an enjoyable discussion; thanks for the education.
three comments:
1. andreas laupacis and i started NNTs in order to give ourselves and our
residents a "poor clinicians' cost-effectiveness ratio" of how hard we
[and our patients] would have to work, for how long, in order to keep one
more of them from suffering a bad event. lots of smarter folks have taken
over from there, generating stuff like NNH, NNS(screen, to save a life),
NNE(examine, to find a treatable case), etc. it's a measure for
clinicians, not patients, and i don't include it in my talks with my
patients.
2. among the smarter people is sharon straus, who got the prize for giving
the best paper at the 2nd intl conf on systematic reviews on her creation
and testing (among patients in oxford and toronto) of a method that
incorporates patients' values, NNTs, and NNHs into a quickly generated,
patient-friendly measure she calls "the likelihood of being helped vs.
harmed." it's in press and will be available on our website as soon as it
comes out.
3. also among the smarter people are paul glasziou and les irwig at the
individual patient level (BMJ 1995;311:1356-9) and gordon guyatt at the
policy level (Chest. 1998 Nov; 114(5 Suppl): 441S-444S) on whom to treat
based on NNT, NNH, and "thresholds."
cheers,
dls
............................................................................
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
As of 1 June 1999: The Kilgore Trout Research, Chainsaw Management,
and Conference Centre at Irish Lake,
RR #1, Markdale, Ontario, Canada N0C 1H0
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