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EVIDENCE-BASED-HEALTH  March 2003

EVIDENCE-BASED-HEALTH March 2003

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Subject:

Re: EVIDENCE-BASED-HEALTH Digest - 27 Feb 2003 to 28 Feb 2003 (#2003-36)

From:

steve thayne <[log in to unmask]>

Reply-To:

steve thayne <[log in to unmask]>

Date:

Fri, 28 Feb 2003 16:49:13 -0800

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (469 lines)

Hi,

  Many thanks for all the comments.

> The question comes to my mind - what has this to do
> with evidence?

 The point of relevance was an interesting one to me,
as a practioner. Who is Evidence Based Health for? If
it is to have any purpose, basing health care on the
best available evidence is for the patient. We can
have very hard working clinicians convinced they are
doing a good job, and equally hard working researchers
/ managers / health planners convinced they are doing
a good job, but if the different experiences do not
integrate with and inform each other, there is the
danger we can all be wasting our time.

  The desire to have our work as health practioners
and the experience of those in mental health distress
measured, is something we welcome. There has been for
years a lot of talk about evidence based health, and
disseminating best practice. But the experience of
locums or agency workers or anyone working in a
variety of mental health settings in the uk, is that a
patient presenting with similar difficulties will be
offered a variety and at times conflicting health care
interventions, within the same PCT never mind from one
region to another. The effective measurement of our
interventions and the outcomes for the people we work
with can be a way to improve both. But where this does
not happen effectively, it has to be identified. And I
feel it is absolutely relevent to identify it in a
forum such as this. Internet based mailing lists offer
a rare opportunity for a diverse community to learn
from each others experience - it is only if there is a
dialogue between all those involved that the most
effective health care based on the best available
evidence can, i believe, be reached.

Many thanks again for all the comments, it's been
useful and interesting.


Steve Thayne.



