However, please remember that assessment of methodological quality of these RCTs is based on the published quality which does not necessarily represent the actual quality/conduct as reflected in the protocol. Here is the citation BMJ. 2004 Jan 3;328(7430):22-4.

There is also another paper coming along which once published we would love to share with the group. 

Thanks

Ambuj Kumar, MD, MPH

On Feb 17, 2012, at 6:34 PM, Anoop Balachandran <[log in to unmask]> wrote:

Thanks to everyone for the reply. Thanks Patricia for the detailed reply. Thanks Mike for the book suggestion. 

Piersante answered my question, almost. The revised CONSORT statement  in 2011 states that "Overwhelming evidence now indicates that the quality of reporting
of randomized, controlled trials (RCTs) is less than optimal".  

So if the RCT  that is answering your specific question is not well done (poor methodology/bias), can we fall back to basic science? Can basic science stand alone as evidence if the quality of RCT is questionable? 

An example: I am thinking RCT's of homeopathy, but which completely goes against any basic science. 

Thanks.

On Fri, Feb 17, 2012 at 3:55 PM, piersante sestini <[log in to unmask]> wrote:
On 2/17/2012 7:48 PM, Nino Cartabellotta wrote:
Who added to the definition of EBM "often from the basic sciences"?
It was Dave Sackett ;-)
Although the sentence should be quoted more in full:

"By best research evidence we mean valid and clinically relevant research , often from the basic sciences of medicine, but especially from patient-centered clinical research..."

So, the "often" is actually overrun by "especially".

There are of course numberless occasions when pathophysiological reasoning complements or surrogate evidence from missing/incomplete clinical trials, particularly when adapting the evidence to the care of individual patients.
The simplest example that comes to mind is in choosing the right antibiotic for an infection in a  patient with liver disease (patients with liver disease are often excluded from clinical trials). Of course you would prefer an antibiotic that you know from basic science that is not metabolized in the liver.

The important thing to remember is that pathophysiology is an acceptable warrant for treatment only when specific clinical evidence is not available. (in the example above: imagine that an antibiotic has been proved useful and safe in patients with liver disease, you won't have to care any more about its metabolism).

But equally important is to remember that without a good grasp of pathophysiology (background information) is impossible to ask good clinical questions and to practice decent EBM.

cheers,
Piersante Sestini




-----Messaggio originale-----
Da: Evidence based health (EBH) [mailto:EVIDENCE-BASED-HEALTH@JISCMAIL.AC.UK] Per conto di Anoop Balachandran
Inviato: venerdì 17 febbraio 2012 13:51
A: EVIDENCE-BASED-HEALTH@JISCMAIL.AC.UK
Oggetto: Evidence Based Approach Question

I had a question about EBM. The definition of EBM is" The best available research evidence means evidence from valid and practically relevant research , often from the basic sciences ..."

So can we use just basic science to justify a treatment? Can anyone give an example please.

Thanks.