Dear Colleagues,
If anyone can help Dan Hughes I should be grateful if you would respond to him directly.
All good wishes,
Olive
>>> "Dan Hughes" <[log in to unmask]> 04/01/2008 13:53 >>>
Olive, I wonder if anyone in the group might be aware of a paper or a
good discussion on the issue of applying evidence to a "single" patient
in the clinic or at the "coal face".
The issue is how to apply the "evidence" that we find in our searches
to a single patient. I am assuming that we have already added in
physician expertise and patient values. Kathryn Montgomery calls this
generalization and particularization or lumping and splitting in her
book.."How doctors think..." Someone else refers to the issue as
"misplaced concreteness". Stephen Jay Gould touched on the subject in
his essay.."The median isn't the message". He says too much emphasis is
placed on the treatment effect value rather than the variation. As we
know he lived more than 20 years after being diagnosed with an abdominal
mesiothelioma which, at the time, had a median survival of 8 months. He
obviously was in the tail end of a right skewed curve.
Standard deviations tell us the variability within a specific sample
and standard errors the variability of means with many samples.
Confidence intervals give us an idea of where our study results fit in
the "real" population, but where does our single patient fit?
Is there an "interval" where we can say our one patient might fit? How
do we translate the results from a particular study into something that
a patient can understand? Is this something the Knowledge Translation
folks are dealing with?
I await with great anticipation. Thanks , Dan.
Dr. Dan Hughes
IWK Health Centre
Children's Site-1st floor
Box 9700
5850/5980 University Ave.
Halifax,N.S. B3K 6R8
Ph.(902)470-8218
Fax.(902)470-7223
E-mail: [log in to unmask]
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