International journal of technology assessment in health care
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When it is well conducted, a randomized clinical trial provides the strongest evidence available for evaluating the comparative effectiveness of the interventions tested. Over the last two generations, we have learned much about various devices for strengthening them and about methods of avoiding pitfalls in their design, execution, analysis, and reporting. ⋯ Because the controlled trial depends on an argument based on exclusion (i.e., no other causes or differences affected the experimental groups), we strengthen its inference by taking steps to exclude any such differences. This article discusses a number of issues that deserve consideration: problems and generalizability, devices for strengthening trials, issues of power and sample size, the relationship between study design and reported gains, when to undertake a trial, the role of collaborative trials, and ways to make trials more feasible in clinical settings.
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At present there is no definitive test for appendicitis and no clear set of signs and symptoms, so that diagnosis is uncertain and probabilistic. A computer model for analyzing clinical data can improve physician accuracy in diagnosing appendicitis by assessing the outcome probabilities associated with the treatment options. Should a definitive test become available, the computer model will aid clinicians in determining when to test. Once our proposed model has been validated, it will not only improve physician decision-making, but also provide quality assurance feedback, generate reports for documentation, and compile a data base of many cases for study and reference.
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Int J Technol Assess Health Care · Jan 1989
Test of a noninvasive instrument for measuring hemoglobin concentration.
A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instrument's colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instrument's accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. ⋯ The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for further care or for supplementation with iron.
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Int J Technol Assess Health Care · Jan 1988
The transfer of medical information. A journalist's view.
Despite the quantity of material on medical issues which journalists typically receive, and the tremendous public interest in health news, journalists are only rarely able to provide medical information of any real value to the public. Good news, no matter how tentative, always gets more attention than critical assessment. Deadlines pressure journalists to look only at the surface of the issues that they describe, and few have the expertise necessary to judge the importance of their stories. When accurate, authoritative information is available in a structured format; however, the news media can publicize medical findings rapidly, effecting significant changes in public behavior.
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Int J Technol Assess Health Care · Jan 1988
Evaluation of the consensus conference program in Sweden. Its impact on physicians.
The impact of consensus conferences on physicians was studied in 1985 for the first four conferences Sweden held in 1982-1985. For each conference a main target group was defined as hospital-based physicians in supervisory positions within relevant clinics. Data were collected through a postal survey of all 1,668 members of the four different target groups. ⋯ The consensus statement evoked changes in clinical practice according to 7%-10% of the respondents and changes were proportionally higher for physicians in smaller hospitals. Most of the respondents (61%-83%) reported no change, claiming that the consensus statement reflected clinical practices established prior to the conference. The validity of self-reported data is discussed.