![]() ![]() The editorialists give guidelines on producing guidelines that should work. ![]() Worse, many of them contradict each other, don’t help with the problems that clinicians face, and are out of date and only loosely based on evidence. Guidelines are one way to bridge the gap between evidence and practice, but “clinicians,” write Rodney Jackson and Gene Feder, “are being inundated by a tidal wave of guidelines” (p 427). But, as is so often the case, these conclusions are based on limited evidence where there are few studies of different interventions against each other and severe problems with generalising from studies done in particular contexts. What do seem to work are educational outreach visits, reminders (manual or computerised), interactive educational meetings, and “multifaceted interventions” that include at least two of audit and feedback, reminders, local consensus processes, and marketing. What we also learn from the review is that those who are trying to change health care spend most of their resources on the passive approaches (publication, mailings of educational material, and lectures) that don’t work. They observe that “It is striking how little is known about the effectiveness and cost effectiveness of interventions that aim to change the practice or delivery of health care.” It is striking because trying to change health care is what a huge number of people spend their lives doing. We know about the ineffectiveness of simply disseminating information from the overview by Lisa Bero and others of interventions to promote the implementation of research findings (p 465). Simply disseminating information won’t achieve change. If any benefit is to flow from the journal then much work remains to be done. For those of us who produce the BMJ the completed journal is the reality, but for readers it is the idea. ![]() T S Eliot put it thus: “Between the idea/And the reality/Between the motion/And the act/Falls the shadow.” This BMJ illustrates that theme. The LP title is also obviously lifted from. There's a new lineup behind principals Randy Stodola and Dianne Chai, and the album opens with 'Heart Full of Soul,' which the Yardbirds had a number two hit in Britain with in 1965 (see Rave Up ). Plato maintained that what we perceive is a distorted image of the Ideas that represent the real world. Their first LP as Zarkons was pretty dreadful, but there are hints on this one that it might be better. Dreaming up what might be done is, in contrast, easy. Platos shadows are stand ins for our perceptions. ![]()
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