Article type
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Abstract
Discussion: We assumed that doctors need information immediately available when they have a patient in front of them (Covell 1985). Because of the large amount of information they need, they cannot rely only on their memory, and because of the short time allowed they cannot browse the systematic review database. Hence, an intermediate step is required, that we called a message. A message carries a piece of information related to an intervention (e.g. propranolol) or a class of interventions (e.g. beta-blockers), a condition (e.g. post-myocardial infarction) and a therapeutic objective (e.g. reduction of a patient's risk of sudden death). This information is quantitative (RR, absolute benefit, NST) and an algorithm to adjust the size of the efficacy to each patient. This algorithm is based on the effect model for the intervention, the therapeutic objective and the condition. The size of the effect is marked with a level of evidence according to an established scale with a easily understandable mark. We want here to stress the differences between messages and recommendation (or guidelines).
1. A message is directly drawn from the available evidence, with no interpretation and no selection, whereas the recommendations are built on the available evidence (in the best case) with interpretation and choice of the " best" intervention according to the opinion of the panel of experts. The comparisons made by the experts are, most of the time, indirect.
2. The style of the message is neutral (this is what we know) whereas the style of recommendation is either positive (you should do that) or negative (you should not do that).
3. The message covers one intervention, one therapeutic objective, one disease, whereas the recommendation, usually, covers one condition.
4. The message leaves the final choice of the most appropriate intervention for the patient to the doctors, whereas with a recommendation the choice has been made by the experts.
5. The message allows to adjust the choice to each patient according to his/her characteristics, predicted untreated risk and likely toxic effects of each considered intervention for this patient.
6. The message has no sponsor, whereas the recommendation has been sponsored by a Society, a Regulatory Body, an Institution or the like.
7. We believe that messages are easier to incorporate in doctors' workstation functions.
8. Finally, the time required to update a message is short, because new data from cumulative meta-analysis is incorporated immediately, whereas it takes much longer to update a recommendation (at least reconvening the experts, agreeing on a new text...). However, messages and recommendations are more complementary than concurrent. First, a recommendation can be viewed as a combination of messages (alike a molecule which is a combination of atoms). Second, recommendations can be best used as training material, to make the doctors sensitive to the problems in the framework of continuous medical education.
1. A message is directly drawn from the available evidence, with no interpretation and no selection, whereas the recommendations are built on the available evidence (in the best case) with interpretation and choice of the " best" intervention according to the opinion of the panel of experts. The comparisons made by the experts are, most of the time, indirect.
2. The style of the message is neutral (this is what we know) whereas the style of recommendation is either positive (you should do that) or negative (you should not do that).
3. The message covers one intervention, one therapeutic objective, one disease, whereas the recommendation, usually, covers one condition.
4. The message leaves the final choice of the most appropriate intervention for the patient to the doctors, whereas with a recommendation the choice has been made by the experts.
5. The message allows to adjust the choice to each patient according to his/her characteristics, predicted untreated risk and likely toxic effects of each considered intervention for this patient.
6. The message has no sponsor, whereas the recommendation has been sponsored by a Society, a Regulatory Body, an Institution or the like.
7. We believe that messages are easier to incorporate in doctors' workstation functions.
8. Finally, the time required to update a message is short, because new data from cumulative meta-analysis is incorporated immediately, whereas it takes much longer to update a recommendation (at least reconvening the experts, agreeing on a new text...). However, messages and recommendations are more complementary than concurrent. First, a recommendation can be viewed as a combination of messages (alike a molecule which is a combination of atoms). Second, recommendations can be best used as training material, to make the doctors sensitive to the problems in the framework of continuous medical education.