ArticleBMJ evidence-based medicine2022
Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent.
Article in BMJ evidence-based medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Masks and respirators for prevention of respiratory infections: a state of the science review.Clinical microbiology reviews · 2024Pooled it
- Measures implemented in the school setting to contain the COVID-19 pandemic.The Cochrane database of systematic reviews · 2024Pooled it
- Long COVID as a network disorder: a mechanism-anchored framework for biological stratification and therapeutic targeting.Frontiers in medicine · 2026Article
- Article
- Review
- Protocol: a systematic review+ (SR+) to combine associative and mechanistic evidence on the efficacy of face masks in reducing transmission of respiratory diseases.Systematic reviews · 2025Article
- Strategies and Challenges in Coding Ambiguous Information Using MedDRADrug safety · 2025Article
- If things were simple, word would have gotten around. Can complexity science help us improve pediatric research?Pediatric research · 2025Review
- Information Practice as Dialogue: The Case for Collaboration in Evidence Searching and Finding for More Complex Reviews.Cochrane evidence synthesis and methods · 2025Article
- Quick buys for prevention and control of noncommunicable diseases.The Lancet regional health. Europe · 2025Review
- Article
- Commentary: Without Values, Complexity is Reduced to Mathematics.Journal of evaluation in clinical practice · 2025Article
- Thrombosis, Translational Medicine, and Biomarker Research: Moving the Needle.Journal of the American Heart Association · 2025Review
- Knowledge, attitudes and behaviours of evidence-informed practice in respiratory therapy: A cross-sectional survey.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2025Article
- The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses.Human vaccines & immunotherapeutics · 2024Review
- Reevaluating Mask Effectiveness: Insights From Evidence-Based Medicine and Clinical Trials.Cureus · 2024Review
- Developing better understanding of hygiene is key to developing hygiene behaviour change in home and everyday life settings.Perspectives in public health · 2024Article
- Lost in translation: key lessons from conducting dissemination and implementation science in Zambia.Implementation science communications · 2024Article
- Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis.SSM - population health · 2024Article
- Global landscape of COVID-19 research: a visualization analysis of randomized clinical trials.Clinical and experimental medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Evidence-based medicine (EBM's) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday's research can be mapped more or less unproblematically onto today's clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM's experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate. While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as 'high-quality' evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as 'EBM+' when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.