Book Review: The Pharmacist's Guide to Evidence-Based Medicine for Clinical Decision Making

2009 ◽  
Vol 43 (6) ◽  
pp. 1148-1148
Author(s):  
John R Litaker
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Based Medicine

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

Evidence-Based Medicine

2005 ◽  
pp. 125-135 ◽  
Author(s):  
Nilmini Wickramasinghe ◽  
Sushil K. Sharma ◽  
Harsha P. Reddy
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
New Developments ◽  
Postgraduate Educational ◽  
New Knowledge ◽  
Based Medicine

The ongoing tension between certainty over uncertainty is the main force that is driving the evidence-based medicine movement. The central philosophy of this practice lies in the idea that one can never take for granted one’s own practice, but by using a structured, problem-based approach, practitioners can logically manoeuvre their way through the obstacle course of clinical decision-making. Attending postgraduate educational events and reading various science journals are no longer sufficient to keep healthcare practitioners aware of all the new developments in practice. To gain this knowledge they need to accept that there are questions they have to ask about their practice. Having posed a number of questions, answers should be found to the most important, practitioners should appraise the quality of the resulting evidence and, if appropriate, practitioners should implement change in response to that new knowledge.

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