If carefully done, (critically appraised topics) CATs or summaries of
evidence produced by groups or individuals in various areas of health
care could be very useful. There is an increasing number of web sites
with CATs in various specialties and in general medicine. We are in the
process of putting our own neurological CATs in web. The main caveat is
that CATs are not usually peer reviewed and one is left with some unease
about their validity. One trusts one's own CATs, but perhaps not so
wholeheartedly those produce by others. Yet, production of a good CAT
requires a substantial amount of work and there is no reason why these
could not be used as bona fide evidence summaries.
Any suggestions on how to increase the validity of CATs, and increase
the use of banks of CATs produced by others?
Sam Wiebe
Toby Lipman wrote:
>
> In message <[log in to unmask]>, padmanabhan
> badrinath <[log in to unmask]> writes
> >Dear All,
> >
> >Greetings from Al-Ain the oasis city. I just returned from OMAN (our
> >neighbouring country) where I acted as a facilitator in the just concluded
> >EBM workshop which was well attended. We had experts from both sides of the
> >atlantic (Oxford & McMaster) as facilitators.
> >
> >I got the impression that now there is a move to move towards preprocessed
> >information (Cochrane, Clinical evidence, ACP journal club and Up to date).
> >Please see http://bmj.com/cgi/content/full/320/7240/954
> >
> >Although I agree with this in principle I am of the opinion that as all
> >these resources have to be paid for (by some one) it may not be easily
> >available to all. Hence I feel that sources in the public domain (clinical
> >query in PubMed, National guideline clearing house and possibly others)
> >should still be an option when looking for evidence.
> >
> There are two issues here:
>
> 1) should preprocessed evidence be the main source of information for
> EBM?
>
> 2) how should it be made available (and indeed how should primary source
> information be made available?)
>
> So far as 1 is concerned I personally tend to use the Cochrane Library
> in particular in most cases because of the clarity and tight definition
> of the questions and the ease with which one can access summaries of the
> numerical values of outcomes studied. Of course one has to depend on the
> quality of the review in the first place (which is usually at worst
> acceptable) and take it on trust that the figures reported are valid.
> Clinicians do not have the time to critically appraise all studies in a
> systematic review, so validity cannot be assessed in detail from a
> Cochrane review - however since we are usually concerned with
> applicability, and the reviewers usually make helpful comments, this is
> not a problem in practice.
>
> However there are situations where your queston is not addressed by a
> Cochrane review and you need to do a Medline search. Many treatments are
> still used that are justified by tradition and expert opinion. For
> example a patient came to see me with an exacerbation of Meniere's
> disease and told me that her consultant years ago had prescribed
> Naftidrofuryl Oxalate which had worked well. I did a Medline search and
> found only one or two small trials, apparently of poor quality and a
> couple of expert reviews that mentioned it as one of the treatments for
> Meniere's. I was not able to access the full texts and could only
> conjecture that there was not strong evidence to support the
> intervention. So what do you do then? (I prescribed it and asked her to
> come back and let me know if it worked in a very informal n-of-1 trial)
>
> This partly bears on 2. It is now technicaly possible for all clinicians
> to have online access not only to the Cochrane Library, but to textbooks
> and full texts of original papers. However (with the noble exception of
> the BMJ) most journals charge for online access and it is beyond the
> means of many clinicians to pay for the access. I believe that the WHO
> should encourage governments around the world to pay for access to
> online evidence and make this available free of charge to clinicians in
> all countries (and indeed to the general public). In comparison with
> other government expenditure this would be laughably cheap, yet would be
> of great value for health care. Certainly it would seem more effective
> than expecting each health care organisation to make its own
> arrangements (with much of the funding ultimately coming from
> governments anyway). Here the UK has made a good start with the National
> Electronic Library for Health and the NICE website.
>
> best wishes to all
>
> Toby
> --
> Toby Lipman
> General practitioner, Newcastle upon Tyne
>
> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>
> Northern and Yorkshire Evidence-Based Practice Workshops
>
> http://www.eb-practice.fsnet.co.uk/
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