- Email: [email protected]
What is the question?
DISSECTING ROOM
The Refractory What is the question? “The Ball no question makes of Ayes and Noes” Edward Fitzgerald (1809–83)
t is widely accepted that reliable, good quality evidence should inform treatment choices and decisions. Patients have individual preferences and practical needs that will affect the choice they will make with their doctors when offered a range of different treatment options. So it is axiomatic that the right research questions are posed to provide evidence, not just about mortality, but about those aspects of illness that impinge on the quality and practicalities of a patient’s daily life in the specific circumstances in which he or she finds themselves. Are we collaborating with researchers sufficiently to achieve this goal? Such collaboration would certainly accord with today’s recommendations and efforts to ensure that health care is patient-centred.
I
But are researchers asking the sort of questions that will encourage people to take part in their research? It seems rather obvious to suggest that independent qualitative researchers should first seek the views of patients before a trial is launched, to find out if the question being proposed is one that patients think is important, and to ask them if trialists have suggested a feasible and acceptable proposition for prospective participants. Not to do so risks poor recruitment, because prospective participants will not identify with the trial’s objectives—for example, the options being compared might not accord with patients’ perceptions of what might be acceptable randomisation options. To fail to accommodate patients’ opinions from the outset of a trial risks wasting patients’ and researchers’ time and society’s hard-earned money.
Qualitative research to explore the reasons for both poor and rapid recruitment would begin to answer clinicians’ curiosity about these phenomena and inform those seeking to improve methodologies. Moreover, failure to explore these questions risks courting loss of public trust in clinicians’ and trialists’ ability to focus their attention on what patients need to know, rather than on questions that provide data more interesting to the commercial sponsors with whom researchers inevitably work. Preliminary qualitative research to establish feasibility and acceptability to the public and patients would be a way of beginning to redress the balance of power in research endeavours, and provide a proper demonstration by researchers and clinicians of their commitment to consumers’ involvement in research. Refractor e-mail: [email protected]
An essential guide to obstetrics and gynaecology Obstetrics and Gynecology: Principles and Practice Frank W Ling, Patrick Duff, eds. New York: McGraw Hill Publishers, 2001. Pp 1387. $135.00. ISBN 0838572014. his book is formidable in a number of ways. One is its sheer bulk—nearly 1400 largesized pages. Another is its scope—the full range of obstetrics, gynaecology, and general medical issues that affect women’s health. Another is the depth of coverage—detailed and up-to-date information on physiology, pathophysiology, diagnosis, and treatment, and each of the 68 chapters has an extensive bibliography. Obstetrics and Gynecology: Principles and Practice stands out among current combined obstetric-gynaecological texts by virtue of its thoroughness and its attention to non-reproductive disorders. The editors, Frank Ling and Patrick Duff, are both seasoned academicians, respected for their skills and abilities in education. They are joined by 85 contributing authors—about twothirds of them well known obstetriciangynaecologists from across the USA and about a third from other specialties, almost all at Tennessee University. Although comprehensive, the book is organised in a reader friendly way and has several features that enhance its educational value. Chief among these
T
1354
is the innovative listing of five key points at the head of each chapter. This orients the reader at the outset as to what is most important in the chapter and then serves as a “bottom line” summary after finishing the section. It may be a little simplistic to always have exactly five key points, no more and no less, in topics that range from gastrointestinal diseases during pregnancy (four pages) to normal and abnormal labour and delivery (46 pages), but it’s a helpful learning device in any case. Other educationally useful features include tables that list important data or summary information, graphs that illustrate temporal relations, and flow diagrams that present management pathways. All of these are used extensively. Excellent line drawings, most created for this book, illustrate technical points. In any comprehensive, multiauthored textbook, there will inevitably be a degree of redundancy and overlap. Except for increasing the length of the book, this is not a particular problem so long as important topics do not get left out. That seems not to have happened
in this case, but there are a few instances when the quality of the coverage varies in redundant sections. For example, investigation of the abnormal Papanicolaou smear and management of cervical intraepithelial neoplasia are covered very thoroughly in a chapter devoted to that topic (chapter 55), and then in a rather cursory manner in another chapter devoted to cervical cancer (chapter 64). Further, there are occasions when subjects are addressed in the less appropriate of alternative places. For example, useful tables on the safety of gastrointestinal drugs during pregnancy and the effect of pregnancy on liver function tests appear in the section on gastrointestinal diseases in women’s health; there is little or no mention of these topics in the sections on gastrointestinal or liver diseases in pregnancy, maternal physiology, or teratology, where one would probably first look for them. The production and copy-editing aspects of the book are not quite up to the high standards of the content. The organisational scheme varies a bit, with some sections having titles for every paragraph and others characterised by long unbroken text. The use of archaic Latin abbreviations used traditionally in writing prescriptions
THE LANCET • Vol 359 • April 13, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
The Refractory What is the question? “The Ball no question makes of Ayes and Noes” Edward Fitzgerald (1809–83)
t is widely accepted that reliable, good quality evidence should inform treatment choices and decisions. Patients have individual preferences and practical needs that will affect the choice they will make with their doctors when offered a range of different treatment options. So it is axiomatic that the right research questions are posed to provide evidence, not just about mortality, but about those aspects of illness that impinge on the quality and practicalities of a patient’s daily life in the specific circumstances in which he or she finds themselves. Are we collaborating with researchers sufficiently to achieve this goal? Such collaboration would certainly accord with today’s recommendations and efforts to ensure that health care is patient-centred.
