Martin Dawes

Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database

Objectives To estimate the prevalence and incidence in primary care of chronic pelvic pain in women in the UK.

Interferon Alfa Therapy for Malignant Melanoma: A Systematic Review of Randomized Controlled Trials

PURPOSEnNo standard systemic adjuvant therapy has been proven to increase overall survival in melanoma patients. The effect of interferon alfa (IFNalpha) as a single agent or in combination has been widely explored in clinical trials. The purpose of this study was to assess the benefit of IFNalpha therapy in malignant melanoma.nnnMETHODSnWe performed a systematic review of randomized controlled trials comparing regimens with or without IFNalpha adjuvant therapy in melanoma patients. We assessed the effect of IFNalpha therapy on overall survival (OS), disease-free survival (DFS), melanoma recurrences, and toxicity. The quality of each trial was systematically evaluated.nnnRESULTSnNine randomized controlled trials (RCTs) of IFNalpha therapy in melanoma patients were identified. Eight were published and one was unpublished. Eight trials comprising 3,178 patients fulfilled our inclusion criteria and were analyzed. Quality assessment scores ranged from 22 to 71, with a mean score of 55.4 (95% confidence interval, 53.8 to 57.0). For OS, only one trial reported a statistically significant benefit for IFNalpha, but our analysis did not confirm it. Two trials reported statistically significant benefit in DFS for the patients treated with IFNalpha, but our analysis confirmed it in only one trial. There was a wide clinical heterogeneity between included trials, making meta-analysis inappropriate.nnnCONCLUSIONnIn our review, results from included RCTs demonstrated no clear benefit of IFNalpha therapy on OS in melanoma patients. A large RCT is required to answer whether a full regimen of IFNalpha therapy is effective and to identify the subgroups of patients who might benefit from IFNalpha treatment.

Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care.

Objectives To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain.

The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review

Objective Toobtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data.

Combing and combating head lice

Choose between four successive combings or two applications of pediculicide

Economic evaluation in evidence- based practice

The economic evaluation of health care interventions and technologies is an essential part of any modern healthcare system. In recent years a growing demand for information about the economic benefits of healthcare technologies has seen a significant increase in the number of published economic evaluations of healthcare. Economic evaluation reviews have demonstrated considerable methodological flaws in a significant number of analyses in health care. Widely accepted guidance regarding the manner in which multinational economic evaluations should be designed, analysed and presented is still awaited. The main types of economic analyses are described in this article, providing a framework along which to evaluate them.

Getting Doctors to Listen.

deployed by other writers to justify the existence of the poor. In his peroration Epstein argues from (mostly unstated) first principles that substantially (but unspecifically) increased welfare expenditure ought to be deployed in order to redress cultural poverty and to integrate the poor into the basic institutions of American life healthy families, communities, schools, workplaces and the other essential institutions, (page 231) apparently unconcerned that the central project of the social sciences since the 1 960s has been to demonstrate just how bitterly contested are the very concepts he takes for granted such as cultural poverty, healthy institutions and the common good. There is no doubt about Epsteins sincere conviction. But having pronounced a plague upon both the warring houses of poverty research, unfortunately he can offer a no more rational and no less mythical justification for his own option for the poor than those he has dismissed. The problem of poverty, as he wryly comments, remains polemical after all.

Putting evidence into practice

Revised levels of evidence help to find the best evidence, in real time

Knowledge Transfer in Surgery: Skills, Process and Evaluation

INTRODUCTIONnKnowledge transfer is an essential element in the management of surgical health care. In a routine clinical practice, surgeons need to make changes to the health care they provide as new clinical evidence emerges.nnnMATERIALS AND METHODSnThe information was derived from the authors experience and research in evidence-based practice, searching of the literature, teaching and organisation of various national and international workshops on evidence-based medicine.nnnDISCUSSIONnThis manuscript discusses principles of knowledge transfer in surgery including evaluation of recommended changes that can improve quality of health care in routine surgical practice. Skills, process and evaluation are carefully described. Continuous information delivery is required to enable surgeons to improve knowledge transfer and to keep up to date their knowledge.