The Medical journal of Australia
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Review
Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review.
To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. ⋯ Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group.
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Malpractice litigation is now a substantial cost in the provision of healthcare. Despite new attitudes of Australian courts towards medical evidence, expert reports remain the cornerstone of most medical negligence cases. ⋯ If possible, outcome information should be withheld from experts providing reports. If outcome information is not withheld, courts should be made aware of the probability of hindsight bias.
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Randomized Controlled Trial Clinical Trial
The demise of a planned randomised controlled trial in an urban Aboriginal medical service.
To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part "demonstration project". ⋯ Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and "gold-standard" RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.