Hi I have been watching the list for a while and wondered about these
additions:
cholecystectomy for symptomatic gallstones
hip replacement for fractured neck of femur (high death rates with bed rest
alone I understand)
Quoting "Djulbegovic, Benjamin" <[log in to unmask]>:
> Paul, thanks for this update. I tend to think that with this repeated survey,
> the list may be fairly accurate...
> the more I think about this, the more I am astonished how few breaktrough
> interventions actually have been invented...and for all the current hype
> about rational drug design and promise of genomics (and proteomics etc) it
> still appears that more changes in the practice have actually occured due to
> empirical testing in randomized clinical trials...
> would like to issue a repeated call to the members of the group to send me
> nominations for the randomized trials that, in their opinion, changed the
> practice...I will then update the list and CC to all again...thanks
> ben
>
> -----Original Message-----
> From: Paul Glasziou [mailto:[log in to unmask]]
> Sent: Thursday, November 13, 2003 9:30 AM
> To: [log in to unmask]
> Subject: Interventions not needing randomised trials?
>
>
> Dear All,
> Many thanks for your suggestions about what treatments don't need
> randomised trials. The most suggested was insulin for juvenile diabetes,
> but a number were suggested twice and many were already on Ben
> Djulbegovic's list (see below). There were only two (but very helpful)
> suggestions on criteria. So here is the full list - I don't guarantee all
> these are dramatic enough to qualify. In the next stage we plan to look at
> which treatments fit which of several possible criteria. In the meantime,
> if you have other suggestions, please let me know.
> Thanks to all for the excellent contributions,
>
> Paul Glasziou
> Department of Primary Health Care &
> Director, Centre for Evidence-Based Practice, Oxford
> ph: 44-1865-227055 www.cebm.net
> ---------------------
> 1. Dramatic therapies
>
> Endocrine
> * insulin in diabetic coma (2 people) insulin in diabetic
> keto-acidosis - survival
> * thyroid extract for myoedema - cure
> thyrostatics for thyrotoxicosis - cure
> * steroids in the treatment of adrenal cortical hypofunction?
>
> Hematological
> Hemotherapy to treat Hemophilia.
> * Blood transfusion in acute severe blood loss
>
> Nutritional
> * vitamin B12 in pernicious anemia; liver extract for PA and
> subacute combined - cure of PA
> citrus fruits to treat scurvy
>
> Infectious
> streptomycin for TB meningitis - return of consciousness and
> survival
> * penicillin in pneumonia (in bacterial endocarditis)
> gancyclovir for CMV retinitis in AIDs - complete arrest of the
> disease.
>
> Cardiovascular
> Defibrillation for ventricular fibrillation. People lived!
> automatic external defibrillators in cardiac arrest
>
> Musculoskeletal
> total hip and knee replacements
> Closed reduction of fracture of long bones with deformity?
>
> Neurological
> cholinesterase inhibitors for myastheia gravis - immediate return
> of muscle power
>
> Surgical
> appendicectomy in perforated appendicitis
> sewing up wounds,
> ether anesthetic
> maintaining sterile conditions for surgery
>
> Cancer
> * Imatinib in treatment of CML (chronic myeloid leukemia)
> * Combination chemotherapy with cisdiamminedichlorplatinum,
> vinblastine and bleomycine in disseminated testicular cancer.
> Other
> some organ transplantation (e..g liver transplantation in
> fulminant acute hepatitis)
> some antidotes in poisoning
> recompression for decompression illness.
>
> * From Ben Djulbegovic's list at:
> http://www.hsc.usf.edu/~bdjulbeg/oncology/practice-change.htm
>
> 2. suggest WHY they are so convincing that a trial is unnecessary
>
> Nino Cartabellotta suggested:
> We compiled a list of criteria for accepting in clinical practice health
> interventions without RCTs evidence (the criteria should be all satisfied):
> 1. bad outcome of disease if untreated (high/very high control event
> rate)
> 2. drammatic benefit of treatment (high relative risk reduction)
> 3. accettable side effects of treatment (high/very high number need
> to harm)
> 4. no alternative treatment
> 5. convincing physiopatological basis
>
> And Douglas Badenoch pointed out:
> The CEBM's Levels of evidence (www.cebm.net/levels_of_evidence.asp)
> includes a Level 1c for "All or none" case series in Therapy, Prognosis,
> Differential Diagnosis and Economic Analysis.
>
> This has been defined as
> "Met when all patients died before the [intervention] became available, but
> some now survive on it; or when some patients died before the
> [intervention] became available, but none now die on it."
>
> The questions would be, to my mind
> 1 How many is enough for such a case-series?
> 2 How well are the PICO elements of the research defined, measured
> and implemented in the study?
> 3 Do the PICO elements of the study relate to the PICO elements of
> your clinical question?
> ######################################################################
> This transmission may be confidential or protected from disclosure and
> is only for review and use by the intended recipient. Access by
> anyone else is unauthorized. Any unauthorized reader is hereby
> notified that any review, use, dissemination, disclosure or copying of
> this information, or any act or omission taken in reliance on it, is
> prohibited and may be unlawful. If you received this transmission in
> error, please notify the sender immediately. Thank you.
>
> ######################################################################
>
----------------------------------------------------------------
This message was sent using IMP, the Internet Messaging Program.
|