--- Automatic digest processor
<[log in to unmask]> wrote:
> There are 6 messages totalling 292 lines in this
> issue.
>
> Topics of the day:
>
>   1. Research enhanced clinical practice
>   2. How evidence is collected - resourcing the
> time. (3)
>   3. FW: How evidence is collected - resourcing the
> time.
>   4. TRISTAN and COPD
>
>
----------------------------------------------------------------------
>
> Date:    Fri, 28 Feb 2003 01:38:51 -0500
> From:    Eddy Lang <[log in to unmask]>
> Subject: Research enhanced clinical practice
>
> Last chance to register before early bird deadline.
>
>
> http://www.jgh.ca/research/ebm/ebmconf.htm
>
>
> Thanks.
>
>
> Dr. Eddy Lang MDCM CCFP(EM)CSPQ
> Attending Staff, Emergency Department
> SMBD Jewish General Hospital
> McGill University, Montreal Canada
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 11:26:17 +0000
> From:    Peter Griffiths <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> The question comes to my mind - what has this to do
> with evidence? I
> am not aware of evidence that the MDS in any of its
> forms has
> produced improvements in clinical practice (I'm
> happy to be corrected
> on this). The response that management infoormation
> should emerge
> seamless from that gathered to support clinical
> practice is well made
> and seems intuitively obvious but again is not a
> direct matter of
> evidence...
>
> So why am i dipping my oar in? Two points - one is
> that I presume that
> the reason this was posted here in the first place
> is the equation
> data-evidence. It is not - mindless collection of
> data is (in my opinion)
> antithetical to the spirit and practie of evidence
> based health care.
>
> Secondly - let us not underestimate the power of the
> anecdote and in
> this case I am reminded of a visit to the US (whre
> the MDS originated)
> where I observed nurses in a skilled nursing
> facility who were
> employed solely to complete the MDS, they took it
> away and submitted
> it to the state health authority where it was put
> inot a computer to be
> compiled, printed out (so i was told) stacked up and
> put into boxes by
> someone employed specifically for that purpose. The
> information was
> not used for clinical practice but nor was it
> actually used at all.
>
> Information is not knowledge! I hope that this list
> exists to support the
> application of sound (scientific?) knowledge to
> benefit
> patients/clients/consumers....
>
> So I think this has nothing and everything to do
> with evidence- maybe
> the evidence (or lack of it) to support the MDS
> method is the starting
> point in marshalling your defence.
>
> Peter
>
> (Peter Griffiths - Seniot Lecturer King's College
> London)
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 12:37:33 -0000
> From:    Ted Harding <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> On 28-Feb-03 Peter Griffiths wrote:
> > The question comes to my mind - what has this to
> do with evidence? I
> > am not aware of evidence that the MDS in any of
> its forms has
> > produced improvements in clinical practice (I'm
> happy to be corrected
> > on this).
> > [...]
> > So why am i dipping my oar in? Two points - one is
> that I presume that
> > the reason this was posted here in the first place
> is the equation
> > data-evidence. It is not - mindless collection of
> data is (in my
> > opinion) antithetical to the spirit and practie of
> evidence based
> > health care.
> > [...]
>
> The point of Steve Thains post was that "data" would
> be recorded
> in circumstances likely to produce low quality data;
> IF this
> were then used to influence clinical practice (or,
> perhaps more
> sinister, to support a decision not to influence
> clinical practice)
> then that would be a bad thing.
>
> There is certainly at least the following aspect of
> relevance to
> evidence-based medicine: The politicians and
> spin-doctors can quote
> conclusions derived from such "data" and claim (as
> they almost
> certainly would) that these were "Evidence-Based" --
> for this is
> a Buzz Word of some Sanctity whose invocation brings
> Grace upon
> the invoker.
>
> Otherwise put: Going along with that kind of project
> without
> protest makes true evidence-based practice liable to
> being
> hijacked by the manipulators. Relevant?
>
> Best wished to all.
> Ted.
>
>
>
--------------------------------------------------------------------
> E-Mail: (Ted Harding) <[log in to unmask]>
> Fax-to-email: +44 (0)870 167 1972
> Date: 28-Feb-03
>  Time: 12:37:33
> ------------------------------ XFMail
> ------------------------------
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 14:13:35 +0000
> From:    Adrian Midgley <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> > > The question comes to my mind - what has this to
> do with
> > > evidence? I am not aware of evidence that the
> MDS in any of
> > > its forms has produced improvements in clinical
> practice
>
> What is clinical practice?
>
> Clinical practice is what is recorded to be clinical
> practice.
>
> You have jumped ahead.
>
> The problem is that before you get to consider
> evidence the=20
> whole incoming data may be Heisenberged by
> conflicting pressures=20
> including time.
>
>
>
>
> --=20
> =46rom one of the Linux desktops of Dr Adrian
> Midgley=20
> http://www.defoam.net/            =20
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 16:02:05 -0000
>
=== message truncated ===

