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Unbiased Evidence (unbiased + evidence)
Selected AbstractsA case study of publication bias in an influential series of reviews of drug educationDRUG AND ALCOHOL REVIEW, Issue 5 2007JIM McCAMBRIDGE Abstract There has been remarkably little demonstration of the deleterious impact of publication bias within addiction science or indeed in wider healthcare policy and practice. An account is provided here of how publication bias was identified in relation to a series of drug education reviews which have been very influential on subsequent research, policy and practice. Later data analyses unpublished by the same review team demonstrated earlier findings to be unreliable. These later findings were not published. The policy context in which evidence on drug education in schools is produced is considered and the need for unbiased evidence is emphasised. A broadened conception of publication bias is proposed which takes account of the environment in which publication decision-making occurs. It is suggested that this is particularly necessary for subjects with such direct policy relevance as the effectiveness of drug education in schools. [source] Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2008Robert J. Fortuna MD Abstract Background, Prescribing decisions are subject to a myriad of external forces, including patient requests for advertised medications. Although numerous factors influence prescribing, resources to support unbiased evidence-based prescribing are not widely available. Methods, To guide future interventions, we surveyed clinicians about influences on prescribing, awareness of pharmaceutical costs and attitudes towards computerized decision support. A 21-item survey was sent to 604 prescribing clinicians in a large multi-specialty group practice that employs a robust electronic medical record. Results, Surveys were returned from 405 clinicians (67%). Most respondents (87%) felt that direct-to-consumer (DTC) advertising prompts patients to request inappropriate medications, and more than one in five clinicians (22%) reported difficulty declining patients' requests for advertised medications. Providers with more clinical sessions per week reported greater difficulty. Although 93% of clinicians felt they have access to the information needed to guide prescribing, only about half (54%) reported they are aware of how much patients pay for prescription medications. Clinicians' awareness of medication costs varied considerably by specialty, with behavioural health clinicians being the most aware. The majority of providers (79%) stated that computerized prescribing alerts are a clinically useful source of information. Conclusions, Although the majority of clinicians reported that DTC advertising leads many patients to request medications that are inappropriate for their condition, a sizable proportion of clinicians reported difficulty declining these requests, and many are unaware of medication costs. Interventions to support prescribing decisions should provide the busiest clinicians with up-to-date, specialty-specific evidence and cost information. [source] Where are clinical trials going?JOURNAL OF INTERNAL MEDICINE, Issue 2 2004Society, clinical trials Abstract. Clinical trials now increasingly impinge on society at large. First there is growing emphasis from health organizations on the need for unbiased evidence about the effectiveness of promoted remedies. Second, as most novel treatments accrue increased costs to society, these need to be evaluated in terms of value for money. Third, there has been confusion and concern about the resolution of conflicting evidence, especially the role of advertising and commercial pressures from a powerful pharmaceutical industry motivated by profit. Fourth, there is concern about research fraud and the ethics of clinical trials. Fifth, there is increasing suspicion of political advice, which sometimes has sought to reassure an anxious public on the basis of complex and possibly inadequate scientific information. Some of these issues are addressed by truly independent and properly constituted data and safety monitoring committees, which are of particular importance when academic investigators or universities have a large financial conflict of interest. This is now more problematic with the current encouragement of investigator-led spin-off companies. These issues are best resolved by independent financial support (from government or other institutions) rather than relying on the commercial sponsor. [source] Perceptual error and the culture of open disclosure in Australian radiologyJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2006AG Pitman Summary The work of diagnostic radiology consists of the complete detection of all abnormalities in an imaging examination and their accurate diagnosis. Errors in diagnostic radiology comprise perceptual errors, which are a failure of detection, and interpretation errors, which are errors of diagnosis. Perceptual errors are subject to rules of human perception and can be expected in a proportion of observations by any human observer including a trained professional under ideal conditions. Current legal standards of medical negligence make no allowance for perceptual errors, comparing human performance to an ideal standard. Diagnostic radiology in Australia has a culture of open disclosure, where full unbiased evidence from an examination is provided to the patient together with the report. This practice benefits the public by allowing genuine differences of opinion and also by allowing a second chance of correct diagnosis in cases of perceptual error. The culture of open disclosure, which is unique to diagnostic radiology, places radiologists at distinct medicolegal disadvantage compared with other specialties. (i) Perceptual error should be acknowledged as an integral inevitable part of diagnostic radiology; (ii) culture of open disclosure should be encouraged by the profession; and (iii) a pragmatic definition of medical negligence should reflect the imperfect performance of human observers. [source] | ||||||||||