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Commentary| Volume 62, ISSUE 5, P495-498, May 2009

A pragmatic resolution

      In this response to the mechanists [
      • Karanicolas P.J.
      • Montori V.M.
      • Devereaux P.J.
      • Schünemann H.
      • Guyatt G.H.
      The practicalists' response.
      ] we will first address what the mechanists have labeled as areas of possible disagreement and areas of clear disagreement. We will then describe what we believe is at the heart of our disagreement and conclude with what we consider to be a pragmatic resolution.
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      References

        • Karanicolas P.J.
        • Montori V.M.
        • Devereaux P.J.
        • Schünemann H.
        • Guyatt G.H.
        The practicalists' response.
        J Clin Epidemiol. 2008; 62 ([in this issue]): 489-494
        • Schwartz D.
        • Lellouch J.
        Explanatory and pragmatic attitudes in therapeutical trials.
        J Chronic Dis. 1967; 20 ([reprinted in this issue; J Clin Epidemiol 2009;62:499–505].): 637-648
        • Oxman A.D.
        • Lombord C.
        • Treweek S.
        • Gagnier J.J.
        • Maclure M.
        • Zwarenstein M.
        Why we will remain pragmatists: four problems with the impractical mechanistic framework and a better solution.
        J Clin Epidemiol. 2009; 62 ([in this issue]): 485-488
        • Tunis S.R.
        • Stryer D.B.
        • Clancy C.M.
        Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.
        JAMA. 2003; 290: 1624-1632
        • Sackett D.L.
        Explanatory versus management trials.
        in: Haynes R.B. Sackett D.L. Guyatt G.H. Tugwell P. Clinical epidemiology: how to do clinical practice research. Ed 3. Lippincott, Williams and Wilkins, Philadelphia, PA2006 (pp 183–8.)
        • Thorpe K.E.
        • Zwarenstein M.
        • Oxman A.D.
        • Treweek S.
        • Furberg C.D.
        • Altman D.G.
        • et al.
        A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers.
        J Clin Epidemiol. 2009; 62 ([in this issue]): 464-475
        • Caldwell D.M.
        • Ades A.E.
        • Higgins J.P.T.
        Simultaneous comparison of multiple treatments: combining direct and indirect evidence.
        BMJ. 2005; 331: 897-900
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • Jaeschke R.
        • Helfand M.
        • Vist G.E.
        • et al.
        Incorporating considerations of resource use.
        BMJ. 2008; 336: 1170-1173
        • Stephenson B.J.
        • Rowe B.H.
        • Haynes R.B.
        • Macharia W.M.
        • Leon G.
        Is this patient taking the treatment as prescribed.
        JAMA. 1993; 269: 2779-2781
      1. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review.
        JAMA. 2006; 296: 1094-1102
        • Oxman A.D.
        • Guyatt G.H.
        A consumers' guide to subgroup analyses.
        Ann Intern Med. 1992; 116: 78-84
        • Tukey J.W.
        Some thoughts on clinical trials, especially problems of multiplicity.
        Science. 1977; 198: 679-684
        • Karanicolas P.J.
        • Montori V.M.
        • Devereaux P.J.
        • Schünemann H.
        • Guyatt G.H.
        A new “mechanistic-practical” framework for designing and interpreting randomized trials.
        J Clin Epidemiol. 2009; 62 ([in this issue]): 479-484