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the great thing about forums such as this is that folks can vote with their feet, so i'd encourage everyone who is interested in issues of sampling and the organisation of UK-GP research to contact and work with trisha on this. since most of the members of CARE are not UK GPs, i'd like to thank trisha for using e-b-h (rather than CARE) as the forum for these discussions. i look forward to learning the conclusions of your deliberations. 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 ............................................................................ On Thu, 17 Sep 1998, Trisha Greenhalgh wrote: > 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 > ........................................................................... > > > > > > > > > > > > > > > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%