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Evidence-Based Medicine

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paz5559

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BMJ. 2003 Dec 20;327(7429):1459-61.

Republished in:

Int J Prosthodont. 2006 Mar-Apr;19(2):126-8.

Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ. [email protected]

OBJECTIVES: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists. STUDY SELECTION: Studies showing the effects of using a parachute during free fall. MAIN OUTCOME MEASURE: Death or major trauma, defined as an injury severity score > 15. RESULTS: We were unable to identify any randomised controlled trials of parachute intervention. CONCLUSIONS: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
 

f_w

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This is one of those rare cases where I can recommend the use of a parachute based on my own personal experience and very strong anecdotal evidence (the guy impacing the ground 20ft to the right of me who didn't use his parachute).
 

lobelsteve

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f_w said:
This is one of those rare cases where I can recommend the use of a parachute based on my own personal experience and very strong anecdotal evidence (the guy impacing the ground 20ft to the right of me who didn't use his parachute).

Based on thew evidence provided:

n=2
Results
Base case: Ignoring loss to follow-up
Absolute risk increase: 100.00% of patients will experience adverse events under New Therapy (Parachute failure) that they would not have under Control(Parachute deployed).
95% confidence interval: [15.13%, 184.87%]
Number needed to harm: For every 1.0 patients treated with deployable parachute, 1 adverse event will occur beyond those that would have happened under Control (Jim O'brien effect*). To be conservative, you may choose to round this number down to the nearest patient.
95% confidence interval: [0.5, 6.6]


* Jim O'brien was a newscaster in Philadelphia when I was growing up and suffered the adverse event due to parachute nondeployment.
 

Mister Mxyzptlk

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This is from the Placebo Gazette, issue #63 http://www.placebojournal.com/shopexd.asp?id=167


The Family Practice News had one of those BS articles on P4P recently. Sorry about the acronyms. The title was Wanted: Docs to Help Craft Pay for Performance. The most interesting part of the piece, which took quotes from expert panelists at different meetings around the country, was the thoughts of one Twila J. Brase, president of the Citizen’s Council on Health Care. She said that pay for performance was based on what she called the “faulty premise” of evidence-based medicine.

While the original idea behind evidence-based medicine was good, “it is being perverted to allow rationing of care. Because of its insistence on having all physicians practice in the same way, “evidence-based medicine will make every doctor a managed care doctor. It will lead to budget-based care, not customized care.”

 

drrinoo

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I came across a bit of trivia from a health economist.

The single most cost effective and evidenced based intervention with excellent outcomes.....drum roll.....

removal of an ingrown toenail!

gotta love EBM and health economics
 

drrinoo

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The single most cost effective and evidenced based intervention with excellent outcomes.....in all of medicine
 

Mister Mxyzptlk

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drrinoo said:
The single most cost effective and evidenced based intervention with excellent outcomes.....in all of medicine

Uh huh. Where's the evidence? :)
 

drusso

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I was really expecting you to say "hemorrhoidectomy," but I'll buy ingrown toe nail removal. I don't think that medicine has really advanced that much as a science though as "technique & craft" it has clearly advanced a thousand fold.

By the way, the 2006/Q1 total non-facility relative value units (RVU) for CPT 11730 (toenail removal) is 1.7 and the national average non-facility fee for CPT 11730 is $64.86. The RVU for excision of external hemorrhoid is 46221 with a total non-facility relative value units (RVU) of 3.92 amounting to $148.57.

Not bad work if you can get it!
 
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