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Re: Corticosteroids for sore throat: a clinical practice guideline
We thank Dr. Linder for taking the time to consider and respond to our recommendation. A focus on hypothesis testing (and p-values) within individual studies can be misleading for a variety of reasons. Individual studies might be underpowered or overpowered, and p-values tell us nothing about the effect size or the importance of the outcomes. Instead of vote counting significant p-values, we and the GRADE approach suggest a focus confidence intervals around the absolute treatment effects for each patient-important outcome. We perform this assessment across the whole body of evidence, including the study by Hayward and colleagues, which provided the impetus for this Rapid Recommendation. The Hayward study's results are for the most part consistent with the results of the other nine randomised trials. As summarized in our infographic and in the systematic review supporting this recommendation (http://www.bmj.com/content/358/bmj.j3887), we also considered other factors contributing to the certainty of effects, namely the risk of bias, indirectness, inconsistency, and publication bias. Our panel considered all these factors across the entirety of the evidence base to issue the Rapid Recommendation.