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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…

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…

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…

Genetics and Personalized Medicine: Where’s the Revolution?

23 Jul, 15 | by BMJ Clinical Evidence

By Tim CaulfieldTimothy Caulfield

I started my academic career in the early 90s working on the policy issues associated with something called the “genetic revolution”, which we were constantly told (by researchers, government and the media) was just around the corner. As a result of this impending seismic shift, we needed to ready ourselves for all the profound social implications – or so the story (and the arguments for grant money) went.

Since then, the claims that we are in the middle of a genetic revolution have come at a steady pace, but the nature of alleged, near-future, healthcare transformation have evolved. First it was going to be gene therapy (it didn’t really pan out as planned). Then it was highly predictive disease genes (ditto). And now the revolution has taken the form of personalized medicine, also known as personalized genetics, personalized genomics or, in accordance with the latest semantic tweak, precision medicine. more…

Trigeminal neuralgia – gaps in evidence

14 May, 15 | by BMJ Clinical Evidence

by Joanna M. Zakrzewska and Mark E. Linskey

Trigem imageTrigeminal neuralgia is a rare condition that causes excruciating intermittent short-lasting, usually unilateral facial pain especially provoked by light touch.
Although the criteria for diagnosis appear to be clear cut, there have been no case control studies to validate them, and there is no cohort data on progression of the disorder. This is especially important as—while the disorder is generally progressive over time—in more than 50% of cases this progression is interspersed with unpredictable remissions that can last 6 months or longer. 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…

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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