getting the question right - university of...
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http://clahrc-peninsula.nihr.ac.uk
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There is a gap between research and practice
Errors in the interpretation of research evidence
Pressure from “payers” for justification for services
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We may not know about evidence
We misinterpret evidence
We reason from “first principles”
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The clinical value of thrombolysis for
myocardial infarction
... remains uncertain.”
Oxford Textbook of Medicine, 1987
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16,570 more
34,474 more
2,432
randomised
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Arch Dis Ch 2001;84:24-30
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Cot death Front vs. back sleeping
1.0
Doctors recommended putting babies to sleep on the front
Advice changed to sleep on back
Gilbert et al. International Journal of Epidemiology 2005;34:874–887
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Disturbances in cardiac rhythm are one of the main causes for death after heart attacks.
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Disturbances in cardiac rhythm are one of the main causes for death after heart attacks.
Lidocaine reduces the risk of rhythm disturbance.
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Disturbances in cardiac rhythm are one of the main causes for death after heart attacks.
Lidocaine reduces the risk of rhythm disturbance.
Lidocaine will reduce the risk of death after heart attack.
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Use of lidocaine in acute myocardial infarction is associated with a 14% increase in mortality.
(systematic review of RCTs)
Furberg 1993
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We see patterns where there are none
We see relationships where there are none
We seek out evidence that confirms our
views
It is in the Lancet so it must be good?
**Bias: preconceived ideas, prejudice,
partiality, unfairness...
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16 of the 17 delinquents remained law-abiding for three months after attending ‘Scared Straight’ – a 94% success rate (Fickenauer 1982).
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Find the right evidence
Decide whether it fits our question
Decide to what extent the study can be believed
Think about how it applies in our situation
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Speeding is associated with an increase in
accidents
Putting up speed cameras in accident blackspots reduces accidents
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US Department of Transportation Federal Highway
Administration (2010) Highway Safety Improvement
Program Manual
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US Department of Transportation Federal
Highway Administration (2010) Highway
Safety Improvement Program Manual
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http://www.testingtreatments.org/