Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

Institutionalising the evaluation function: A South African study of impartiality,use and cost

PurposeThis article explores the implications of outsourcing the evaluation function in South Africa, a context where there is a mismatch between evaluation supply and demand. It unpacks the tradeoffs between internal and external evaluation, and challenges some commonly held assumptions about both.ApproachBased on experiences as an internal evaluator, external evaluator, evaluation manager, and building evaluation capacity, the author explores how each role changes when evaluation is a scarce skill, and looks at implications outsourcing has for both the organization, and the evaluation.FindingsThe purpose of the evaluation must drive the decision to outsource. However, with changing models of collaboration, there may be hybrid options that allow organizations to build evaluation capacity.Practical implicationsOrganisations are faced with a trade-off between commissioning an evaluation, and building internal evaluation capacity. To better understand each approach, it is important to consider the purpose and context of the evaluation. This shifts some commonly held assumptions about internal and external evaluations. Re-examining these assumptions will help organizations make a more informed decision about an evaluation approach.Originality/valueThe field of evaluation is particularly concerned with evaluation use. Most of the literature on this has focused on the approach of individual evaluators, and insufficient attention has been paid to the institutional architecture of the evaluation. This article considers how some of the organisational structures around an evaluation contribute to evidence use, and the case study of South Africa also shifts the focus to the central but overlooked role of context in the debate.     

论我国刑事证据展示制度的确立--以公正、效率为视角

公正与效率既是刑事诉讼的基本价值目标,也是我们分析和研究刑事诉讼相关问题的一种基本方法。而刑事证据展示制度的确立对刑事诉讼中公正与效率的实现有着十分重要的意义。以刑事诉讼公正与效率价值目标为视角,通过对刑事证据展示制度与公正、效率价值目标关系的分析,指出了我国目前刑事证据展示制度在实现公正与效率价值目标方面存在的问题,并对如何确立我国的刑事证据展示制度提出了一些设想。     

英国刑事相似事实证据规则的新发展——以《2003年刑事审判法》为基点

自《2003年刑事审判法》颁布以来,英国刑事相似事实证据规则发生巨大变革。新法将相似事实证据归于不良品格证据项下,并废除了普通法上的相似事实证据规则,改而以类型化的一般相关性为可采性标准,并辅以详尽的采纳程序。这虽然改变了普通法严格的可采性标准,限制了法官的自由裁量权,却大大简化和统一了相似事实证据规则的适用,也促进司法公正的实现。     

Promoting Children's Welfare by Inter‐professional Practice and Learning in Social Work and Primary Care

Social work in the United Kingdom is an activity that benefits from, and often requires, co‐operation between different staff and across different professions. How this is to be achieved has been a central dilemma for practice and policy for many years. Primary care health services often play a key role. New policy and practice developments are designed to promote inter‐professional working with children, where research has shown significant problems in the community‐based health care of looked after children, children leaving care, and children at serious risk. There is, however, little evidence from research that supports current developments in inter‐professional practice; analysis of the particular nature of the inter‐professional problems is lacking, as are therefore the relevant inter‐professional solutions. A framework for better analysis, linked to developments in practice‐based research, one that would yield significant improvements for children's welfare, is presented here.     

中国古代的证据制度及其特点

中国古代司法的证据主要分为七种,但存在证据制度上的先天不足,表现在与西方重神判的宗教传统不同,中国审判重人判,重视口供与刑讯逼供的采用等。与西方法律相比较,中国古代的证据制度内容比较简单,加上证据采集手段的简单粗糙,官员注重自由心证,导致刑讯逼供频繁,冤假错案时有发生,证据制度应有的功能与作用发挥得并不充分。     

口述历史在美国刍议

口述历史资源反映的是大众文化和大众记忆内容，收集整理这方面资源，有助于增强公民道德意识及其自觉的社会主人翁态度。为了准确深入地再现口述历史，发挥口述资源的作用，历史学者在尊重史实并不断提高史料分析技能的前提下，善于去捕捉有用信息，把握好与被采访者在思想情感上进行沟通与交流的契机。口述历史应被积极运用到体察民意和改善社会环境的工作当中去。     

Evidence-based practice: from medicine to social work

The last 10 years have witnessed an increasing interest in evidence-based practice in the field of medicine. The product of a time characterised by the explosion of information technology, a heightened sense of risk, and the enshrining of the principles of economy, effectiveness, transparency and consumerism, evidence-based practice has rapidly expanded from medicine to other fields, including social work. The new paradigm has generated not only great enthusiasm in many areas of the social work profession but also an intense debate about the transferability of the principles of evidence-based practice from medicine to a discipline that operates amidst particularly complex and multifaceted societal factors. Similarly, the concept of evidence upon which social work practice should be based has been the object of considerable discussion, though initial emphasis on results from randomised controlled trials seems to be gradually shifting towards broader approaches to defining evidence. Although organisational constraints and job pressures are likely to favour the use, among practitioners, of ‘preappraised’ resources, this should not prevent social workers from acquiring the skills and knowledge necessary to make independent and critical appraisal of evidence.     

The truth and lie story: developing a tool for assessing child witnesses' ability to differentiate between truth and lies

Within the court arena, the credibility and competency of child witnesses often comes under scrutiny and the decision whether a child is considered to be credible or not strongly in?uences whether their evidence will be heard by the court. A child's ability to demonstrate that they understand the difference between truth and lies and the importance of telling the truth is synonymous with competency. Research suggests that many professionals undertaking the task of establishing competency ?nd it very dif?cult, especially with younger children (Aldridge and Wood, 1997, cited in Aldridge and Wood, 1998). This paper describes the process involved in developing an innovative tool for helping professionals assess whether a child understands the difference between truth and lies. The development of the tool arose from the concerns of of?cers from Northumbria Police Force (in the UK) relating to interviews following the protocol of the government's Memorandum of Good Practice (Home Of?ce and Department of Health, 1992) on interviewing child witnesses, and the need to establish whether child witnesses can differentiate between truth and lies. As an example of good practice, The Truth and Lie Story described here has now been included in the Home Of?ce (2002) guidance Achieving Best Evidence in Criminal Proceedings, which is a revision of the 1992 Memorandum of Good Practice. Copyright © 2004 John Wiley & Sons, Ltd.     

论口供补强规则

本文认为确立口供补强规则是发现真实、保障人权的需要、通过口供补强规则的三个特征 ,对其必要范围以及补强证据的证明力及其证明程度进行了探讨