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Where can treatment uncertainties come from, and what do we do with them?

Where can treatment uncertainties come from, and what do we do with them?. Mark Fenton James Lind Initiative, Oxford Editor, UK Database of Uncertainties about the Effects of Treatments Thursday 19 th April 2012. Types of uncertainty about the effects of treatments.

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Where can treatment uncertainties come from, and what do we do with them?

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  1. Where can treatment uncertainties come from, and what do we do with them? Mark Fenton James Lind Initiative, Oxford Editor, UK Database of Uncertainties about the Effects of Treatments Thursday 19th April 2012

  2. Types of uncertainty about the effects of treatments ‘We’re uncertain whether anyone knows the effects’ uncertain uncertainty ‘We’re uncertain what the effects will be on you’ stochastic uncertainty ‘We’re uncertain because we don’t know your values’ value uncertainty ‘We’re uncertain because no-one knows the effects’ certain uncertainty

  3. “As we know, there are known knowns. There are things we know we know. “We also know there are known unknowns. That is to say we know there are some things we do not know. “But there are also unknown unknowns, the ones we don't know we don't know.” Donald Rumsfeld One creditworthy contribution to posterity: identifying different types of uncertainty

  4. What is an uncertainty? Patient/Population Intervention Comparison Outcome

  5. Good Medical Practice is the core ethical guidance the GMC provides to doctors. It is also intended to let the public know what they can expect from doctors

  6. Austin Bradford Hill, 1965Four questions to which readers want answers when reading reports of research. 1. Why did you start? 2. What did you do? 3. What answer did you get? 4. And what does it mean anyway?

  7. What are the effects of methylxanthines (caffeine, theophylline) for apnoea of prematurity?

  8. The results of five trials that enrolled a total of 192 preterm infants with apnea indicate that methylxanthine therapy leads to a reduction in apnea and use of IPPV in the first two to seven days. The effects of methylxanthines on long-term outcomeswill be addressed in data from the trial awaiting assessment.

  9. Volume 357:1893-1902 November 8, 2007 Number 19 Long-Term Effects of Caffeine Therapy for Apnea of Prematurity Barbara Schmidt, M.D., Robin S. Roberts, M.Sc., Peter Davis, M.D., Lex W. Doyle, M.D., Keith J. Barrington, M.D., Arne Ohlsson, M.D., Alfonso Solimano, M.D., Win Tin, M.D., for the Caffeine for Apnea of Prematurity Trial Group Conclusions Caffeine therapy for apnea of prematurity improvesthe rate of survival without neurodevelopmental disability at18 to 21 months in infants with very low birth weight

  10. What are the effects of prophylactic antibiotics for inhibiting preterm labour with intact membranes?

  11. This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics… The 17 citations awaiting classification may alter the conclusions of the review once assessed.

  12. Because uncertainties about the long term effects of prescribing antibiotics in spontaneous preterm labour and caffeine for apnoea of prematurity were not investigated 25 years ago, tens of thousands of people are now living with cerebral palsy that might have been prevented.

  13. We need to confront important uncertainties about the effects of treatment because otherwise:● patients will be denied unrecognised beneficial care● patients will be given unrecognised harmful care● resources will be wasted on useless or unnecessarily expensive care

  14. Uncertainties from Patients, carers and clinicians • - from today onwards; challenging • Uncertainties from research recommendations • easy access, Cochrane Systematic Reviews, NICE Guidelines, journals. • Uncertainties from ongoing research • - no need to duplicate what is already happening

  15. UK DUETshttp://www.library.nhs.uk/duets

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