The RCT turned 60 this year

Hello again and my apologies for neglecting my bloggerly duties.  I have indeed been looking for work, and the search will likely continue into the new year as, at this time, employers are, no doubt, busy doing an extra-cautious version of Christmas shopping.  I’m in Canada for Christmas and nothing has shocked me more than the fall of snow that greeted me when I arrived.  It does not snow at Christmas in Victoria.  Ever.  Alan, I hope you feel better!

Although I am sure that many fine minds have remarked on it this year, I wanted to mention that it is the 60th birthday of the start of the first randomised controlled trial in Britain.  There is some confusion as to which study was the first RCT.  The trial that started first was designed to test the efficacy of immunisation against whooping cough; however, it was shortly followed by an RCT on streptomycin for treating pulmonary tuberculosis.  The streptomycin paper is frequently cited as the first RCT because it beat the whooping cough paper to press by several years.

This anniversary does not paint an accurate picture of the RCT’s usage as, initially, of course, it was slow to be taken up as standard practice.  The first RCTs were quite small, so were not well-built for detecting a difference in the treatment and control groups.  “For example, many early trials of the treatment of myocardial infarction, stroke, and cancer, which were not large by modern standards, consequently led to the misleading conclusion that there was no benefit.”

Before the RCT, patients were allocated in an alternating fashion to treatment and control groups.  Thus, studies were at high risk of bias even if the investigator was blinded.

While many organisations consider RCTs to be a gold standard (Cochrane, etc.), the RCT design cannot be useful for all research questions, and equal emphasis should be placed on looking at how to make good qualitative and cohort studies, as these are the bricks and mortar of what forms a good topic for research in the first place.  This is my opinion, having run into the problem whilst searching for narrow questions.  Limiting to RCTs is no good if the question is something like “Does the removal of the hand jewelry and artificial nails and/or nail polish reduce the rate of surgical site infection?” as it will be unlikely that any RCTs (or many other studies, for that matter) have been conducted on this question.

A group called Project Impact is soliciting for exemplars of good RCTs from 1948 to now.  A register of added studies is available on their site, with names of studies, a link to a structured abstract on PDF (sometimes), and a mailto link to give one’s feedback on the study.

Have a Merry Christmas and Happy Holidays in the likely case that I do not blog until the New Year!

Reflective writing – a friday afternoon experiment

Well this blog hasn’t been updated for a while, has it? Danielle is busy looking for work (or no doubt juggling all the job offers flying her way) while I’ve been sick, again(!). Virus after virus attached itself to me over the last few months like a series of dear old friends coming into town, all desperate to catch up and spend a bit of ‘quality time’ together. Sweet of them, but there are limits. Anyway, I should like to say that I’ve not forgotten about the blog. I plan to write some posts on the different types of search I/we use, and perhaps start thinking about naming them so that I have a vocabulary that will amaze and impress my colleagues, and I’ve also just flicked through a copy of HILJ where it talks about the importance of being a ‘critically reflective practitioner’ – part of which involves doing a bit of ‘reflective writing’. Maybe I should do a bit of that in this blog…

Hmm, what of significance happened today? Well I tried haika, a semantic search engine, and it wasn’t (rather surprisingly) totally useless. I still think that 99.9% of the time a really well structured Google search will get as good results as you’re likely to get. Am I missing something? Do we keep on using all these specialist search engines just to try and prove that we’re more ‘advanced’ than your average googler? Trying to prove our existence?

I’m meant to write, reflectively, for six minutes. Is that six minutes? I’m sure it feels like six minutes to you, dear reader (and you’ll never get the time back).

Preserving web resources – new advisory handbook from JISC

Been a bit of a busy week in office land. Just time though to give you a little pointer to what might be an interesting and up-to-date little handbook to some of you. It’s from the Joint Information Systems Committee, more commonly known as JISC, and it “offers a wealth of tips and information for web managers, data professionals and those making decisions concerning the long-term preservation of online resources“; so there you go. JISC assures me that It “provides solutions” and gives “illustrative case studies”.

JISC also do regular podcasts, including one entitled “Library spaces for the ‘Google Generation” – how hip are they at JISC?

In case you’re wondering who are these hip, active JISC people, it’s all rather British. They exist to “support education and research by promoting innovation in new technologies and by the central support of ICT services” and are funded by, amongst others, the Higher Education Funding Council for England, the Higher Education Funding Council for Wales, the Department for Employment and Learning, the Scottish Funding Council, and the Department for Children, Education, Lifelong Learning and Skills.

