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  1. Article ; Online: Catalogue of bias: selective outcome reporting bias.

    Thomas, Elizabeth T / Heneghan, Carl

    BMJ evidence-based medicine

    2022  Volume 27, Issue 6, Page(s) 370–372

    MeSH term(s) Humans ; Bias ; Selection Bias
    Language English
    Publishing date 2022-02-17
    Publishing country England
    Document type Journal Article
    ISSN 2515-4478
    ISSN (online) 2515-4478
    DOI 10.1136/bmjebm-2021-111845
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  2. Article ; Online: Diclofenac in adolescents: diagnosing and treating gastrointestinal adverse drug reactions can prevent future deaths.

    Thomas, Elizabeth T / Richards, Georgia C

    BMJ evidence-based medicine

    2021  

    Language English
    Publishing date 2021-02-10
    Publishing country England
    Document type Journal Article
    ISSN 2515-4478
    ISSN (online) 2515-4478
    DOI 10.1136/bmjebm-2020-111640
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  3. Article ; Online: General practitioners' perspectives on diagnostic tests for children: a qualitative interview study.

    Thomas, Elizabeth T / Glogowska, Margaret / Hayward, Gail / Gill, Peter / Perera, Rafael / Heneghan, Carl

    The British journal of general practice : the journal of the Royal College of General Practitioners

    2024  

    Abstract: Background Most healthcare contacts for children in the UK occur in general practice. Diagnostic tests can be beneficial in narrowing differential diagnoses, however, there is substantial variation in the use of tests for children in general practice. ... ...

    Abstract Background Most healthcare contacts for children in the UK occur in general practice. Diagnostic tests can be beneficial in narrowing differential diagnoses, however, there is substantial variation in the use of tests for children in general practice. Unwarranted variation in testing can lead to variation in quality of care and exacerbate health inequities. No prior study has tried to understand why variation in testing exists for children in general practice. Aim To explore GP perspectives on using diagnostic tests for children in primary care and the underlying drivers of variation. Design and setting Semi-structured interviews were conducted with GPs and trainee GPs in England. Methods We conducted interviews with 18 GPs and 2 trainees between April and June 2023. The interviews were transcribed and analysed thematically. Results GPs reflected that their approach to testing in children differed from adults; their threshold to test was higher, but the threshold to refer to specialists was lower. GPs' perceptions of test utility varied, including objective testing for asthma. Perceived drivers of variation in testing included: 1) intrinsic (clinician) factors relating to their risk tolerance and experience, and 2) extrinsic factors, including disease prevalence, parental concern and expectations of healthcare, workforce changes leading to fragmentation in care, time constraints and differences in guidelines. Conclusions The findings of this study identify actionable issues for clinicians, researchers, and policymakers to address gaps in education, evidence, and guidance, reduce unwarranted differences in test use and improve the quality of health care delivered to children in general practice.
    Language English
    Publishing date 2024-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 1043148-2
    ISSN 1478-5242 ; 0035-8797 ; 0960-1643
    ISSN (online) 1478-5242
    ISSN 0035-8797 ; 0960-1643
    DOI 10.3399/BJGP.2023.0469
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  4. Article ; Online: The power of integrating data: advancing pain research using meta-analysis.

    Fundaun, Joel / Thomas, Elizabeth T / Schmid, Annina B / Baskozos, Georgios

    Pain reports

    2022  Volume 7, Issue 6, Page(s) e1038

    Abstract: Publications related to pain research have increased significantly in recent years. The abundance of new evidence creates challenges staying up to date with the latest information. A comprehensive understanding of the literature is important for both ... ...

    Abstract Publications related to pain research have increased significantly in recent years. The abundance of new evidence creates challenges staying up to date with the latest information. A comprehensive understanding of the literature is important for both clinicians and investigators involved in pain research. One commonly used method to combine and analyse data in health care research is meta-analysis. The primary aim of a meta-analysis is to quantitatively synthesise the results of multiple studies focused on the same research question. Meta-analysis is a powerful tool that can be used to advance pain research. However, there are inherent challenges when combining data from multiple sources. There are also numerous models and statistical considerations when undertaking a meta-analysis. This review aims to discuss the planning and preparation for completing a meta-analysis, review commonly used meta-analysis models, and evaluate the clinical implications of meta-analysis in pain research.
    Language English
    Publishing date 2022-10-04
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2471-2531
    ISSN (online) 2471-2531
    DOI 10.1097/PR9.0000000000001038
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  5. Article ; Online: 2023 Update on Pediatric Medical Overuse.

    Money, Nathan M / Wolf, Elizabeth R / Marin, Jennifer R / Liang, Danni / Thomas, Elizabeth T / Ho, Timmy

    Pediatrics

    2023  Volume 152, Issue 4

    MeSH term(s) Child ; Humans ; Medical Overuse/prevention & control ; Health Services Misuse
    Language English
    Publishing date 2023-09-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2023-062650
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  6. Article ; Online: The quality of diagnostic guidelines for children in primary care: A meta-epidemiological study.

