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All muck and no brass (Editorial)

Palliative care
Electronic Bandolier
You can't dam half a stream

Evidence-based diagnostic testing is such barren ground. Most studies of diagnostic tests are so flawed that systematic reviews of diagnostic tests are bonkers: they just measure how high the muck is piled. They can't tell us whether there's brass in the muck.

This month's Bandolier concentrates on diagnostic testing. It may not be obvious, but there is a theme about clinical signs and symptoms and clinical scoring systems. The theme also extends to using information from clinical trials to generate useful diagnostic criteria. This extends ideas extolled in the Internet version of Bandolier in a web essay on diagnostics and it is delightful to see good examples.

Predicting risk of cardiovascular disease and a diagnostic tool for erectile function in primary care both come directly from randomised trial data. Diagnostic decision rules are not often tested, but there is a comparative test to help decide which rule to use for sending women for bone density measurements . And there's information about not being flummoxed by trigger points in fibromyalgia .

Palliative care


The Bandolier Palliative care Internet site this month examines meta-analyses of treatments for chemotherapy and radiotherapy-induced nausea and vomiting. Several things of note. First that there are four good meta-analyses in this arcane area, and second that when put together it all makes sense. Some treatments are better than others, and choices can be facilitated by a quick examination of all relevant evidence in one place.

Electronic Bandolier


Monthly visitors to the site are now just under 400,000. They come from all over the world, even if it's only one or two from Andorra, Uganda and Nepal. What's fascinating is the incredible spread of stories visited. There's more this month on healthy living and headache and migraine. By the Autumn we hope to be able to announce an even bigger electronic effort. If you want a monthly email about what's new at the Bandolier Internet site, just drop an electron to bandolier@pru.ox.ac.uk .

You can't dam half a stream


Interesting stuff from Boston Consulting Group on whether interventions to inhibit prescribing ever work. Many references to read, but maybe another area to explore (see Bandolier 92 ).


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