introduction evidence-based research network meeting

Bergen, Norway
December 1st and 2nd, 2014
Radisson Blu Royal Hotel
Nanos Gigantum
Humeris Insidentes
"If I have seen further
it is by standing on
the shoulders of
“If, as is sometimes supposed,
science consisted in nothing but
the laborious accumulation of
facts, it would soon come to a
standstill, crushed, as it were,
under its own weight……
The work which deserves, but I
am afraid does not always
receive, the most credit is that in
which discovery and explanation
go hand in hand, in which not
only are new facts presented, but
their relation to old ones is
"The Helsinki Declaration states
that biomedical research
involving people should be
based on a thorough knowledge
of the scientific literature. That is,
it is unethical to expose human
subjects unnecessarily to the
risks of research.
Ideally, the introduction should
include a reference to a
systematic review of previous
similar trials or
a note of the absence of such
The PhD program
• Bergen University College is obliged to get
their PhD programs accredited.
• One criteria is a common theme of each
PhD program.
• Different health areas lead us to argue for
demanding all PhD students to be
systematic in their preparation and
completion of their PhD project.
• Our PhD program tried to described how
The PhD program
We have identified a presentation by Iain
• "The scandalous failure of scientists to
cumulate scientifically",
and the four papers by
• Clarke & Chalmers.
By reference and citation search we
identified several other studies all showing
the same result.
The PhD program
We suggested the approach to be
• Rapid response in BMJ to "All trials must be registered
and the results published" (12 November 2013)
• Article in Norwegian Medical Journal (
The PhD program
We meet several opposing arguments,
such as:
• “We can’t expect all PhD students to
prepare a systematic Review before
doing the research”, and
• “We will have too many references if
we should include a systematic
search in the Background”.
Thus, there was an apparent need for
The PhD program
The committee wrote e.g.:
“The notion that research doesn’t build upon an update of
our present knowledge seems very simplified. That kind of
research may occur, but the committee thinks that an
update of the present knowledge is necessary for the
quality, the ethics and the originality of research supported
by external grants. Thus the “need” for an EBR approach in
the PhD program may be undermined”,
and further
“Strictly speaking it seems hard to imagine any research
not evidence-based. At least it seems impossible to
imagine that articles published in journals with a high
impact factor do not relates to earlier research"
… and THEN we
Karen Robinson wrote in her thesis in 2009:
“Research synthesis, the cornerstone of evidence-based
health care, is cumulative in nature. To limit bias, all
relevant studies must be identified and considered in a
synthesis of existing evidence. While the use of research
synthesis to make evidence-informed decisions is now
expected in health care, there is also a need for clinical
trials to be conducted in away that is evidence-based (1).
Evidence-based research is one way to reduce waste
in the production and reporting of trials, through the
initiation of trials that are needed to address outstanding
questions and through the design of new trials in away that
maximizes the information gained (2).” Thesis (2009) page
Do we need an EBR
A short view of the
Lau 1992 (i.v. streptokinase)
Clarke & Chalmers
1998 (Islands in search of a continent?) – 2002, 2007,
Fergusson 2005
After 1994:
More than 2500
Fergusson 2005
Wetterslev, Hemmingsen
(2008, 2009, 2011)(Trial Sequential Analysis)
Chalmers, Glasziou
Greenberg 2009
Citation is both an impartial
scholarly method and a
powerful form of social
Through distortions in its
social use that include bias,
amplification, and invention,
citation can be used to
generate information
cascades resulting in
unfounded authority of claims.
Construction and analysis of a
claim specific citation network
may clarify the nature of a
published belief system and
synthesis as
the key to
and efficient
Bastian 2010
Bastian 2010
Seventy-five trials
and eleven
systematic reviews a
how will we ever
Goudie 2010
• More than half (56%) of the 27 trials
referred to previous individual trial(s) in the
introduction section of the report
• six (22%) referred to a meta-analysis
• two (7%) a systematic review
• one (4%) a review combining both
observational studies and trials
• leaving three (11%) not citing any of these
Goudie 2010
Consulting previous research
before embarking on a new trial
and basing decisions about
future research on the impact
on an updated meta-analysis
will make the reporting of
research more coherent and the
Robinson 2011
A Systematic Examination of the Citation of Prior Research in Reports of Randomized, Controlled Trials
Robinson 2011
Sheth 2011
Our review of studies of hip fracture treatment
suggests poor citation of the previous literature.
Studies in higher-impact journals with positive
results are more likely to be cited in subsequent
studies. Therefore, redundancy in publication and
unnecessary surgical trials often occur.
Andrade 2013
Jones 2013
Trials that have been funded by the NIHR HTA program during the
period of 2006 to 2008
Research Waste – Lancet
Habre 2014
Robinson 2014
• For 46% (118 of 259) of networks, the
RCTs formed a single connected citation
group - one island.
• For the other 54% of networks, where at
least one RCT group was not cited by
others, 39% had two citation islands and
4% (10 of 257) had 10 or more islands.
• On average, the citation networks had
38% of the possible citations to other
trials (if each trial had cited all earlier
Robinson 2014
Why having a network?
Here and now:
1. Inspire and spar to work with EBR
2. Secure no double work – together we will be strong
4. Conference
5. Website
6. PhD courses
7. Education
8. Txt books
The EQUATOR (Enhancing the QUAlity and
Transparency Of health Research) Network is an
international initiative that seeks to improve the
reliability and value of published health research
literature by promoting transparent and
accurate reporting and wider use of robust
reporting guidelines.
INASP is an international development charity
working with a global network of partners to
improve access, production and use of research
information and knowledge, so that countries
are equipped to solve their development
IASP brings together scientists, clinicians, healthcare providers, and policymakers to stimulate
and support the study of pain and to translate
that knowledge into improved pain relief
Aim and Tasks for
Suggestion for aim of the network:
Inspiring and promoting researchers
aim to use of the totality of evidence
to identify important answerable
questions, to design and apply
research methods to answer those
questions, and to place the results
within the context of the totality of
earlier research.
1. Define competencies, knowledge and skills for
researchers. The competencies should be formulated
so different levels are clearly separated
2. Formulate some criteria of how to evaluate whether the
competencies are achieved. Funding agencies, ethics
committees and editors/reviewers could use these
criteria to evaluate the systematic use of earlier
research in application/projects/papers.
3. Prepare methods and tools. A method is a process or
series of steps to organize e.g. a framework to prioritize
among research questions. A tool is an instrument to
e.g. evaluate the introduction or discussion paragraph
of a research proposal or research paper. Methods and
tools should be formulated within different areas;
1. Should researchers, and if so, how can researchers
perform Evidence-Based Research (EBR) – i.e.
formulate a framework/method.
2. The network should facilitate collaborative research
within EBR.
3. Define criteria and methods by which Funding
Agencies can evaluate the evidence-based
foundation of a research application.
4. Define criteria and methods by which ethics
committees can evaluate the evidence-based
foundation for a research project.
5. Define criteria and methods by which editors and