[EXTERNAL] [IMPROVEDX] What comes first

marius-laurent at HOTMAIL.FR marius-laurent at HOTMAIL.FR
Tue Mar 14 07:53:25 UTC 2017


Just to add some references to this topic about “evidence bloat”:

1.             Page MJ, Moher D. Mass Production of Systematic Reviews and Meta-analyses: An Exercise in Mega-silliness? Milbank Q 2016;94:515-9. 

 <https://www.ncbi.nlm.nih.gov/pubmed/27620684> https://www.ncbi.nlm.nih.gov/pubmed/27620684

2.             Ioannidis JP. The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. Milbank Q 2016;94:485-514.

 <https://www.ncbi.nlm.nih.gov/pubmed/27620683> https://www.ncbi.nlm.nih.gov/pubmed/27620683

 

Marius Laurent

 

De : Edward Winslow [mailto:edbjwinslow at GMAIL.COM] 
Envoyé : mardi 14 mars 2017 00:45
À : IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Objet : Re: [IMPROVEDX] [EXTERNAL] [IMPROVEDX] What comes first

 

Close on Guidelines, but it is worse than we might expect. In November 2015 The National Guideline Clearing House claimed that there were:

*	486 guidelines for "Hypertension"
*	517 guidelines for "Heart Failure"
*	and "only" 129 for "Atrial Fibrillation"

There is certainly guideline bloat. We had hoped, I think, that the Coordinating Committee for Comparative Effectiveness Research would help clarify what worked and what was adding little. This group will be abolished by the American Health Care Plan.

I posted on this topic about a year and a bit ago. If you want, I can direct you to the post.

 

 

On Mon, Mar 13, 2017 at 3:19 PM, Samuel, Rana <Rana.Samuel at va.gov <mailto:Rana.Samuel at va.gov> > wrote:

The place to start would be by tidying up the guidelines themselves. What credibility do guidelines have when multiple differing guidelines exist on a topic? I believe someone on this listserve mentioned earlier that there were 6 guidelines on Atrial fibrillation, and they all had differing recommendations!

First set the standard, then promote / facilitate use of the standard!

Rana

Rana Samuel, MD, FCAP
Chief, Pathology and Laboratory Medicine Service (PALMS, 113)
Lead pathologist - VISN 2
VA western New York Healthcare System (VAWNYHS)
3495 Bailey Avenue, Buffalo, NY 14215
Ph:    716-862-8701 <tel:716-862-8701> 
Fax:  716-862-7824 <tel:716-862-7824> 
Rana.samuel at va.gov <mailto:Rana.samuel at va.gov> 


-----Original Message-----
From: Robert Bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG <mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG> ]
Sent: Monday, March 13, 2017 11:55 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG> 
Subject: [EXTERNAL] [IMPROVEDX] What comes first

Could I add one big item to my list to tidy up medicine, and that is the number of medical guidelines not followed by so many HCPs.

It reminds me of doing surgery today without a sterile environment as was done in the 1800s. As we learn should we not change? Does the guideline field need studying? Do computers need to remind us of critical aspects of a guideline. What is a critical aspect?

Rob Bell, MD

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