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reviewed and adapted. Where the new evidence led to reversal of a conclusion and key
message, this was noted in the text.
Review and revision of key messages
INTRODUCTION New New evidence leads to new key message(s).
The new evidence is consistent with the data used to formulate the original key
Unchanged
message. The key message in the original report remains unchanged.
The new evidence is consistent with the data used to formulate the original key
Strengthened
message. The key message in the original report remains unchanged or expanded.
been strengthened to reflect this additional evidence.
The new evidence is inconsistent with the data used to inform the original key
Weakened The level of evidence and/or content of the key message in the original report has
message(s). However, the new evidence does not alter the key message but weakens
the level of evidence.
Qualified The new evidence is consistent with the data used to formulate the original key
message. The key message in the original report remains unchanged but applicability
may be limited to specific patient groups/ circumstances.
Reversed The new evidence is inconsistent with the data used to inform the original key
message(s). The strength of the new evidence alters the conclusions of the original
document.
NB Clinical and scientific judgment informed the choices made by the Working Party
members; there was no mandatory threshold of new evidence (eg number of studies,
types of studies, magnitude of statistical findings) that had to be met before
classification to categories occurred.
The first letter of each of the words (New, Unchanged etc) was used to denote the
changes (if any) from the last edition of this document.
Management of retracted publications
In May 2009, two editorials (Shafer et al, 2009; White et al, 2009) were published in Anesthesia
and Analgesia giving details of 21 publications that had been retracted by a number of
journals because of allegations of scientific fraud. The editorial by Shafer (Shafer et al, 2009)
contains a list of the retracted articles. This list can also be found at
http://www.aaeditor.org/HWP/Retraction.Notice.pdf.
The position of the journal was that unretracted articles ‘remain part of the unimpeached
literature, at least for now’. In a companion editorial White et al (White et al, 2009) reviewed
both the retracted and unimpeached literature, ‘distinguishing our understandings that
remain fully supported from those that are no longer supported by the unimpeached
literature.’ Also in May 2009, Eisenach (Eisenach, 2009), the editor of Anesthesiology, presented
a graph of numbers of citations of retracted and unretracted articles affected by this issue and
called for research re‐examining the conclusions of the retracted articles.
A July 2009 editorial by Neal (Neal, 2009) described contact with ‘the lead or high ranking
authors’ of six original articles and one review article in that editor’s journal and which had not
been retracted. These articles are listed in this editorial. He concluded that ‘Based on the
attestations of the involved coauthors and the investigations of the Chief Academic Officer of
Baystate Medical Center, the Editorial Board of Regional Anesthesia and Pain Medicine is
comfortable recommending that practitioners continue to make clinical decisions based on the
information contained within the seven below cited articles.’
viii Acute Pain Management: Scientific Evidence
