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
James Lind Initiative
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
James Lind Initiative
Within treatment evaluation
there aretwo important problems
James Lind Initiative
First problem
Researchers ignore patients’ & clinicians’ questions
James Lind Initiative
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.
James Lind Initiative
James Lind Initiative
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)
James Lind Initiative
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
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Second problem
Researchers ignore treatment outcomes
that are important to patients
James Lind Initiative
Priority treatment outcome from a survey of patients with rheumatoid arthritis
was not pain
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Priority treatment outcome from a survey of patients with rheumatoid arthritis
was not pain
It was fatigue!
James Lind Initiative
An initiative of the National Therapeutic Ignorance Service
James Lind Initiative
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
James Lind Initiative
James Lind Initiative
James Lind Initiative
James Lind Initiative
James Lind Initiative
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.
James Lind Initiative
James Lind Initiative
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.
James Lind Initiative
James Lind Initiative
To visit DUETs go to:
www.duets.nhs.uk