    Thomas, Elizabeth T / Thomas, Sarah T / Perera, Rafael / Gill, Peter J / Moloney, Susan / Heneghan, Carl

    Journal of paediatrics and child health

    2023  Volume 59, Issue 9, Page(s) 1053–1060

    Abstract: Aim: To determine the quality of paediatric guidelines relevant to diagnosis of three of the most common conditions in primary care: fever, gastroenteritis and constipation.: Methods: We undertook a meta-epidemiological study of paediatric guidelines ...

    Abstract Aim: To determine the quality of paediatric guidelines relevant to diagnosis of three of the most common conditions in primary care: fever, gastroenteritis and constipation.
    Methods: We undertook a meta-epidemiological study of paediatric guidelines for fever, gastroenteritis and gastroenteritis. We systematically searched MEDLINE, Embase, Trip Database, Guidelines International Network, the National Guideline Clearinghouse and WHO from February 2011 to September 2022 for guidelines from high-income settings containing diagnostic recommendations. We assessed the quality of guideline reporting for included guidelines using the AGREE II tool.
    Results: We included 16 guidelines: fever (n = 7); constipation (n = 4) and gastroenteritis (n = 5). The overall quality across the three conditions was graded moderate (median AGREE II score 4.5/7, range 2.5-6.5) with constipation guidelines rated the highest (median 6/7), and fever rated the lowest (median 3.8/7). Major methodological weaknesses included consideration of guideline applicability. Half of the guidelines did not report involving parent representatives, and 56% did not adequately declare or address their competing interests.
    Conclusions: Substantial variations exist in the quality of paediatric guidelines related to the diagnosis of primary care presentations. Better quality guidance is needed for general practitioners to improve diagnosis for children in primary care.
    MeSH term(s) Child ; Humans ; Gastroenteritis ; Constipation ; Databases, Factual ; Epidemiologic Studies ; Fever ; Primary Health Care
    Language English
    Publishing date 2023-06-19
    Publishing country Australia
    Document type Systematic Review ; Journal Article
    ZDB-ID 1024476-1
    ISSN 1440-1754 ; 1034-4810
    ISSN (online) 1440-1754
    ISSN 1034-4810
    DOI 10.1111/jpc.16454
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  7. Article ; Online: The quality of paediatric asthma guidelines: evidence underpinning diagnostic test recommendations from a meta-epidemiological study.

    Thomas, Elizabeth T / Thomas, Sarah T / Perera, Rafael / Gill, Peter J / Moloney, Susan / Heneghan, Carl J

    Family practice

    2023  

    Abstract: Background: Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when ... ...

    Abstract Background: Asthma is one of the most frequent reasons children visit a general practitioner (GP). The diagnosis of childhood asthma is challenging, and a variety of diagnostic tests for asthma exist. GPs may refer to clinical practice guidelines when deciding which tests, if any, are appropriate, but the quality of these guidelines is unknown.
    Objectives: To determine (i) the methodological quality and reporting of paediatric guidelines for the diagnosis of childhood asthma in primary care, and (ii) the strength of evidence supporting diagnostic test recommendations.
    Design: Meta-epidemiological study of English-language guidelines from the United Kingdom and other high-income countries with comparable primary care systems including diagnostic testing recommendations for childhood asthma in primary care. The AGREE-II tool was used to assess the quality and reporting of the guidelines. The quality of the evidence was assessed using GRADE.
    Results: Eleven guidelines met the eligibility criteria. The methodology and reporting quality varied across the AGREE II domains (median score 4.5 out of 7, range 2-6). The quality of evidence supporting diagnostic recommendations was generally of very low quality. All guidelines recommended the use of spirometry and reversibility testing for children aged ≥5 years, however, the recommended spirometry thresholds for diagnosis differed across guidelines. There were disagreements in testing recommendations for 3 of the 7 included tests.
    Conclusions: The variable quality of guidelines, lack of good quality evidence, and inconsistent recommendations for diagnostic tests may contribute to poor clinician adherence to guidelines and variation in testing for diagnosing childhood asthma.
    Language English
    Publishing date 2023-05-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 605939-9
    ISSN 1460-2229 ; 0263-2136
    ISSN (online) 1460-2229
    ISSN 0263-2136
    DOI 10.1093/fampra/cmad052
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    Zs.A 2021: Show issues Location:
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  8. Article ; Online: Trends in diagnostic tests ordered for children: a retrospective analysis of 1.7 million laboratory test requests in Oxfordshire, UK from 2005 to 2019.