I
But are researchers asking the sort of questions that will encourage people to take part in their research? It seems rather obvious to suggest that independent qualitative researchers should first seek the views of patients before a trial is launched, to find out if the question being proposed is one that patients think is important, and to ask them if trialists have suggested a feasible and acceptable proposition for prospective participants. Not to do so risks poor recruitment, because prospective participants will not identify with the trial’s objectives—for example, the options being compared might not accord with patients’ perceptions of what might be acceptable randomisation options. To fail to accommodate patients’ opinions from the outset of a trial risks wasting patients’ and researchers’ time and society’s hard-earned money.
Qualitative research to explore the reasons for both poor and rapid recruitment would begin to answer clinicians’ curiosity about these phenomena and inform those seeking to improve methodologies. Moreover, failure to explore these questions risks courting loss of public trust in clinicians’ and trialists’ ability to focus their attention on what patients need to know, rather than on questions that provide data more interesting to the commercial sponsors with whom researchers inevitably work. Preliminary qualitative research to establish feasibility and acceptability to the public and patients would be a way of beginning to redress the balance of power in research endeavours, and provide a proper demonstration by researchers and clinicians of their commitment to consumers’ involvement in research. Refractor e-mail: [email protected]
An essential guide to obstetrics and gynaecology Obstetrics and Gynecology: Principles and Practice Frank W Ling, Patrick Duff, eds. New York: McGraw Hill Publishers, 2001. Pp 1387. $135.00. ISBN 0838572014. his book is formidable in a number of ways. One is its sheer bulk—nearly 1400 largesized pages. Another is its scope—the full range of obstetrics, gynaecology, and general medical issues that affect women’s health. Another is the depth of coverage—detailed and up-to-date information on physiology, pathophysiology, diagnosis, and treatment, and each of the 68 chapters has an extensive bibliography. Obstetrics and Gynecology: Principles and Practice stands out among current combined obstetric-gynaecological texts by virtue of its thoroughness and its attention to non-reproductive disorders. The editors, Frank Ling and Patrick Duff, are both seasoned academicians, respected for their skills and abilities in education. They are joined by 85 contributing authors—about twothirds of them well known obstetriciangynaecologists from across the USA and about a third from other specialties, almost all at Tennessee University. Although comprehensive, the book is organised in a reader friendly way and has several features that enhance its educational value. Chief among these
T
1354
is the innovative listing of five key points at the head of each chapter. This orients the reader at the outset as to what is most important in the chapter and then serves as a “bottom line” summary after finishing the section. It may be a little simplistic to always have exactly five key points, no more and no less, in topics that range from gastrointestinal diseases during pregnancy (four pages) to normal and abnormal labour and delivery (46 pages), but it’s a helpful learning device in any case. Other educationally useful features include tables that list important data or summary information, graphs that illustrate temporal relations, and flow diagrams that present management pathways. All of these are used extensively. Excellent line drawings, most created for this book, illustrate technical points. In any comprehensive, multiauthored textbook, there will inevitably be a degree of redundancy and overlap. Except for increasing the length of the book, this is not a particular problem so long as important topics do not get left out. That seems not to have happened
in this case, but there are a few instances when the quality of the coverage varies in redundant sections. For example, investigation of the abnormal Papanicolaou smear and management of cervical intraepithelial neoplasia are covered very thoroughly in a chapter devoted to that topic (chapter 55), and then in a rather cursory manner in another chapter devoted to cervical cancer (chapter 64). Further, there are occasions when subjects are addressed in the less appropriate of alternative places. For example, useful tables on the safety of gastrointestinal drugs during pregnancy and the effect of pregnancy on liver function tests appear in the section on gastrointestinal diseases in women’s health; there is little or no mention of these topics in the sections on gastrointestinal or liver diseases in pregnancy, maternal physiology, or teratology, where one would probably first look for them. The production and copy-editing aspects of the book are not quite up to the high standards of the content. The organisational scheme varies a bit, with some sections having titles for every paragraph and others characterised by long unbroken text. The use of archaic Latin abbreviations used traditionally in writing prescriptions
THE LANCET • Vol 359 • April 13, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.