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Autism Interventions: Ask for the Evidence

5 May, 16 | by BMJ Clinical Evidence

Michael Fitzpatrick_2_cropBy Michael Fitzpatrick

“There’s so many cures for autism on-line, it’s a wonder anyone still has it”

This wry observation from the father of a five-year-old newly diagnosed with autism in the BBC’s ‘The A Word’ strikes a chord with every parent who has been through this experience. As a GP with an autistic son – now 23 –  I have seen wonder cures, from secretin and facilitated communication to chelation and hyperbaric oxygen therapy, appear and disappear at a bewildering pace over the past two decades.  An internet survey in the USA found parents were using 111 different treatments, including diverse speech and behaviour therapies, medications, diets, vitamins and supplements – on average using seven such ‘interventions’ concurrently.
Given that no specific intervention – beyond behavioural educational programmes – has been shown to be beneficial for children with autism, the vast variety of treatments on offer puts parents who are struggling to cope with the challenges of autism in a difficult position. In the spirit of ‘Ask for the Evidence’, I suggest three simple questions:

more…

Culture, evidence and implementation

7 Apr, 16 | by BMJ Clinical Evidence

James Cave croppedBy James A. H. Cave

Over two decades ago I joined a practice in the rolling Berkshire Downs. As a young thrusting, straight-out-of-VTS GP I was keen to do a new activity called “an audit”. This was a completely new thing to my partners and it took some explaining to them why it might be useful. “But I always check the electrolytes on my patients on an ACEI “ the senior partner replied when I suggested we could audit this, “you’ll just be wasting your time”. more…

What does Evidence-based actually mean? or Where have all the sceptics gone?

25 Feb, 16 | by BMJ Clinical Evidence

Caroline Blaine

By Caroline Blaine

Commonly held opinions of Evidence-Based Medicine (EBM) include:

“Surely all medicine practised today is evidence-based.”

OR

“EBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not “fit” the patient in front of me.”

Neither of these assumptions is true. The first one denies—against all evidence—that a problem exists, and the second is far from what the founders of EBM described.

Looking back to the publications on EBM from the early 1990’s onwards gives a perspective of the serious issues they were tackling, and the desire to make this fun, as well as easy to understand and adopt. Re-reading the original papers, it is disappointing to reflect on how little the paradigm has shifted. more…

How systematic reviews can reduce waste in research

11 Feb, 16 | by BMJ Clinical Evidence

Paul Glasziou

Iain ChalmersBy Paul Glasziou and Iain Chalmers

This blog was originally written for thebmj and posted on bmj.com/blogs

 

If you asked a member of the public “Should researchers review relevant, existing research systematically before embarking on further research?” they would probably be puzzled. Why would you ask a question with such an obvious answer? But in the current research system, researchers are only rarely required by research funders and regulators to do this. more…

Is 85% of health research really “wasted”?

11 Feb, 16 | by BMJ Clinical Evidence

Paul GlasziouIain ChalmersBy Paul Glasziou and Iain Chalmers

This blog was originally written for thebmj and posted on bmj.com/blogs

 

Our estimate that 85% of all health research is being avoidably “wasted” commonly elicits disbelief. Our own first reaction was similar: “that can’t be right?” Not only did 85% sound too much, but given that $200 billion per year is spent globally on health and medical research, it implied an annual waste of $170 billion. That amount ranks somewhere between the GDPs of Kuwait and Hungary. It seems a problem worthy of serious analysis and attention. But how can we estimate the waste? more…

Where’s the evidence for teaching evidence-based medicine?

17 Dec, 15 | by BMJ Clinical Evidence

Dragan Ilic photoBy Dragan Ilic

The term evidence-based medicine (EBM) was first coined in the 1990s, with the aim of promoting the greater integration of evidence with clinical experience and patient values in medical decision making. EBM has since blossomed into an inter-disciplinary field, being adopted across medicine, nursing, allied health, health policy, and biomedical and health research. What initially began as EBM, has since evolved into evidence-based practice (EBP), evidence based clinical practice (EBCP) and evidence-based health care (EBHC). The last decade has seen the discipline embedded as a foundation unit across many medical, nursing and health science courses.
As someone who has been involved with the teaching of EBM to medical students for over a decade, I’ve always been curious to identify new strategies that may improve the student learning experience. more…

GATE – a Graphic Appraisal Tool for Epidemiological studies

12 Nov, 15 | by BMJ Clinical Evidence

Rod Jackson head shotBy Rod Jackson

The Graphic Appraisal Tool for Epidemiological studies (GATE) is a simple, easily remembered toolkit to help you critically appraise epidemiological studies that includes one picture, two equations and three acronyms. GATE uses a picture of a triangle, circle, square and two arrows to represent the generic structure of epidemiological studies. We call this picture ‘the GATE frame.’ All common epidemiological study designs, from randomised controlled trials to case-control studies, can be illustrated using a GATE frame. While the GATE approach to critical appraisal covers the same ground as other critical appraisal guides, its point of difference is its generic graphic framework that emphasises the similarities between all study designs. With GATE, your goal is to ‘hang’ a study on the GATE frame as follows: more…

The Skeptics’ Guide to Emergency Medicine (SGEM)

16 Jul, 15 | by BMJ Clinical Evidence

By Ken Milne

Ken Milne

“It takes 50 years to get a wrong idea out of medicine, and 100 years a right one into medicine”. (Dr. John Hughlings Jackson – British Neurologist)

Dr. Jackson’s quote points out how long it can take for knowledge translation (KT) in medicine. More recent data suggests it can take an average of 17 years for 14% of medical information to reach the patient’s bedside.

This is far too long in the age of social media. Don’t panic! The goal of the Skeptics’ Guide to Emergency Medicine (SGEM) is to shorten that KT window down from over ten years to less than one year. more…

BMJ Clinical Evidence – putting evidence in context

18 Jun, 15 | by BMJ Clinical Evidence

By Caroline Blaine

Caroline Blaine

 

BMJ Clinical Evidence is now 16 years old. Those in the UK and North America may remember the handbook – initially pocket size it grew over the years as new topics and new evidence were constantly added. Clinical Evidence is now very much an online resource offering a unique systematic overview of the current evidence base for common clinical conditions. This is combined with our tools to practise, learn and teach evidence-based medicine making it a go to place for clinicians, researchers and students. more…

A gap in the evidence – What is the role of surgery in the patient with severe (secondary) Raynaud’s phenomenon?

21 May, 15 | by BMJ Clinical Evidence

by Ariane Herrick and Lindsay Muir

Herrick

Lindsay_Muir_crop

 

People with Raynaud’s phenomenon secondary to an underlying disease or condition (the best researched one being systemic sclerosis) can progress to irreversible tissue injury with ulceration and/or critical ischaemia and gangrene. Although there has been increasing interest in recent years in identifying new drug therapies for severe Raynaud’s phenomenon with randomised controlled trials (RCTs) of, for example, phosphodiesterase inhibitors and endothelin receptor antagonists, the recent BMJ Clinical Evidence overview identified no RCTs of any of the surgical procedures that  have been advocated for advanced peripheral vascular disease. more…

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Clinical Evidence is a database of systematic overviews on the effectiveness of key interventions, together with tools and resources to learn and practise EBM. Visit site



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