    Thomas, Elizabeth T / Withrow, Diana R / Shine, Brian / Gill, Peter / Perera, Rafael / Heneghan, Carl

    Archives of disease in childhood

    2023  Volume 109, Issue 1, Page(s) 30–36

    Abstract: Objective: To better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK.: Design: Descriptive study of population-based secondary data.: Setting: Oxfordshire University ... ...

    Abstract Objective: To better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK.
    Design: Descriptive study of population-based secondary data.
    Setting: Oxfordshire University Hospitals National Health Service Trust laboratories.
    Participants: Children aged 0-15 years in Oxfordshire who received at least one blood test.
    Main outcome measures: We estimated average annual percentage changes (AAPCs) in test use using joinpoint regression models. Temporal changes in age-adjusted rates in test use were calculated overall and stratified by healthcare setting, sex, and age.
    Results: Between 2005 and 2019, 1 749 425 tests were performed among 113 607 children. Overall test use declined until 2012, when test rates appeared to increase (AAPC 1.5%, 95% CI -0.8% to 3.9%). Most tests were performed in inpatient settings, where testing rates stayed steady (AAPC -0.6%, 95% CI -2.1% to 0.9%). Increases were highest in females, those aged 6-15 years and in the outpatient setting. The greatest increase in testing was for vitamin D (AAPC 26.5%), followed by parathyroid hormone (9.8%), iron studies (9.3%), folate (8.4%), vitamin B
    Conclusions: After an initial decline, laboratory test use by children in Oxfordshire demonstrated an apparent increase since 2012. Test use increased in outpatient and general practice settings, however remained steady in inpatient settings. Further research should examine the root causes and implications for test increases, and whether these increases are warranted. We encourage clinicians to consider the individual and systemic implications of performing blood tests in children.
    MeSH term(s) Female ; Humans ; Child ; Retrospective Studies ; State Medicine ; Vitamins ; United Kingdom/epidemiology ; Diagnostic Tests, Routine
    Chemical Substances Vitamins
    Language English
    Publishing date 2023-12-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/archdischild-2023-325550
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  9. Article: Use of the terms "overdiagnosis" and "misdiagnosis" in the COPD literature: a rapid review.

    Thomas, Elizabeth T / Glasziou, Paul / Dobler, Claudia C

    Breathe (Sheffield, England)

    2019  Volume 15, Issue 1, Page(s) e8–e19

    Abstract: Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term "overdiagnosis" in general has been associated with variable definitions. In connection ... ...

    Abstract Challenges in the diagnostic process of chronic obstructive pulmonary disease (COPD) can result in diagnostic misclassifications, including overdiagnosis. The term "overdiagnosis" in general has been associated with variable definitions. In connection with efforts to reduce low-value care, "overdiagnosis" has been defined as a true positive diagnosis of a condition that is not associated with any harm in the diagnosed person. It is, however, unclear how the term "overdiagnosis" is used in the COPD literature. We conducted a rapid review of the literature to explore how the terms "overdiagnosis" and "misdiagnosis" are used in the context of COPD. Electronic searches of Medline were conducted from inception to October 2018, to identify primary studies that reported on over- and/or misdiagnosis of COPD using these terms. 28 articles were included in this review. Overdiagnosis and misdiagnosis in COPD were found to be used to describe five main concepts: 1) physician COPD diagnosis despite normal spirometry (14 studies); 2) discordant results for COPD diagnosis based on different spirometry-based definitions for airflow obstruction (10 studies); 3) COPD diagnosis based on pre-bronchodilator spirometry results (three studies); 4) comorbidities (
    Key points: In the COPD literature, the terms "overdiagnosis" and "misdiagnosis" are often used interchangeably and almost always refer to a false positive diagnosis.Use of spirometry with correct interpretation of the results can avoid a substantial proportion of cases of misdiagnosis of COPD.
    Educational aims: To explore the use of the terms "overdiagnosis" and "misdiagnosis" in the COPD literature.To identify the main sources of overdiagnosis and misdiagnosis in COPD.
    Language English
    Publishing date 2019-02-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2562899-9
    ISSN 2073-4735 ; 1810-6838
    ISSN (online) 2073-4735
    ISSN 1810-6838
    DOI 10.1183/20734735.0354-2018
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  10. Article ; Online: Working in global health: A planning and implementation framework for international electives.

    Thomas, Sarah T / Thomas, Elizabeth T / McLean, Michelle

    Medical teacher

    2018  Volume 40, Issue 10, Page(s) 1055–1059

    Abstract: Purpose: ...

    Abstract Purpose:
    MeSH term(s) Developing Countries ; Global Health ; Health Status Disparities ; Humans ; International Educational Exchange ; Rural Health Services/organization & administration
    Language English
    Publishing date 2018-01-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 424426-6
    ISSN 1466-187X ; 0142-159X
    ISSN (online) 1466-187X
    ISSN 0142-159X
    DOI 10.1080/0142159X.2018.1425547
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