It appears that a considerable controversy was stirred with the
debate about hierarchy of medical evidence and "proportion of zero
findings". However, nobody tried to answer the original question:
"If we assume that there is hierarchy of evidence, how would you rank "ALL
or NONE" findings? " (say, in category of therapeutics).
Therefore, I thought it would be interesting to survey members of
the discussion group on this question. To facilitate survey I suggest the
following format.
Using Oxford grading of medical evidence (see:
http://cebm.jr2.ox.ac.uk/docs/levels.html) ranking of "ALL or NONE" findings
is:
a) appropriately placed
b) appropriately placed only if n of "ALL or NONE" series =>
6, 8, 10, 12, 14, 16, 18, 20
(choose 1)
c) should be ranked as 1a, 2b, 1c, 2a, 2b, 2c, 3a,
3b, 4, 5 level of evidence
(choose 1)
d) ranking cannot be determined outside applicability of
this evidence within a given clinical context and prior knowledge (about
this therapy)
Your Comment:___________________________________________
To avoid annoying others with individual answers, please e-mail your
answers directly to me. I will then tally them and share the results with
the rest of the group. I will also keep all answers confidential.
Again, let me just reiterate that I personally think that
the most important legacy of EBM movement is to highlight the significance
of grading of our knowledge to reflect its "closeness to the truth"; the
Hierarchy of Evidence Table succinctly captures this new paradigm in
clinical medicine (Applicability and integration of this knowledge at the
bedside is later development within EBM movement). However, in the spirit of
EBM I believe that everybody should welcome input of other interested
parties on this key aspect of EBM.
I believe that I share this opinion with the most of you,
and I look forward to your answers. Thanks again.
ben
Benjamin Djulbegovic, MD
Associate Professor of Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Division of Blood and Bone Marrow Transplant
12902 Magnolia Drive
Tampa, FL 33612
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
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