Results did not show usefulness of the Diffusion-weighted magnetic resonance imaging and T1-weighted images for assessing the consistency of pituitary macroadenomas, nor as a predictor of the degree of surgical resection 1)


In classical deductive logic, a consistent theory is one that does not entail a contradiction. The lack of contradiction can be defined in either semantic or syntactic terms.


Clinicians' trust level of evidence 1 recommendations, issued on preponderantly solid randomized clinical trials (RCTs), to guide best practice decision-making. However, sometimes physicians following one clinical practice guidelines (CPG) find themselves in a situation in which they do not follow another, issued on the same strong evidence base. The aim of Volovici et al. is to reflect on the consistency of recommendations in different guidelines (between-guideline consistency). They also consider within-guideline consistency (or durability), defined as the number of recommendations carried over from one edition to another in consecutive editions of the same CPG. For illustration purposes, they use two examples: hypertension guidelines and traumatic brain injury (TBI) guidelines. They conclude that just like research, CPGs also need to have between-guideline and within-guideline consistency (akin to the reproducibility of studies). Clinicians and researchers should take into account the lower consistency of guidelines that are not based on at least one strong RCT 2).

1)
Barbosa MA, Pereira EGR, da Mata Pereira PJ, Guasti AA, Andreiuolo F, Chimelli L, Kasuki L, Ventura N, Gadelha MR. Diffusion-weighted imaging does not seem to be a predictor of consistency in pituitary adenomas. Pituitary. 2024 Jan 25. doi: 10.1007/s11102-023-01377-6. Epub ahead of print. PMID: 38273189.
2)
Volovici V, Steyerberg EW. Lost in translation between evidence and recommendations: Expert opinion is needed to define “level I”. World Neurosurg. 2021 Mar 25:S1878-8750(21)00465-4. doi: 10.1016/j.wneu.2021.03.095. Epub ahead of print. PMID: 33775869.