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Editorial: Spinning wheels

Spinning wheels

This month Bandolier picks out a clever systematic review of audits of the inappropriate use of clinical laboratory tests. It shows that an awfully large proportion of tests are inappropriate. This makes for a lot of wheel spin in an area which consumes a significant chunk of NHS spending. We do some back-of-an-envelope calculations to show what this means in financial terms.

This is not just about potentially saving money. There is also an opportunity cost. The huge pressures of ever increasing workloads for laboratories often prevents the introduction of better, though perhaps more expensive, tests. Nor do studies often tell us about tests which should have been done which weren't.

Bandolier would like to tell more positive stories about tests, about how test results might be better be presented, and about how tests may be employed to reduce health care costs. They seem awfully hard to find. We would like your help, therefore, in locating papers which report how tests help in diagnosis or prognosis, or help in defining or delivering a service, or in helping provide a higher quality or cheaper service.

Getting a grip

The number-needed-to-treat (NNT) has provided a common currency for describing the intervention-specific benefits that accrue from treatments. A report from Wessex shows that about 35% of GPs are able to understand NNTs and feel confident about explaining it to others. Given that a few years ago none of us knew anything about NNTs, that's quite an advance, probably because NNTs make sense and are understandable.

But new readers and thinkers join all the time, so this month we reprise the calculation of NNTs and NNHs. We also look at where GPs get their evidence-based information. OK, so Bandolier looks good in that report , but the main point is that awareness of evidence-based information is low.

Getting Bandolier

Which brings us to the business of getting Bandolier . This is given in detail again , but of course much will change with the new Regions next year. Many people photocopy Bandolier we hear. That may be more wheel spin. It is probably more expensive than asking for more copies. The extra cost of producing and distributing more copies of Bandolier is negligible - tripling the distribution would add less than 10% to the total cost. So if you want copies for each partner, nurse, or manager, or for community pharmacists, then don't fret or copy, just ask and we'll do our best to help.

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