Posts Tagged ‘British Medical Journal’

GRADEing Studies & Evidence

July 19th, 2012

As I mentioned in my previous post, scientific studies (e.g. experimental v. observational design) have different strengths and weaknesses. Sources of evidence range from case reports at the lower end to well-designed large randomized experimental clinical studies that minimize bias.  Relying on poor quality evidence can lead to policy decisions that aren’t in patients’ best interests- and it’s super important to figure out the actual “weight of evidence” that published studies provide- so public health can make good evidence-based decisions. 

That’s where the Grading of Recommendations Assessment, Development and Evaluation- or GRADE system comes in.  The GRADE system was developed to provide researchers and policy makers a systematic way of grading the strength of studies to help policy makers in medicine and public health to interpret studies and make better decisions.  The GRADE system has all kinds of applications.  For example, the U of A used the GRADE methodology to evaluate the quality of the studies looking at the benefits and harms of using Cannabis to treat the conditions that were petitioned to add to the list of qualifying conditions for a medical marijuana card.

You can read alot more about the GRADE system and how it works in this article in the British Medical Journal (unfortunately you need to pay to read the whole thing).

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Midwifery & the Democratic Process

March 28th, 2012

Here’s a short story about using the democratic process to get things done.  Some of you might remember a protest last December in front of our 150 Building.  About 100 folks or so were carrying placards in front of our building asking us to make it easier to have a home-birth in AZ. 

Many of you probably didn’t know that ADHS licenses 60 Midwives who practice in Arizona.  Our licensing rules for Midwives were last revised in the mid 1990’s and are out of date; the application is too complicated.  That day last December, Colby Bower and I met with 2 community folks, Allyson Fernstrom and Sarah Macklin, and 2 midwives including Connie Canada, during the demonstration- and we had a productive discussion.  We set up a dialog so we could come up with a solution together.  Allyson and Sarah followed through with flying colors, built an effective coalition, worked with our team (Colby and Rohno Geppert) and the state legislature- and shepherded a bill through the process that will go a long way toward solving some of the issues they were concerned about. 

The Governor signed the bill yesterday- providing us with exempt rulemaking authority to overhaul our rules for licensing AZ Midwives and setting up an advisory committee and process to review the official “Scope of Practice” for AZ Midwives.  You can check out the final bill online. We’ll also have some information up on our Midwife website shortly that will highlight where we go from here.

It just goes to show you that the democratic process works…  that ordinary folks, like Allyson and Sarah, can get together, organize, and petition their government and elected officials to get things done.  The key is working within the process, staying involved, and applying the most important skill anybody can have- working well with others (the most important grade any of us get in our academic career).  Well done all.

P.S. There was a study published in the British Medical Journal recently suggesting that there’s little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals vs. those who gave birth at home with a midwife.  Of course- the article is more complicated than that- so visit the journal website.

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Home Birth Protest

December 6th, 2011

Those of you that were working at our downtown campus last Wednesday afternoon may have seen the 100 or so folks carrying placards in front of our 150 Building.  They were asking us to make it easier to have a home-birth in AZ.  How can we do that, you ask? 

Many of you probably didn’t know that we license the 50 or so Midwives that practice in Arizona.  Our licensing rules for Midwives were last revised in the mid 1990’s, our rules are out of date, and the application is too complicated.  I met with 4 of the community folks upstairs during the demonstration- and we had a productive discussion.  Basically- they asked us to consider revising our Midwife licensing rules to simplify the application process and consider revising their scope of practice.  We talked during our meeting about the rulemaking process (both exempt and regular), gave them a realistic forecast of how quickly we could revise the rules using each approach, and set up a dialog so we could come up with a solution together. 

Coincidently- there was a study published in the British Medical Journal this week regarding the safety etc. of home births. The study basically suggests that there’s little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals vs. those who gave birth at home with a midwife.  Of course- the article is more complicated than that- so visit the journal article for more info…

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