Dear Dan,
An excellent question! There has been quite a bit of interest in this in
the past decade. An early paper was:
Glasziou PP, Irwig LM. An evidence based approach to individualising
treatment. BMJ. 1995 Nov 18;311(7016):1356-9.
which suggested a 4-step process: you need to work out the individual
prognosis and then apply the relative risk of the study (and then think
about harms!).
A more recent and thorough exploration is the book edited by Peter
Rothwell: Treating Individuals From randomised trials to personalised
medicine, Elsevier · Published July 2007.
Best Wishes
Paul Glasziou
Olive Goddard wrote:
> 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]
>
>
--
Paul Glasziou
Director, Centre for Evidence-Based Medicine,
Department of Primary Health Care,
University of Oxford www.cebm.net
ph - +44-1865-289298 fax +44-1865-289287
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