How Clinical Evidence is put together
The systematic reviews produced by Clinical Evidence result from a rigorous process aimed at ensuring that they are both reliable and relevant to clinical practice.
Selecting topics
Clinical Evidence aims to cover common or important clinical conditions seen in primary and hospital care. To decide which conditions to cover we review national data on consultation rates, morbidity and mortality, we take account of national priorities for health care such as those outlined in the UK National Service Frameworks and in the US Institute of Medicine reports, and we take advice from generalist clinicians and patient groups.
Review planning — Selecting the questions
The questions in Clinical Evidence concern the benefits and harms of preventative and therapeutic interventions, with emphasis on outcomes that matter to patients. Questions are selected for their relevance to clinical practice by section advisors and contributors, in collaboration with primary care clinicians and editors. Each month Clinical Evidence includes new questions as well as updates of existing questions. Readers can suggest new clinical questions via the Contact us page.
For each review update we undertake an inclusive review planning process. This process provides a number of quality checks both prospectively and retrospectively. As part of the process we identify a priori study quality parameters (e.g. randomisation, concealment, intention to treat analysis) and chosen outcomes to ensure that material is appraised systematically. The review planning process also provides a retrospective check that the review content matches the search accurately. To ensure the relevance and "currency" of existing reviews, the review planning process involves a check of EBM resources, UK and other major international guidelines (e.g NICE, ACP), drug databases including Martindale, and patient websites.
Searching and appraising the literature
For each systematic review, the literature is searched for other published systematic reviews and randomised controlled trials which answer the agreed clinical questions. In areas where there are few or no good systematic reviews or randomised controlled trials, we may also search for observational studies. Medline, Embase, the Cochrane Library and, where appropriate, other electronic databases, are searched. Results are collated and abstracts assessed by an information specialist. Selected studies are sent to the Clinical Evidence contributor for additional assessment, using pre-determined criteria to identify relevant studies. Of the total number of studies identified in the search, only a small proportion will be of sufficient quality to be summarised in Clinical Evidence. Contributors, chosen for their clinical expertise in the field, review the initial selection of studies and justify any additions or exclusions they wish to make. We aim to repeat this process every 12 months to incorporate any newly published studies. The date of the search is recorded in the methods section for each topic.
Click here for more details on our search process.
Summarising the evidence, peer review, and editing
The contributors summarise the evidence relating to each question. Each review is then peer reviewed by at least two external expert clinicians. The revised text is then extensively edited by editors with clinical and epidemiological training, and data are checked against the original study reports. Consistency and quality measures also include an internal peer review process (pal-edit) for each edited review.
For each review we maintain an editorial audit trail to ensure consistent quality, and also to record communications from the contributor, peer reviewers and users for further consideration.
Adding value to the core evidence
Drug safety alerts
If important information on drug safety is issued from regulatory authorities or any other reputable source before a review is updated, we aim to add a drug safety alert to all reviews mentioning the drug within 72 hours. The alert contains a link to the source of the drug safety alert for more information. The information prompting a drug safety alert is processed together with any new evidence we may find for the next update of the review.
Guidelines
To assist clinicians put evidence into practice, Clinical Evidence reviews now have links to the full text of major guidelines relevant to the review's clinical area. All linked guidelines have been produced by national or international government sources, professional medical organisations or medical speciality societies, and have met predetermined quality requirements. New guidelines are added regularly, and old guidelines are replaced by their revised versions as these are published.
Updates
We aim to update Clinical Evidence reviews annually. In addition to this cycle, details of clinically important studies are added to the relevant reviews throughout the year using the BMJ Updates service. BMJ Updates is produced by collaboration between the BMJ Group and the internationally acclaimed McMaster University's Health Information Research Unit to provide clinicians with access to current best evidence from research. All citations (from over 110 premier clinical journals) are rated by trained researchers for quality, and then rated for clinical relevance, importance and interest by at least three members of a worldwide panel of practicing physicians. The final content is indexed by health professionals to allow news of studies to be added to all relevant Clinical Evidence reviews.
Feedback, error corrections and user responses
Clinical Evidence considers feedback an important tool for assessing the validity of the information we publish and for improving the way our systematic reviews are presented and distributed. All feedback is managed by a member of our experienced editorial team. Urgent problems are dealt with immediately and less urgent comments taken into account during our monthly content cycle. If you have any comments about Clinical Evidence please let us know by emailing us.
In addition to general feedback, we also have a 'Your Responses' facility for each individual review. This service is very similar to the BMJ's successful 'Rapid Responses' service, and comments will be quickly processed by a member of the editorial team before publication on the website. Responses may include suggestions for research questions not yet covered by Clinical Evidence, or comments on how the evidence relates to clinical practice. To submit a comment, click on link to the right of the relevant systematic review.
Declaration of competing interests
As part of our policy of maximum transparency, all authors of Clinical Evidence systematic reviews are required to declare any competing interests each time their review is published. This declaration is published with the systematic review. In addition, all Clinical Evidence staff involved in the initial selection or assessment of studies relating to those reviews, with the critical appraisal, reporting, or editing of those reviews, or with the planning of future reviews or other products for Clinical Evidence, are also required, once a year, and on an ongoing basis, to actively declare any competing interests. The declaration of competing interests for Clinical Evidence staff is reported below. These declarations are provided by the Editorial Director, the Editor, the Deputy Editor, all Clinical, Scientific, and Quality Assurance Editors, the Information Specialist Manager, and all Information Specialists employed by Clinical Evidence. For full names of Clinical Evidence staff, please see Team and advisors. Any changes to the following declarations reported by staff will be updated on this site on a monthly basis.
KP, MB, SB, SK, SL, IM, NL, RM, ONO, AL, OB, MA, SG, SM, JM, and AM declare that they have no competing interests.
Dr Charles Young, Editor of Clinical Evidence and Editor in Chief of BMJ Point of Care and Best Practice, declares that his mother-in-law, Dr Aileen Allsop, is Vice President for Science Policy at AstraZeneca.
Dr Alison Martin, Clinical Lead of BMJ Evidence Centre, declares that she was formally employed by a medical education agency that produced promotional materials on behalf of a wide range of pharmaceutical companies.