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Update issues (Editorial)

Quantity and quality
Getting better

This issue of Bandolier is mostly about updating stories from previous months and years. Why update? For a number of reasons, but these boil down to quantity and quality.

Quantity and quality

Quantity may be just a reflection of time. Over even a few years trials may be completed and published which just weren't available earlier. Newer trials may be larger, or done to higher standards, or may concentrate more on important outcomes. An example is the review in this issue on outcomes after epidural analgesia for labour compared with parenteral opioids. A review from 1994 suggested that a higher Caesarean section rate was associated with epidural analgesia. A new review, with more than 10 times as many patients, says that there is no difference.

Quality may reflect other factors, some as simple as search strategies. An example is a new review on the effect of exercise on bone mass in women . The new review found many more studies than a similar review published less than a year ago.

Getting better

The point is that our knowledge base continues to strengthen as more and better systematic reviews appear. Reviews are also beginning to concentrate more on outcomes that are important to patients and practitioners, rather than just on outcomes that are measurable. We feature a review looking at definitions of a cure for fungal toenail infections as an update on a story in Bandolier several years ago.


The divergence between what appears in the paper version of Bandolier each month, and what appears on our Internet site will continue to grow. Many of you like the Oxford Pain Internet Site . Plans are being laid to extend the idea of concentrating and summarising knowledge in various areas. About 14 target areas have been identified for similar treatment, including evidence-based healthy living, palliative care, and possibly diagnostic testing. It all depends on getting the resources to do the work, but expect major changes over the next year. The aim is to provide accessibility to all with Internet access, free, and understandable. Ideas and comments welcome.

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