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  1. Article ; Online: A 'reluctant' critical review: 'Manual for evidence-based clinical practice (2015)'.

    Seshia, Shashi S

    Journal of evaluation in clinical practice

    2015  Volume 21, Issue 6, Page(s) 995–1005

    Abstract: ... surgical disciplines; (iii) Greenhalgh et al.'s essay on EBM; (iv) alternate views on the hierarchy ...

    Abstract Background: The Users' Guides to the Medical Literature Manual has been a major influence on the teaching and practice of health care globally.
    Methods: The 3rd edition of the multi-authored Manual was reviewed using the principles outlined in Evidence-based Medicine (EBM) texts. One 'clinical scenario' was selected for critical appraisal, as were several chapters; objectivity was enhanced by citing references to support opinions. RESULTS (SUMMARY OF THE APPRAISAL): (1) Strengths: Clinical pearls, too numerous to list.
    Examples: (i) evidence is never enough to drive clinical decision making; (ii) do not rush to adopt new interventions; and (iii) question efficacy data based only on surrogate markers. (2) Weaknesses: The Manual shares shortcomings of textbooks discussed by Straus et al.: (i) references may not be current, important ones may be excluded and citations may be selective; (ii) often, opinion-based; and (iii) delays between revisions. (3) Notable omissions: Little or no discussion of: (i) important segments of the population: those <18 years of age, >65 years of age and those with multimorbidity; (ii) surgical disciplines; (iii) Greenhalgh et al.'s essay on EBM; (iv) alternate views on the hierarchy of evidence; and (vi) critical thinking. (4) Additional issues: (i) Omission of important references on dabigatran (clinical scenario: chapter 13.1); (ii) authors' advice (Chapter 13.3) to 'bypass the discussion section of published research'; and (iii) the advocacy of pre-appraised sources of evidence and network meta-analysis without warnings about limitations, are critiqued.
    Conclusion: The Manual has several clinical pearls but readers should also be aware of shortcomings.
    MeSH term(s) Clinical Decision-Making ; Diagnostic Techniques and Procedures/standards ; Evidence-Based Medicine/standards ; Humans ; Manuals as Topic/standards ; Randomized Controlled Trials as Topic/standards
    Language English
    Publishing date 2015-12
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1327355-3
    ISSN 1365-2753 ; 1356-1294
    ISSN (online) 1365-2753
    ISSN 1356-1294
    DOI 10.1111/jep.12509
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 4464: Show issues Location:
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  2. Article: Response to the Letter to the Editor.

    Seshia, Shashi S / Young, G Bryan

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2015  Volume 41, Issue 1, Page(s) 129

    MeSH term(s) Evidence-Based Medicine ; Humans
    Language English
    Publishing date 2015-12-10
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100017479
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  3. Article ; Online: The iatrogenic opioid crisis: An example of 'institutional corruption of pharmaceuticals'?

    Makhinson, Michael / Seshia, Shashi S / Young, Gordon Bryan / Smith, Preston A / Stobart, Kent / Guha, Indra Neil

    Journal of evaluation in clinical practice

    2021  Volume 27, Issue 5, Page(s) 1033–1043

    Abstract: Rationale: Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual ... ...

    Abstract Rationale: Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis.
    Methods: The study population encompassed the entire age spectrum and included those in whom opioids prescribed for chronic pain (unrelated to malignancy) were associated with death or morbidity. Root cause analysis, incorporating recent suggestions for improvement, was used to identify possible contributory factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential.
    Results: The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were pharmaceutical, political, and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and most other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables.
    Limitations: The analysis suggests associations not causality.
    Conclusion: The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
    MeSH term(s) Analgesics, Opioid/adverse effects ; Humans ; Iatrogenic Disease/epidemiology ; Opioid Epidemic ; Pharmaceutical Preparations ; Retrospective Studies
    Chemical Substances Analgesics, Opioid ; Pharmaceutical Preparations
    Language English
    Publishing date 2021-03-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 1327355-3
    ISSN 1365-2753 ; 1356-1294
    ISSN (online) 1365-2753
    ISSN 1356-1294
    DOI 10.1111/jep.13566
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    Zs.A 4464: Show issues Location:
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  4. Article ; Online: Chronic daily headache in children and adolescents.

    Seshia, Shashi S

    Current pain and headache reports

    2011  Volume 16, Issue 1, Page(s) 60–72

    Abstract: Chronic daily headache (CDH) may be primary or secondary. Secondary causes can be suspected through "red flags" in the history and examination. With a prevalence of at least 1% and several associations, primary CDH is a common, often complex, chronic ... ...

