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Evidence-based dilemmas in pre-school vision screening
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What should policy makers do with systematic reviews that fail to find evidence of effectiveness for interventions currently provided in the NHS? Is no evidence of effectiveness sufficient evidence of no effectiveness? The systematic review process has made great progress in minimising the influence of personal bias in the selection and critical appraisal of evidence. By bringing together in one place and critically appraising all the relevant studies, these reviews can show the fragility of the evidence on which some current practice is based.
Policy makers in the NHS take the results of these reviews seriously
and expect to be able to act on their findings. But clinicians argue
that it is wrong to close down a service, which might be doing good,
just because the research evidence of effectiveness is poor. The review
of pre-school vision screening commissioned by the NHS Health
Technology Assessment Programme1 raises this dilemma and
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