, which vanishes entirely into statistical insignificance after looking at the reanalysis by others.
Highlighting this, and throwing a bone to the CBT people that it may somewhat help with anxiety and sleep, but is not measurably effective on any other measure would seem solidly within the remit of this rapid 'new evidence' process.

http://help.magicapp.org/knowledgeb...rganization-is-non-profit-do-i-have-to-pay-an - non profits seem also to be able to have some input, though I have not investigated properly exactly what.

 

[trishrhymes]

I don't quite understand it from a quick browse, but it looks interesting. Looked really promising until I came across the bit that listed Cochrane as a major collaborator.


'Cochrane collaboration have been crucial to the involvement of Evidence Based Medicine.

They use the GRADE methodology and have been a long standing member of the GRADE working group. We work with people from Cochrane on the topic of data-flow, import of studies, and continuous updating.'

Does this mean they will take on face value the awful Cochrane ME/CFS report so heavily influenced by PACE, I wonder.

 

[RogerBlack]

Does this mean they will take on face value the awful Cochrane ME/CFS report so heavily influenced by PACE, I wonder.

The hope was yes, they take it into account - but they look at the recent significant evidence - that of the recently released data from the PACE trial and weigh the significance to give to PACE and any meta-analysis influenced by it on this basis.

The likely result of doing this would be to significantly downgrade APT and CBT over normal care, compared to existing recommendations - if they accept the non-published in a peer reviewed journal analysis, and don't require waiting.

 

[trishrhymes]

Does anyone know whether they've looked at ME yet? I couldn't work out whether it is a new initiative with no actual content yet, or something well established.