Dave
Thanks for updating us all on CARE. I think it's a great project and appropriately broad in its vision.
I do however feel that the 'primary care' arm of this study would benefit from a steering group of primary care researchers who would consider the protocol and adapt it if necessary to the different setting of primary care. I'm not sure that a loosely drawn general email discussion group is the best format for that, and I'd be interested in whether other primary care academics share my slight unease about the planning of this study, especially the sampling methods for recruiting from primary care as currently projected. As I said in an earlier email, there are existing networks of research practices who might provide a more generalisable set of data than the minority of practitioners that are accessible from an EBM email list.
I am not volunteering to do all the work myself, but it may be that I could co-ordinate a small working group on the primary care aspects of the study. (I'd also be more than happy if someone else wanted to do this!) What do people think?
trish
Dr Trish Greenhalgh
Senior lecturer in primary health care
Unit for Evidence-Based Practice and Policy
Joint Department of Primary Care and Population Sciences
Royal Free and University College London Schools of Medicine
Whittington Hospital
London N19 5NF
Direct line tel: + 44 (0) 171 288 5731
Personal Assistant (Marcia Rigby): + 44 (0) 171 288 3246
Fax: + 44 (0) 171 281 8004
web http://www.ucl.ac.uk/primcare-popsci/uebpp/uebpp.htm
email [log in to unmask]
-----Original Message-----
From: Dave Sackett [SMTP:[log in to unmask]]
Sent: 16 September 1998 13:27
To: Clinical Assessment of the Reliability of the Examination-CARE
Cc: EBH Discussion Group; Centre for EBM Members
Subject: CARE Update - September 10, 1998 (fwd)
(prefaced by apologies for cross-posting, especially to those who have to
face this beast 3 times!)
dear CARErs,
1. the response to my initial invitation to join an email/internet group
interested in determining the validity and precision of the medical
history and clinical examination has been brilliant:
a. as of the end of august we already have 71 individual and group
members!
***(any non-members who'd like to join should send a message to:
[log in to unmask])***
b. folks are full of enthusiasm, support, encouragement, and advice.
2. dls will soon have a bit more time to devote to this project, as i'm
moving back to canada next summer as the deepwoods-professor of clinical
epidemiology with mcmaster and the u of ottawa. i'm putting a
state-of-the-art electronic office in our forest-home there and will focus
on making this enterprise a success (since we get snowed-in pretty often
there [our annual fall is 14 feet] i'll have plenty of time in-between
snow-shoeing/skiing to devote to it).
3. there is great enthusiasm for the proposed first study on simple signs
for chronic obstructive airways disease (=COAD, the preferred term, rather
CAL for chronic airflow limitation). accordingly, sharon straus, finlay
mcalister and i have (and will continue to) incorporate your suggestions
into a very simple first study (CARE-COAD Study #1) that will:
a. test the system (e.g., we'll set up an internet-based, pre-addressed
data form for reporting your results)
b. test your resolve! (how many of you will translate your statements of
interest into some actual data?!)
c. answer a very simple clinical question: does laryngeal location and
descent, when coupled with other information that takes only seconds to
ascertain and enter on a data form (age, sex, ever a smoker, wheeze)
predict FEV1 and or FEV1/FVC.
d. initiate a progressive sequence of studies of the exam for COAD, the
results of each determining what is added to/subtracted from the next one.
e. provide a test-bed for pursuing other CARE studies into other areas of
our common interest (your nominees include detecting depression, cancer,
left ventricular ejection fraction, pre-op assessments, and (surprise!)
strep throat.
we'll put the current version of protocol for this study out to the
CARE-email group and on the centre's website (we'll point to it from our
homepage and give you the "url" for going directly to it as soon as we've
finished our current editing/buffing). that way we can discuss and revise
it until we're all satisfied and ready to go.
4. i'm confident that we all hope that this enterprise combines good
science, better patient-care, and great fun. in the spirit of the
lattermost, i regard the successful performance of large (>100 clinicians
and >1000 patients) simple studies of the Clinical Assessment of the
Reliability of Examination (CARE) a bit like getting a bull moose to dance
swan lake; this first study won't precipitate his recruitment as director
of the ballet russe, but at least it will tell us whether we can get him
up on his hind feet!
cheers,
dls
reminders:
1. any non-members of CARE who'd like to be kept informed of this
and future studies should send a message to:
[log in to unmask]
2. we'll inform members as soon as the CARE pages go up on our website
...........................................................................
Prof David L. Sackett
Director, NHS R&D Centre for Evidence-Based Medicine
Consultant in Medicine Editor, Evidence-Based Medicine
Nuffield Department of Medicine, University of Oxford
Level 5, John Radcliffe Hospital, Oxford OX3 9DU, England
Phone: +44-(0)1865-221320 Fax: +44-(0)1865 222901
Email: [log in to unmask] WWW: http://cebm.jr2.ox.ac.uk
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