--- Automatic digest processor
<[log in to unmask]> wrote:
> There are 6 messages totalling 292 lines in this
> issue.
>
> Topics of the day:
>
>   1. Research enhanced clinical practice
>   2. How evidence is collected - resourcing the
> time. (3)
>   3. FW: How evidence is collected - resourcing the
> time.
>   4. TRISTAN and COPD
>
>
----------------------------------------------------------------------
>
> Date:    Fri, 28 Feb 2003 01:38:51 -0500
> From:    Eddy Lang <[log in to unmask]>
> Subject: Research enhanced clinical practice
>
> Last chance to register before early bird deadline.
>
>
> http://www.jgh.ca/research/ebm/ebmconf.htm
>
>
> Thanks.
>
>
> Dr. Eddy Lang MDCM CCFP(EM)CSPQ
> Attending Staff, Emergency Department
> SMBD Jewish General Hospital
> McGill University, Montreal Canada
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 11:26:17 +0000
> From:    Peter Griffiths <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> The question comes to my mind - what has this to do
> with evidence? I
> am not aware of evidence that the MDS in any of its
> forms has
> produced improvements in clinical practice (I'm
> happy to be corrected
> on this). The response that management infoormation
> should emerge
> seamless from that gathered to support clinical
> practice is well made
> and seems intuitively obvious but again is not a
> direct matter of
> evidence...
>
> So why am i dipping my oar in? Two points - one is
> that I presume that
> the reason this was posted here in the first place
> is the equation
> data-evidence. It is not - mindless collection of
> data is (in my opinion)
> antithetical to the spirit and practie of evidence
> based health care.
>
> Secondly - let us not underestimate the power of the
> anecdote and in
> this case I am reminded of a visit to the US (whre
> the MDS originated)
> where I observed nurses in a skilled nursing
> facility who were
> employed solely to complete the MDS, they took it
> away and submitted
> it to the state health authority where it was put
> inot a computer to be
> compiled, printed out (so i was told) stacked up and
> put into boxes by
> someone employed specifically for that purpose. The
> information was
> not used for clinical practice but nor was it
> actually used at all.
>
> Information is not knowledge! I hope that this list
> exists to support the
> application of sound (scientific?) knowledge to
> benefit
> patients/clients/consumers....
>
> So I think this has nothing and everything to do
> with evidence- maybe
> the evidence (or lack of it) to support the MDS
> method is the starting
> point in marshalling your defence.
>
> Peter
>
> (Peter Griffiths - Seniot Lecturer King's College
> London)
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 12:37:33 -0000
> From:    Ted Harding <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> On 28-Feb-03 Peter Griffiths wrote:
> > The question comes to my mind - what has this to
> do with evidence? I
> > am not aware of evidence that the MDS in any of
> its forms has
> > produced improvements in clinical practice (I'm
> happy to be corrected
> > on this).
> > [...]
> > So why am i dipping my oar in? Two points - one is
> that I presume that
> > the reason this was posted here in the first place
> is the equation
> > data-evidence. It is not - mindless collection of
> data is (in my
> > opinion) antithetical to the spirit and practie of
> evidence based
> > health care.
> > [...]
>
> The point of Steve Thains post was that "data" would
> be recorded
> in circumstances likely to produce low quality data;
> IF this
> were then used to influence clinical practice (or,
> perhaps more
> sinister, to support a decision not to influence
> clinical practice)
> then that would be a bad thing.
>
> There is certainly at least the following aspect of
> relevance to
> evidence-based medicine: The politicians and
> spin-doctors can quote
> conclusions derived from such "data" and claim (as
> they almost
> certainly would) that these were "Evidence-Based" --
> for this is
> a Buzz Word of some Sanctity whose invocation brings
> Grace upon
> the invoker.
>
> Otherwise put: Going along with that kind of project
> without
> protest makes true evidence-based practice liable to
> being
> hijacked by the manipulators. Relevant?
>
> Best wished to all.
> Ted.
>
>
>
--------------------------------------------------------------------
> E-Mail: (Ted Harding) <[log in to unmask]>
> Fax-to-email: +44 (0)870 167 1972
> Date: 28-Feb-03
>  Time: 12:37:33
> ------------------------------ XFMail
> ------------------------------
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 14:13:35 +0000
> From:    Adrian Midgley <[log in to unmask]>
> Subject: Re: How evidence is collected - resourcing
> the time.
>
> > > The question comes to my mind - what has this to
> do with
> > > evidence? I am not aware of evidence that the
> MDS in any of
> > > its forms has produced improvements in clinical
> practice
>
> What is clinical practice?
>
> Clinical practice is what is recorded to be clinical
> practice.
>
> You have jumped ahead.
>
> The problem is that before you get to consider
> evidence the=20
> whole incoming data may be Heisenberged by
> conflicting pressures=20
> including time.
>
>
>
>
> --=20
> =46rom one of the Linux desktops of Dr Adrian
> Midgley=20
> http://www.defoam.net/            =20
>
> ------------------------------
>
> Date:    Fri, 28 Feb 2003 16:02:05 -0000
>
=== message truncated ===


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