![]() ![]() The balance of these two elements may be termed the 'signal to noise ratio'.WhatsApp's new update to its privacy policy and terms of service hasn't gone down well with users, several of whom are now looking for better alternatives to switch to. Fundamentally flawed research will still be rejected, but more commonly papers can still be used, tempering the importance that we attach to their signal by the amount of 'noise' around that signal. It includes an assessment of methodological quality, balancing this against the weight of its message, rather than rejecting studies which are below a certain threshold for quality. It explicitly introduces judgement into the appraisal and synthesis of evidence, and affords more flexibility in attaching weight to evidence that might otherwise be lost. We propose a classification of research which does not reject studies on the basis of design alone, but recognizes the importance of assessing the message or 'signal' within each piece of research. This would run the risk of missing or distorting the true message that the review is trying to identify. Systematic reviews must therefore address the danger of underestimating the evidence from relevant literature if it includes only that of a certain methodological quality. Yet we still need to make best use of the available evidence. Also, much research is not well designed. On conventional hierarchies of evidence, 'weaker' study designs are often more feasible. Clinical practice frequently generates questions that are not easily answered by randomized trials. ![]()
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