    Abstract Chronic daily headache (CDH) may be primary or secondary. Secondary causes can be suspected through "red flags" in the history and examination. With a prevalence of at least 1% and several associations, primary CDH is a common, often complex, chronic pain syndrome in children and adolescents. The intricate associations between stressors, psychiatric disorders (especially anxiety and depression), and CDH can be explained by "the limbically augmented pain syndrome" proposed by Rome and Rome. Disorders of sleep and other pain syndromes also may co-occur. For these reasons, a multiaxial classification is ideal. Many with primary CDH have features of both chronic migraine and chronic tension-type headache, contributing to confusion in subtyping. Primary CDH is often transformed from a primary episodic headache type, stressors being most responsible. Genetic factors also may facilitate chronification. Management should be biopsychosocial, family-centered, and often multidisciplinary, drugs being only one component. Treatment is still based on consensus, not evidence. Girls, migraineurs, and those with psychiatric comorbidity, medication overuse, and CDH onset before the age of 13 years and lasting for 2 years or longer, are at high risk for persistence; hence, such patients should be followed up into adult life. A classification for CDH should be included in the third edition of the International Classification of Headache Disorders.
    MeSH term(s) Adolescent ; Analgesics/therapeutic use ; Anxiety/epidemiology ; Child ; Child, Preschool ; Chronic Disease ; Depression/epidemiology ; Depression/etiology ; Diagnosis, Differential ; Female ; Headache Disorders/diagnosis ; Headache Disorders/drug therapy ; Headache Disorders/epidemiology ; Humans ; Incidence ; Male ; Risk Factors ; Severity of Illness Index
    Chemical Substances Analgesics
    Language English
    Publishing date 2011-11-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2055062-5
    ISSN 1534-3081 ; 1531-3433
    ISSN (online) 1534-3081
    ISSN 1531-3433
    DOI 10.1007/s11916-011-0228-9
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    Zs.A 5477: Show issues Location:
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  5. Article: Reproduction of tables: are some publishers ignoring fair use/dealing?

    Seshia, Shashi S

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2009  Volume 37, Issue 6, Page(s) 914–916

    MeSH term(s) Copyright/legislation & jurisprudence ; Humans ; Publishing/legislation & jurisprudence
    Language English
    Publishing date 2009-10-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100051751
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  6. Article ; Online: 'Cognitive biases plus': covert subverters of healthcare evidence.

    Seshia, Shashi S / Makhinson, Michael / Young, G Bryan

    Evidence-based medicine

    2016  Volume 21, Issue 2, Page(s) 41–45

    MeSH term(s) Bias ; Cognition ; Conflict of Interest ; Ethics, Institutional ; Ethics, Professional ; Evidence-Based Medicine/ethics ; Humans
    Language English
    Publishing date 2016-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1324346-9
    ISSN 1473-6810 ; 1356-5524
    ISSN (online) 1473-6810
    ISSN 1356-5524
    DOI 10.1136/ebmed-2015-110302
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    Zs.A 4793: Show issues Location:
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  7. Article: Gratification, masturbation or paroxysmal hyperkinetic motor syndrome of infancy?

    Phillips, Dawn F / Seshia, Shashi S

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2011  Volume 40, Issue 3, Page(s) 278–279

    MeSH term(s) Child Behavior Disorders/etiology ; Developmental Disabilities/etiology ; Female ; Humans ; Male ; Masturbation/complications ; Nervous System Diseases/etiology
    Language English
    Publishing date 2011-03-28
    Publishing country England
    Document type Editorial ; Comment
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100014189
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  8. Article: Chronic daily headache in children and adolescents.

    Seshia, Shashi S

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2004  Volume 31, Issue 3, Page(s) 319–323

    MeSH term(s) Adolescent ; Adult ; Age Distribution ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Headache Disorders/diagnostic imaging ; Headache Disorders/epidemiology ; Headache Disorders/therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Sex Distribution ; Tomography, X-Ray Computed
    Language English
    Publishing date 2004-09-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100003383
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  9. Article: Mixed migraine and tension-type: a common cause of recurrent headache in children.

    Seshia, Shashi S

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2004  Volume 31, Issue 3, Page(s) 315–318

    MeSH term(s) Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Migraine Disorders/diagnostic imaging ; Migraine Disorders/epidemiology ; Migraine Disorders/therapy ; Prospective Studies ; Recurrence ; Sex Distribution ; Tension-Type Headache/diagnostic imaging ; Tension-Type Headache/epidemiology ; Tension-Type Headache/therapy ; Tomography, X-Ray Computed
    Language English
    Publishing date 2004-09-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100003371
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  10. Article: The evidence-based medicine paradigm: where are we 20 years later? Part 2.

    Seshia, Shashi S / Young, G Bryan

    The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

    2011  Volume 40, Issue 4, Page(s) 475–481

    Abstract: In Part 2, we discuss the challenges of keeping up with the 'literature,' evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 ... ...

    Abstract In Part 2, we discuss the challenges of keeping up with the 'literature,' evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the 'measurements' for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.
    MeSH term(s) Evidence-Based Medicine ; Humans
    Language English
    Publishing date 2011-03-28
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 197622-9
    ISSN 0317-1671
    ISSN 0317-1671
    DOI 10.1017/s0317167100014554
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