Badri: Thanks for the reference. Since Mark brought it to my attention I
also traced it down. Fineberg indeed identified twenty-five studies "judged
to have clear implications for practice" in order to study how practice is
ACTUALLY changed by these trials. Our goal at this point is not to study
impact of RCTs on actual practice but to catalog those trials that
potentially could or should (or have altered the practice) (according to
criteria that I highlighted in my previous message). The problem with
Fineberg's list is that primary references are not given but trials are
selected from secondary or tertiary resources. I am not sure that I will
have time to review all these references, and at this point, I intend to
include Fineberg's list of RCTs in the final list that I am currently
compiling based on numerous responses that I received from the members of
the list. However, if someone wants to join me in this project on
compilation of RCT that changed the practice and help "clean" Fineberg's
list by locating primary references, the members of the group and myself
would greatly appreciate it (again, judging by numerous responses that I
have received, it appears that there is a great interest for having such a
list). I indend to make it available on the web allowing it to be
continually updated (credits will of course be given where credits due!). I
hope to have a list ready within 2-3 weeks. Thanks for all responses that I
received so far. I am hoping to get some more within the next couple of
weeks.
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
Editor: Evidence-based Oncology
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
> -----Original Message-----
> From: padmanabhan badrinath [SMTP:[log in to unmask]]
> Sent: Friday, February 04, 2000 2:31 PM
> To: [log in to unmask]; [log in to unmask];
> [log in to unmask]
> Subject: Fineberg review
>
>
> >Fineberg in 1987 reviewed 28 "landmark" studies, and found tha tonly >2
> had
> >an immediate (1-2 year) impact on practice. Sorry, don't have >the full
> >reference handy...should be able to find it via Medline with >that
> >information.
> >
> >Mark
>
> Here is the review by Fineberg
>
> Clinical evaluation: how does it influence medical practice?
> Fineberg HV Bull Cancer 1987 74:3 333-46
>
> Abstract
>
> This paper reviews reports of the effects of clinical evaluations on
> physician awareness and behavior. Among the reviewed papers, there are 28
> studies of the effect of specific randomized clinical trials (RCTs) on 19
>
> different medical practices. After analyzing these 28 papers, there remain
>
> two (7%) where the RCT has clear implications for practice, where the
> pattern of practice reported quantitatively over time conforms fully to
> the
> RCT findings, where the RCT preceded the change in the pattern of
> practice,
> and where findings from the RCT differ from the results of other forms of
>
> evaluation. The majority of the reviewed papers do not support an
> inference
> that RCTs have a strong, direct influence in changing established clinical
>
> practices. Clinical evaluation is one among many factors bearing on
> changes
> in medical practices. Improving the care of patients requires both
> improved
> methods of evaluation and more effective translation of the results of
> evaluation into practice. Evaluations are likely to exert a greater impact
>
> on medical practices if they are buttressed by attention to other
> controllable factors, like channels of communication and environmental
> constraints and incentives, that affect the adoption and abandonment of
> medical practices.
>
> Cheers and warm regards,
>
> Badri
>
> Dr.P.Badrinath M.D.,M.Phil.,(Epid) PhD(Cantab)
> Assistant Professor and Epidemiologist,
> Department of Community Medicine,
> UAE University, PO Box 17666, Al Ain,
> United Arab Emirates.
> Tel: 00 971 3 5039 652
> Fax: 00 971 3 672022.
> [log in to unmask]
>
> For a quick up date on current health literature with an emphasis
> on evidence based practice please visit
> http://www.geocities.com/jscan_uae
>
>
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