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How do we create, and improve, the evidence base?

N P T Innes1, F Schwendicke2, T Lamont1

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Improving clinical care requires high-quality evidence. Aggregating marginal gains in research and evidence synthesis processes enhances the reliability of medical information for better patient outcomes.

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Area of Science:

  • Medical Research Methodology
  • Evidence-Based Practice
  • Clinical Guideline Development

Background:

  • Best clinical care relies on effective evidence for treatment decisions.
  • Significant wastage exists in biomedical literature production, with <50% of published research being fit for purpose.
  • Independent collaborations have emerged over 30 years to optimize evidence for patient care.

Purpose of the Study:

  • To highlight the issue of wastage in biomedical evidence production.
  • To advocate for the routine use of tools that reduce research quality leakage.
  • To emphasize the 'aggregation of marginal gains' approach for improving evidence quality.

Main Methods:

  • Review of independent collaborative initiatives focused on optimizing research quality.
  • Analysis of the evidence production and distillation process.
  • Application of the 'aggregation of marginal gains' perspective to cumulative improvements.

Main Results:

  • Collaborative initiatives offer incremental improvements at various stages of evidence production.
  • The cumulative effect of small enhancements significantly improves the quality of final evidence.
  • A substantial portion of biomedical literature is currently unfit for informing clinical decisions.

Conclusions:

  • Routine implementation of quality-improving tools is essential for all stakeholders involved in research.
  • The 'aggregation of marginal gains' strategy effectively enhances the reliability of evidence-based medicine.
  • Ensuring research benefits patients requires collective responsibility from funders, researchers, participants, and users.