James Lind Initiative Database of Uncertainties about the Effects of Treatments (DUETs) what gaps in the evidence matter to patients and doctors? Iain.

James Lind Initiative

Database of Uncertainties about the Effects of Treatments (DUETs) what gaps in the evidence matter to

patients and doctors?

Iain Chalmers

NLH Eyes and Vision Specialist Library

Birmingham, 14 March 2007


Consequences of maldistributionof resources for research

James Lind InitiativeNumbers of randomized controlled trials starting between 1980 and 2002, by main category of funder and type of intervention

0

50

100

150

200

Intervention

No

by

cate

go

ries

of

inte

rven

tio

n

MRC

NHS/DH

CHARITY


Within treatment evaluation

there aretwo important problems


First problem

Researchers ignore patients’ & clinicians’ questions


Osteoarthritis of the knee

Tallon D, Chard J, Dieppe P.Relation between agendas of the research community and the research consumer. Lancet 2000;355:2037-40.



1st choices among research priorities in survey of 67 patients

Knee replacement (35.8) Education and advice (20.9) Complementary therapy (6.0) Tablets (4.5) Injections in the knee (4.5) Physical therapy (3.0) No treatment at all (1.5) Miscellaneous other priorities (23.9)


Analysis of 460 randomised trials of treatments for osteoarthritis of the knee

380 trials of drugs29 trials of complementary therapies24 trials of physiotherapy/exercise14 trials of education13 trials of surgery


Second problem

Researchers ignore treatment outcomes

that are important to patients


Priority treatment outcome from a survey of patients with rheumatoid arthritis

was not pain


Priority treatment outcome from a survey of patients with rheumatoid arthritis

was not pain

It was fatigue!


An initiative of the National Therapeutic Ignorance Service


DUETs’ working definition of uncertainty about

the effects of treatments

No up-to-date systematic reviews existOR

Up-to-date systematic reviews show that uncertainty exists






The Specialist Libraries of the National Library for Health [NLH] are

now assuming responsibility for developing and maintaining DUETs

modules within their respective spheres of responsibility.



The DUETs Core Team would be delighted if members of the

NLH Eyes & Vision Specialist Library team and their colleagues would like to develop and manage a DUETs module within their sphere of responsibility.



To visit DUETs go to:

www.duets.nhs.uk

James Lind Initiative Database of Uncertainties about the Effects of Treatments (DUETs) what gaps in the evidence matter to patients and doctors? Iain.

Documents

james lind initiative

research slide

james lind initiative

james lind initiative

trials of surgery slide

survey of patients

trials of education

patients knee replacement