Hilda
I enjoyed your remark about "antibodies against EBM" and I read with
interest the paper that you recommended: "Is general inpatient obstetrics
and gynaecology evidence-based? A survey of practice with critical review
of methodological issues."
The paper, inadvertently, illustrates that the percentage you get when
measuring the proportion of care that is evidence-based depends on (i) the
granularity of the questions asked, and (ii) the viewpoint of the
questioner.
Granularity.
The authors seem (the article does not provide enough detail to make a
definite assessment) to have taken the highest (lumpiest) level of
granularity; for example caesarian section as an atom of intervention. I
doubt if they considered the evidence base for the type of incision,
choice of sutures, type of anaesthetic, supportive fluids, monitoring
equipment in the operating theatre, etc, etc
Point of view
The authors seem to have taken the viewpoint of an obstetrician-
gynaecologist. Other viewpoints might have looked for evidence for
different aspects of the care provided; for example: What is the evidence
for the infection control procedures used? Is there evidence that similar
results for mother and baby could not be obtained by specialist
nurses/midwives trained to provide the most commonly required services? Is
there evidence to support the length of time that the mothers and their
babies were kept in hospital? etc etc.
This shows that you could choose methods to measure the proportion of care
that is evidence-based in such a way that you could get the answer that
you wanted (and, as an added bonus, seem to be evidence-based while doing
it).
Skeptically yours,
Michael
On Thu, 28 Dec 2006 18:28:11 +0100, Bastian, Hilda
<[log in to unmask]> wrote:
>G'day!
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>Yes, that list is really out of date. There was a new one on O&G
published this year, too:
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>http://www.biomedcentral.com/1472-6874/6/5
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>And its references 2 to 6 are similar, recent attempts to measure this.
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>The problem is, it also depends then in which health service you mean it.
Some hospitals are no doubt better than others, for example. It differs
from country to country - and some payment systems or regulatory systems
make particular forms of evidence-based practice impossible. I live in a
country for example where the consultation times are so short, the
evidence about the best ways to communicate with patients must be applied
only a small proportion of the time, because the structure of the service
does not allow for it.
>
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>One thing I think is pretty certain though: the 90% claim is one of those
types of statements that probably caused a lot of antibodies against EBM.
Life's just not that simple.
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>Ruth's question is a really interesting one though: how do we know if we
are making progress?
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>Hilda
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>Hilda Bastian
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