At issue: Cochrane, early intervention, and mental health reform: analysis, paralysis, or evidence-informed progress?
Identifieur interne : 002B95 ( Main/Exploration ); précédent : 002B94; suivant : 002B96At issue: Cochrane, early intervention, and mental health reform: analysis, paralysis, or evidence-informed progress?
Auteurs : Patrick Mcgorry [Australie]Source :
- Schizophrenia bulletin [ 1745-1701 ] ; 2012.
Descripteurs français
- KwdFr :
- Humains (MeSH), Intervention médicale précoce (MeSH), Littérature de revue comme sujet (MeSH), Politique de santé (MeSH), Pratique factuelle (méthodes), Processus politique (MeSH), Recherche sur les services de santé (méthodes), Réforme des soins de santé (méthodes), Services de santé mentale (normes), Troubles psychotiques (thérapie).
- MESH :
English descriptors
- KwdEn :
- MESH :
- methods : Evidence-Based Practice, Health Care Reform, Health Services Research.
- standards : Mental Health Services.
- therapy : Psychotic Disorders.
- Early Medical Intervention, Health Policy, Humans, Policy Making, Review Literature as Topic.
Abstract
Among the noncommunicable diseases, mental ill-health represents the major threat to social and economic progress because it impacts so powerfully on the most critical decades of life. Consequently, mental health reform is increasingly recognized as an urgent priority worldwide. This brings into sharp focus the role of evidence, and more specifically the Cochrane paradigm, in influencing decisions about health system reform. Cochrane clearly still has great value, especially in evidence-based medicine, where the focus is the evaluation of individual treatments. However, it cannot be allowed to be a dominant influence in evidence-based health care (EBHC) policy decisions for health system reform, unless it is modernized or complemented. Health services reform should definitely be as evidence-based as possible; however, the jury should consider its verdict on key reform proposals based on the balance of probabilities and informed by the best "available" evidence from all sources, not only randomized clinical trials, which in many domains may be never be feasible. This is particularly the case when reform is urgent, and the status quo has manifestly failed. So on the one hand, the evidence-based paradigm must not be misused to stifle or paralyze urgent reform. Alternatively, there is a real risk that, if we do not improve the sophistication of EBHC, the whole paradigm will be sidelined and reform will remain reactive, impulsive, and desultory. The recent Cochrane review on early intervention in psychosis provides an opportunity to consider these issues and their wider significance.
DOI: 10.1093/schbul/sbr185
PubMed: 22247539
PubMed Central: PMC3283140
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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noncommunicable diseases, mental ill-health represents the major threat to social and economic progress because it impacts so powerfully on the most critical decades of life. Consequently, mental health reform is increasingly recognized as an urgent priority worldwide. This brings into sharp focus the role of evidence, and more specifically the Cochrane paradigm, in influencing decisions about health system reform. Cochrane clearly still has great value, especially in evidence-based medicine, where the focus is the evaluation of individual treatments. However, it cannot be allowed to be a dominant influence in evidence-based health care (EBHC) policy decisions for health system reform, unless it is modernized or complemented. Health services reform should definitely be as evidence-based as possible; however, the jury should consider its verdict on key reform proposals based on the balance of probabilities and informed by the best "available" evidence from all sources, not only randomized clinical trials, which in many domains may be never be feasible. This is particularly the case when reform is urgent, and the status quo has manifestly failed. So on the one hand, the evidence-based paradigm must not be misused to stifle or paralyze urgent reform. Alternatively, there is a real risk that, if we do not improve the sophistication of EBHC, the whole paradigm will be sidelined and reform will remain reactive, impulsive, and desultory. The recent Cochrane review on early intervention in psychosis provides an opportunity to consider these issues and their wider significance.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">22247539</PMID><DateCompleted><Year>2012</Year><Month>06</Month><Day>12</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1745-1701</ISSN><JournalIssue CitedMedium="Internet"><Volume>38</Volume><Issue>2</Issue><PubDate><Year>2012</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Schizophrenia bulletin</Title><ISOAbbreviation>Schizophr Bull</ISOAbbreviation></Journal><ArticleTitle>At issue: Cochrane, early intervention, and mental health reform: analysis, paralysis, or evidence-informed progress?</ArticleTitle><Pagination><MedlinePgn>221-4</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/schbul/sbr185</ELocationID><Abstract><AbstractText>Among the noncommunicable diseases, mental ill-health represents the major threat to social and economic progress because it impacts so powerfully on the most critical decades of life. Consequently, mental health reform is increasingly recognized as an urgent priority worldwide. This brings into sharp focus the role of evidence, and more specifically the Cochrane paradigm, in influencing decisions about health system reform. Cochrane clearly still has great value, especially in evidence-based medicine, where the focus is the evaluation of individual treatments. However, it cannot be allowed to be a dominant influence in evidence-based health care (EBHC) policy decisions for health system reform, unless it is modernized or complemented. Health services reform should definitely be as evidence-based as possible; however, the jury should consider its verdict on key reform proposals based on the balance of probabilities and informed by the best "available" evidence from all sources, not only randomized clinical trials, which in many domains may be never be feasible. This is particularly the case when reform is urgent, and the status quo has manifestly failed. So on the one hand, the evidence-based paradigm must not be misused to stifle or paralyze urgent reform. Alternatively, there is a real risk that, if we do not improve the sophistication of EBHC, the whole paradigm will be sidelined and reform will remain reactive, impulsive, and desultory. The recent Cochrane review on early intervention in psychosis provides an opportunity to consider these issues and their wider significance.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>McGorry</LastName><ForeName>Patrick</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, VIC 3052, Australia. pmcgorry@unimelb.edu.au</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2012</Year><Month>01</Month><Day>12</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Schizophr 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IdType="pubmed">7853049</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Australie</li></country><region><li>Victoria (État)</li></region><settlement><li>Melbourne</li></settlement><orgName><li>Université de Melbourne</li></orgName></list><tree><country name="Australie"><region name="Victoria (État)"><name sortKey="Mcgorry, Patrick" sort="Mcgorry, Patrick" uniqKey="Mcgorry P" first="Patrick" last="Mcgorry">Patrick Mcgorry</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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