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Beyond the App – a novel take on personalizing digital health can increase its effectiveness

7 Oct, 16 | by BMJ Clinical Evidence

talya-miron-shatz_croppedBy Talya Miron-Shatz

As a health professional, you know that digital health tools, such as wearables and apps, abound. You hope these help patients adhere to medication, monitor their blood pressure, manage their diet and other treatment, maintenance and prevention tasks which take place outside of the clinical encounter, and have an effect on health outcomes. You also know that these tools are not always effective. In fact, a systematic review found that only 39% of randomized control trials using mobile health to promote adherence to medication reported significant improvements between groups. more…

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…

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…

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 Straw Men of Integrative Health and Alternative Medicine

22 Oct, 15 | by BMJ Clinical Evidence

By Timothy Caulfield

Debating the value of integrative health and complementary and alternative medicine (CAM) can be a frustrating endeavour. Proponents are often passionate. For many, it is like a religion and, as a result, they usually don’t care about what the science says. (Obviously.) But what I find most exasperating is the continued use of numerous logical fallacies, such as the straw man argument. In order to bolster their cause, CAM supporters suggest that skeptics like me hold a host of ridiculous and uninformed positions.

In an effort to put an end to this practice (a man can dream!), below are the four most annoying CAM straw man arguments. more…

“One of the Most Fascinating Stories in the History of Medicine”

15 Sep, 15 | by BMJ Clinical Evidence

By Nóirín O’Neill  Noirin O'Neill

The history of Acute Promyelocytic Leukaemia (APL) is one of the most fascinating stories in the history of medicine.” Dr Francesco Lo-Coco, Professor of Haematology.

APL is a rare form of leukaemia that affects one in a million people in Europe. Dr Leaft Hillestad first described APL in 1957. Dr Hillestad identified APL as a distinctive subtype of AML and one that is aggressive and rapidly fatal if not correctly diagnosed and treated immediately. Morphologically, it is identified as the M3 subtype of acute myeloid leukemia by the French-American-British classification and cytogenetically is characterised by a balanced reciprocal translocation between chromosomes 15 and 17, which results in the fusion between promyelocytic leukaemia (PML) gene and retinoic acid receptor α (RARα). Further research was carried out by French and American scientists into the disease but it was Chinese doctors (Dr Zhen-yi Wang, Dr Zhu Chen) who made the revolutionary discovery that APL was responsive to all trans-retinoic acid (ATRA), a Vitamin A derivative. The drug ATRA causes leukaemic cells to abandon their relentless growth and mature into white blood cells. ATRA makes the leukemic cells “behave”. APL was transformed from a highly fatal disease to a highly curable disease. Dr Zhen-yi Wang’s group introduced ATRA in treating APL in 1985, and APL patients like me have benefited from his achievement. more…

Addressing gaps in evidence

9 Apr, 15 | by BMJ Clinical Evidence

?????????????????????????????????????????????????????????????????????????Evidence-based medicine (EBM) is an approach that—in addition to clinical experience and patient preferences—takes into account existing research evidence to draw conclusions on the best approach for the care of individual patients. It is a key tool for clinical decision making as the need to balance research, new tests and treatments, and available resources with clinical experience and patient requirements continues to be an important focus in healthcare. 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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