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Sunday, June 29, 2003

the wonderful james lind library has won a scientific american award ;
an article in the bmj describes six types on interpretation bias

Sunday, June 22, 2003

'strangely enough criticism is generally reckoned to be negative when critical is often enthusiastically positive as in the cliche critical acclaim.'
dot wordsworth
the spectator10.10.98

Saturday, June 21, 2003

'in the second world war the best officers in the intelligence branch of the staff were civilians; they seemd to have the best brain for that type of work , trained in the " rules of evidence ", fertile and with great imagination , and bill williams stood out supreme among them all'
montgomery's memoirs

i now work in the williams room , named after the wife of bill williams but have no idea what monty meant by "rules of evidence"
bernard rosenthal , my wife's uncle and a classical scholar found an evidence based approach to the classics by richard sharpe ,who was, like my wife, a libdem councillor

Monday, June 09, 2003

evidence biased medicine is the name given to decisions based on evidence where pharmaceticals companies ahd been involved in production in a special issue of the bmj

Saturday, June 07, 2003

the alteplase story; a bmj article in 2002 cast doubt on the benefits of alteplase criticising an earlier study and pointing out that many of the amer heart assoc guideline writers had links to the industry
it is of course not only industry that can influence the nih. consumer pressure can also do so ,eas shown by the nat inst of cancers reversal of guidekines about breast screening under fifty.maybe it is right that public values should be a more important base than evidence .

these american examples must however be considered from the perspective of a society in which decions are made from the point of view of the individual , not the population.these issues are described in evidence based healthcare

Thursday, June 05, 2003

another way of thinking about eb decision making is that the first step is not question formulation but an immediate conclusion of what should be done , followed , but not always by
1. reflection.
2. doubt
3. question formulation
etc
etc

Wednesday, June 04, 2003

if the problem is both diagnosed and common the clinician could

1. consult the relevant national guideline or local rpotocol, perhaps prompted by a pathway
2. formulate a question
3. identify options
4. relate to the individual patient -personalise
5. determine preferred consulting style
6. present options without framing
7. help the patient relate the choice to their values

Tuesday, June 03, 2003

the first step in evidence based decision making is the formulation of the question; dave sackett and the ebm team defined twp types of question - fore ground and background. the former about an individual patient the latter about the disease

foreground questions have
1. a patient and a problem
2. an intervention
3. an alternative intervention
4. an outcome

Monday, June 02, 2003

the absence of evidence of effectiveness is not evidence of ineffectiveness; 'it is never correct to claim that treatments have no effect or that there is no difference in the effects of treatments' phil alderson and iain chalmers

Sunday, June 01, 2003

when we developed the term eb healthcare we did so to distinguish the use of evidence to make decisions about groups or populations from the use of evidence to make decisions about individuals in eb clinical practice or medicine as it was popularly called

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