Effectiveness and Efficiency
01 Nov 1994-British Journal of Psychiatry (Royal College of Psychiatrists)-Vol. 165, Iss: 05, pp 702-704
About: This article is published in British Journal of Psychiatry.The article was published on 1994-11-01. It has received 373 citations till now.
Citations
More filters
••
TL;DR: The specialty of obstetrics and gynaecology will benefit from several related groups already working within the Cochrane Collaboration, and it is hoped that the ‘wooden spoon’ can be discarded from the authors' ranks for good.
Abstract: Summary In the current era of patients seeking better information, managers seeking cost-effective treatments, clinicians struggling to keep up with the expanding medical literature, and professional groups requiring continuing medical education, there is a clear need for up-to-date and relevant systematic reviews of the effectiveness of treatment within our specialty. Such reviews will play an increasing role in the education of health professionals and lay people, in the evolution of the health service and in the direction of future research. The Cochrane Collaboration provides the infrastructure for the development and dissemination of these reviews. The specialty of obstetrics and gynaecology will benefit from several related groups already working within the Cochrane Collaboration (Pregnancy and Childbirth, Subfertility, Menstrual Disorders and Incontinence). Other groups are in the process of, or likely to, register in the near future (Fertility Control, Gynaecological Cancer). However, the need and demand for a large number of systematic reviews exceeds the current capacity of those who have committed themselves to prepare and maintain such reviews, and substantial challenges remain. However, there is every reason to believe that a concerted effort over many years will be worth while. Earlier in this commentary, obstetrics and gynaecology was referred to as the specialty most deserving of the ‘wooden spoon’ for its lack of evidence-based practice. With the development of various gynaecological groups within the Collaboration, we hope that the ‘wooden spoon’ can be discarded from our ranks for good.
2,561 citations
•
TL;DR: A consensus was reached by at least 90% of participants that the following 4 domains should be evaluated in future phase III trials of knee, hip, and hand OA: pain, physical function, patient global assessment, and, for studies of one year or longer, joint imaging.
Abstract: Significant progress has been made in outcome measurement procedures for osteoarthritis (OA) clinical trials, and guidelines have been established by the US Food and Drug Administration, European League Against Rheumatism, the World Health Organization/International League of Associations for Rheumatology, and the Group for the Respect of Ethics and Excellence in Science. However, there remains a need for further international harmonization of measurement procedures used to establish beneficial effects in Phase III clinical trials. A key objective of the OMERACT III conference was to establish a core set of outcome measures for future phase III clinical trials. During the conference, using a combination of discussion and polling procedures, a consensus was reached by at least 90% of participants that the following 4 domains should be evaluated in future phase III trials of knee, hip, and hand OA: pain, physical function, patient global assessment, and, for studies of one year or longer, joint imaging (using standardized methods for taking and rating radiographs, or any demonstrably superior imaging technique). These evidence based preferences, achieved with a high degree of consensus, establish an international standard for future phase III trials and will also facilitate metaanalysis and Cochrane Collaborative Project goals.
713 citations
••
Wageningen University and Research Centre1, Rutgers University2, Spanish National Research Council3, Naturalis4, University of Leeds5, Institut national de la recherche agronomique6, Michigan State University7, University of Freiburg8, University of California, Berkeley9, University of New England (United States)10, University of Vermont11, University of California, Davis12, National University of Singapore13, Hungarian Academy of Sciences14, University of Göttingen15, Cornell University16, Swedish University of Agricultural Sciences17, Stellenbosch University18, Centre national de la recherche scientifique19, Simon Fraser University20, University of Reading21, University of Würzburg22, Plant & Food Research23, University of Giessen24, University of Texas at Austin25, University of Bern26, Hebrew University of Jerusalem27, Lund University28, Federal University of Bahia29
TL;DR: It is shown that, while the contribution of wild bees to crop production is significant, service delivery is restricted to a limited subset of all known bee species, suggesting that cost-effective management strategies to promote crop pollination should target a different set of species than management Strategies to promote threatened bees.
Abstract: There is compelling evidence that more diverse ecosystems deliver greater benefits to people, and these ecosystem services have become a key argument for biodiversity conservation. However, it is unclear how much biodiversity is needed to deliver ecosystem services in a cost-effective way. Here we show that, while the contribution of wild bees to crop production is significant, service delivery is restricted to a limited subset of all known bee species. Across crops, years and biogeographical regions, crop-visiting wild bee communities are dominated by a small number of common species, and threatened species are rarely observed on crops. Dominant crop pollinators persist under agricultural expansion and many are easily enhanced by simple conservation measures, suggesting that cost-effective management strategies to promote crop pollination should target a different set of species than management strategies to promote threatened bees. Conserving the biological diversity of bees therefore requires more than just ecosystem-service-based arguments.
698 citations
••
TL;DR: It is argued that nature conservation along with other fields of applied ecology, should exploit the concept of evidence-based practice developed and used in medicine and public health that aims to provide the best available evidence to the decision-maker on the likely outcomes of alternative actions.
602 citations
••
TL;DR: A number of methodological studies suggest that lack of adequate randomization in published trial reports may be associated with more positive estimates of intervention effects and that bias is difficult to detect and appraise.
Abstract: Research on bias in clinical trials may help identify some of the reasons why investigators sometimes reach the wrong conclusions about intervention effects. Several quality components for the assessment of bias control have been suggested, but although they seem intrinsically valid, empirical evidence is needed to evaluate their effects on the extent and direction of bias. This narrative review summarizes the findings of methodological studies on the influence of bias in clinical trials. A number of methodological studies suggest that lack of adequate randomization in published trial reports may be associated with more positive estimates of intervention effects. The influence of double-blinding and follow-up is less clear. Several studies have found a significant association between funding sources and pro-industry conclusions. However, the methodological studies also show that bias is difficult to detect and appraise. The extent of bias in individual trials is unpredictable. A-priori exclusion of trials with certain characteristics is not recommended. Appraising bias control in individual trials is necessary to avoid making incorrect conclusions about intervention effects.
514 citations
References
More filters
••
TL;DR: The results quantify a trigger leading to rapid, drought-induced die-off of overstory woody plants at subcontinental scale and highlight the potential for such die-offs to be more severe and extensive for future global-change-type drought under warmer conditions.
Abstract: Future drought is projected to occur under warmer temperature conditions as climate change progresses, referred to here as global-change-type drought, yet quantitative assessments of the triggers and potential extent of drought-induced vegetation die-off remain pivotal uncertainties in assessing climate-change impacts. Of particular concern is regional-scale mortality of overstory trees, which rapidly alters ecosystem type, associated ecosystem properties, and land surface conditions for decades. Here, we quantify regional-scale vegetation die-off across southwestern North American woodlands in 2002-2003 in response to drought and associated bark beetle infestations. At an intensively studied site within the region, we quantified that after 15 months of depleted soil water content, >90% of the dominant, overstory tree species (Pinus edulis, a pinon) died. The die-off was reflected in changes in a remotely sensed index of vegetation greenness (Normalized Difference Vegetation Index), not only at the intensively studied site but also across the region, extending over 12,000 km2 or more; aerial and field surveys confirmed the general extent of the die-off. Notably, the recent drought was warmer than the previous subcontinental drought of the 1950s. The limited, available observations suggest that die-off from the recent drought was more extensive than that from the previous drought, extending into wetter sites within the tree species9 distribution. Our results quantify a trigger leading to rapid, drought-induced die-off of overstory woody plants at subcontinental scale and highlight the potential for such die-off to be more severe and extensive for future global-change-type drought under warmer conditions.
349 citations