Pragmatic Evidence-Based Medicine: closing the implementation gap by promoting 'user-friendly' evidence

当一个背部疼痛的病人去看医生时，他想知道实验干预是否比现有的最好的干预更好。这一信息最好在“主动对照试验”中获得。然而，目前的智慧是，衡量有效性的最佳方法是在安慰剂对照试验中。我的论文研究了安慰剂控制在方法上优于积极控制的论点，发现它们是不必要的--好的方法和有效性之间的明显紧张在很大程度上是虚幻的。我打算从两个方面扩展我的论文成果。首先，我将对患者/客户、从业者和政策制定者认为的“用户友好”证据进行社会研究，即容易付诸实践的证据。其次，我打算研究对一种疾病(而不仅仅是一两种)进行实验干预与所有可用的干预措施进行比较的方法。我的项目在医学和社会科学研究方面的影响可能是对最有效干预措施的提供和接受产生立竿见影的效果。

When a patient visits his doctor with a sore back, he wants to know whether the experimental intervention is better than the best existing intervention. This information is best obtained in an ‘active controlled trial‘. Yet, current wisdom has it that the best way to measure effectiveness is in a placebo controlled trial. My thesis examined the arguments that placebo controls are methodologically superior to active controls, and found them to be wanting - the apparent tension between good methods and usefulness is largely illusory. I intend to expand my thesis results in two ways. First, I will conduct social research into what patients/clients, practitioners, and policy makers regard as ‘user-friendly‘ evidence, i.e. evidence that would be easy to put into practice. Second, I intend to investigate the methods for comparing the experimental intervention with all available interventions for a given ailment (rather than just one or two). The impact of my project, both in medical and social science research, could be to have an immediate effect on the delivery and uptake of the most effective interventions.