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Showing papers by "Alessandro Liberati published in 1990"


Journal ArticleDOI
TL;DR: The internal coherence and development of randomized clinical trials in advanced ovarian cancer and their methodologic soundness are quite poor and meta-analysis cannot go beyond a systematic attempt to answer a very general "treatment effectiveness" question.

20 citations


Journal ArticleDOI
TL;DR: It is concluded that any assessment of procedures based on dissemination of information must include a careful analysis of the method of dissemination, and the availability of clinically applicable information must also be realistically appraised before the guidelines approach can be accepted as the most effective.

14 citations



Journal ArticleDOI
TL;DR: The experience acquired over the last four years in developing a program of cooperation in mental health in Nicaragua is reported, and the concept of 'transfer' underlying the intervention and the general framework of Nicaragua's mental health system is discussed.

5 citations


Journal Article
TL;DR: Any assessment of interventions based on diffusion of information must include careful analysis of the process of diffusion itself and the availability of clinically relevant messages must also be realistically considered before deciding whether the "guidelines approach" is the strategy most likely to succeed.
Abstract: Over the last ten years the Italian National Research Council (CNR) has launched an educational program aimed at facilitating the delivery of the most up to date care to cancer patients in community hospitals. Management guidelines were developed for breast, colo-rectal and ovarian cancer by multidisciplinary teams of national experts reported in booklets distributed nationwide under the aegis of disease oriented Task Forces. Some of them in addition endorsed other educational activities and sponsored multicenter trials. In 1988, the CNR funded a study to assess the impact of the whole effort. In particular the evaluation program was designed to see whether: a) the guidelines had a large diffusion in the target physicians' population; b) their content was accepted by those exposed to them and, c) practice patterns were consistent with the guidelines' recommendations. The above mentioned end-points were investigated through physicians' surveys and patterns of care studies carried out in a nationwide sample of 45 community hospitals and, on the whole, involving 1874 doctors (response rate was 41%) and 1483 patients with one of the three cancers. Results indicate a very limited impact of the program. Awareness of the guidelines was unsatisfactorily low (65%, 47% and 48% for breast, colo-rectal and ovarian cancer, respectively) and seemed to be more related to individual physicians' interest than to the functioning of the program. Analysis of practice patterns showed serious deficiencies even in centers where a more widespread awareness of the guidelines might have been expected to result in a better quality of care. We conclude that any assessment of interventions based on diffusion of information must include careful analysis of the process of diffusion itself and that the availability of clinically relevant messages must also be realistically considered before deciding whether the "guidelines approach" is the strategy most likely to succeed.

4 citations