Don’t say you never learn anything from me.

(your own) Tabbloid

Got your RSS feeds clugging up your email or your reader? Got a long commute that’s wasted reading some trashy free newspaper telling you stuff you really don’t want to know about Brittney or Amy? Well, now you can create and print out your very own newspaper from your favourite RSS feeds; Tabbloid does the biz. How clever.

(Note that the service is provided by hp – the makers of print cartridges and printers. How clever.)

Doctors can now pretend to be Sherlock Holmes

A fun (!?) little book on Evidence-Based Medicine, “Evidence-Based Medicine in Sherlock Holmes’ Footsteps” by Jorgen Nordenstrom. Flicking through the first few pages accessible in the “open book” functionality it looks like a fairly normal but readable (and refreshingly short) book on EBM (you know, formulating a question, doing a search, appraising the evidence and applying to practice), just with a few nice pics from Sherlock Holmes novels and a rather contrived example from The Hound of the Baskervilles. Sir Arthur Conan Doyle studied medicine, don’t you know. He also thought that doctors (would) make good murderers.

‘The Evidence Gap’ – examples of interventions despite proof

It is often assumed that evidence-based medicine is all about fabulous new treatments, efficacious but expensive – are they good enough to justify the price tag? But a lot of the work is often around treatments, technologies and interventions that are far less sexy – stuff that’s done all over the country every day, even though there may be little or no evidence base for it.

The New York Times has a series of articles called ‘The Evidence Gap‘ that explores, as they put it, medical treatments used despite scant proof they work and examining steps toward medicine based on evidence. It’s not dryly written, it’s journalism (for better or for worse), and it’s certainly not all just about the science and the medicine. Instead, there’s lots on the culture of medicine and it’s practicioners, it’s researchers, marketeers, administrators, the pharmaceutical companies and of course patients. They are long enough articles to really explore some issues, and worth printing out for an interesting, easy but informative read on the commute home. Dare I opine that you wouldn’t get such quality journalism in the London Times?

NHS Evidence; something for everyone, not (apparently)

In April 2009, NHS Evidence will apparently be launched. An evidence advisory committee has been set up and the service is intended to be a unified evidence base for everyone in the NHS who makes decisions about treatments or the use of resources. It will also be available for use by patients. According to NICE It will include: 1) a fast, comprehensive search function, 2) access to a resource collating information on new drugs for commissioners, 3) a home page users can personalise. Sounds very much like the National Library for Health (NLH), I thought. I then realised that it was one of Darzi’s big ideas and is planned to replace the NLH (which up until recently the NHS has been spending lots of money on). So, I looked at the briefing document to get some more idea of just how NHS Evidence will be different (and presumably better) than the NLH; it says that:

NHS Evidence will consolidate information from a wide range of sources in one central portal, with a common point of access. The service will provide easy access to information that has traditionally been difficult to find, or available only by searching a variety of different sources, such as drug approval status. Furthermore, information included in the portal will not be limited to research evidence – the service will also aim to provide users with access to tools (such as service models and local policies) that they can use to apply the evidence in their day-to day work.

NHS Evidence will apparently not generate new content, rather it will act as a point of access to information including coverage of:

1) Clinical Evidence, including guidelines, systematic reviews, other synthesised content and primary research and ongoing trials

2) Practical Support, including service guidance, tools and models, care pathways, indicators & metrics and improvement information, local examples and tools

3) Drug and Device Information, including prescribing and safety information, NICE technology appraisals, significant new drugs and devices, diagnostics and interventional procedures

4) Non-Clinical Information, including social care information (assured by SCIE), public health information – evidence and practical support

Well, it’s certainly not a miserly set of aspirations. One thing that worries me a bit is that the document says that “NHS Evidence will be designed to meet the needs of users from across the NHS, including (but not restricted to) clinicians, nurses, pharmacists and commissioners” (i.e. pretty much everyone) followed a couple of sentences later with the statement that “NHS Evidence has a clear scope and objective. It is important that the service does not seek to be ’everything to everyone”. Hmm.

Anyway, the briefing document, of course, does not mention libraries or librarians, apart from the fact that it’s replacing the NLH. And it’s going to be run by NICE. Does that mean that librarians have just lost all control of the NHS online information service? I don’t know – let’s see, it’ll be with us in five months or so.