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shared decision making

Digital health interventions: Hype or hope?

30 Sep, 16 | by BMJ Clinical Evidence

emBy Elizabeth Murray

Digitising the NHS is back in the news with the publication of the Wachter report on using IT in the NHS to achieve healthcare’s triple aim of better health, better healthcare and lower cost. As Wachter says, not “giving highest priority to digitisation would be a costly and painful mistake”.[1] 

Although the report focuses on digitising secondary care, many of the recommendations are equally applicable to digital health interventions (DHI). DHI are interventions delivered on a digital platform, such as the web or mobile phones, which aim to deliver health care or health promotion, including behaviour change,[2][3]  self-management support,[4] or treatments such as Internet Cognitive Behavioural Therapy (ICBT). Because of their potential to combine personalisation with scalability, they hold out real hope for delivering better health, better healthcare and lower costs, but the potential has yet to be realised, despite the millions of commercial “health apps” available. more…

Transforming the Communication of Evidence for Better Health

14 Jun, 16 | by BMJ Clinical Evidence

MontoriBy Victor Montori

The main job is to care for the patient. Evidence-based medicine makes use of an adjectival phrase, evidence-based, to note that this is a form of special medical practice, but still it is medicine, it is care. The adjective that modifies this noun, and the verb – to care — it implies, signals the importance of considering the scientific basis of our practice, and the need to use evidence judiciously in the care of patients. This was an important development, maturing in early 90s when the idea and the term, coined by Gordon Guyatt, came into use. The term, and the practice, influenced my late medical training, and have been fundamental in my first two decades at the honorable place of the patient’s bedside.

In some instances, the adjective “evidence-based” took precedence over the noun, and the practice of medicine, the care of the patient, became relegated. The limelight shone on the significant result in a mega trial, an effect on a surrogate or a composite, in a trial stopped earlier than planned, and financed by the company that will profit by using these results in marketing its product. These marketing efforts disguised as evidence-based messages, actively disseminated by those who hold the power of telling us what to know. In 2007, we published with Gordon Guyatt how the corruption of the evidence threatened the practice of EBM and suggested several solutions: more…

The way forward from ‘rubbish’ to ‘real’ EBM in the wake of Evidence Live 2015

24 Apr, 15 | by BMJ Clinical Evidence

by Huw LlewelynHuw Llewelyn

At Evidence Live, Iona Heath (video) reminded us that EBM should not interfere with wisdom and common sense. Trish Greenhalgh (video) gave a hilarious example of ‘rubbish EBM’ when a ‘falls protocols for elders’ was invoked after she went over her bicycle handlebars at speed! The answer is to arrive at initial impressions and decisions based on one’s current knowledge and then AFTERWARDS to check them against transparent reasoning and evidence. more…

An EBM Challenge: When randomized trials are difficult, and belief is strong and hopeful

16 Apr, 15 | by BMJ Clinical Evidence

The case of so-called “moderate” drinking

by Richard Saitz

It is “bad” enough when we have randomized trials to guide practice. What I mean is, of course solid consistent evidence from numerous trials should be used to inform practice, but even then it is challenging: do the benefits outweigh the risks? Do the benefits in tightly controlled trials persist in practice? more…

Six proposals for EBM’s future

27 Mar, 15 | by BMJ Clinical Evidence

by Paul Glasziou

Paul Glasziou

 

Gordon Guyatt coined the term ‘Evidence-based Medicine’ (EBM) over 20 years ago, and it has had a remarkable global influence. But EBM is not a static set of concepts, set in stone tablets in the 1990’s; it is a young and evolving discipline. The fundamental concept of EBM – using the best available research evidence to aid clinical care – may have changed little, but what is best and how to apply the concepts in practice continue to develop. more…

Simply making evidence simple

20 Mar, 15 | by BMJ Clinical Evidence

by James McCormack and Mike Allan

James McCormackMike Allan

In an ideal world in which shared decision making is practiced with impunity, health care providers need—at their fingertips—an appreciation and understanding of (as well as access to) the best available evidence for the main medical conditions they see on a day-to-day basis. more…

Clinical Evidence for the Brave New World on Multimorbidity

12 Mar, 15 | by BMJ Clinical Evidence

by Victor Montori

The most common chronic condition worldwide is, or will soon be, multimorbidity. Previously a concern reserved to the very old, multimorbidity increasingly affects younger people. A prevalence study in Scotland found that the average middle age person is no longer a healthy one, but a patient with at least one chronic condition; 1 in 4 had two chronic conditions. As the population ages, the proportion with multimorbidity approaches universality. As the evidence, often obtained in people with a paucity of comorbidities, gets incorporated into practice guidelines, guideline panels face a key task. more…

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