Hi Frank,
I am sure that your question does not have a simple answer, and hope
that others from the EBM group will give you their opinioins. Here's
mine:
You can critically appraise the evidence and determine the likelihood
that it is valid. This may lead you to one of three answers. The
results are so strong and there is so little likelihood of bias that you
should accept the results as valid and use them in practice (making a
true RCT unethical as you say). The results may not be very valid
because of multiple sources (real or potential) of error or you cant
tell. In either of those cases, you are no longer able to say with
certainty (or even near certainty) that surgical therapy is better than
medical. This means that it is ethical to do an RCT, no matter what
other dentists think of the idea.
Hope this helps,
Best wishes,
Dan
****************************************************************************
Dan Mayer, MD
Professor of Emergency Medicine
Albany Medical College
47 New Scotland Ave.
Albany, NY, 12208
Ph; 518-262-6180
FAX; 518-262-5029
E-mail; [log in to unmask]
****************************************************************************
>>> Olive Goddard <[log in to unmask]> 06/18/07 4:38 AM >>>
Dear Colleagues,
If anyone can help Frank I should be grateful if they would respond to
him directly.
All good wishes,
Olive
Olive Goddard
Centre and Editorial Manager
Centre for Evidence-Based Medicine
Department of Primary Health Care
Old Road Campus, Headington
Oxford, OX3 7LF
.....................................................................
Tel: +44 (0)1865 289337 email: [log in to unmask]
Fax: +44 (0)1865 289336 web: www.cebm.net
Mobile: 07804 625002 web: www.cebmh.com ( http://www.cebmh.com )
>>> "Frank u Patricia Sanner" <[log in to unmask]> 17/06/2007 19:02 >>>
Dear Ms. Goddard,
I was member of a german Consensus conference in Dentistry for
developing a
clinical guideline for the indications for Endodontic surgery compared
to
non-surgical retreatment of teeth with periapical peridontitis.
The problem was, that there are no Level 1 RCT to show the benefit of
non-surgical treatment, but two older studies (1996and 1999) that show
similar success rates for both treatment modalities. Nowadays it is
ethically not possible to randomize patients into the surgical and
non-surgical group, so the two existing studies cannot be repeated with
modern methodology, which would probably favour the modern non-surgical
strategy. What to do with this dilemma. Can well documented cohort
studies
have more evidence than RCT?
Who could help me with this question?
Is there anyone in Germany to help with this question?
Many greetings from Germany
Dr. Frank Sanner
<http://www.praxis-sanner.de/> www.praxis-sanner.de
[log in to unmask]
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