Jon
I tried your first question at clinical answers "In previously well adults
with chicken pox, should we be treating with antivirals? What about in
children under 1 year?
"
In less than 5 minutes on dynamic medical I got the response that there is
no evidence of benefit in children under the age of 2
In about 5 minutes on uptodate I got doses for immunocompetent adults and
children suggesting that acyclovir is effective
In less than 5 minutes I got the BNF which said that the illness was usually
mild form 1 month to 12 years did not warrant antiviral medications
I noticed you got your answer from Prodigy. Did you know that information
was there. Would that be a comprehensive site if you did not know something
was here. The answer to me requires a bit of common sense and a value
judgement. I am inclined to agree with the BNF/prodigy but acyclovir does
seem to be effective (albeit minor benefits) and none of the sources
quantified it.
The future lies with comprehensive sites that are quick to access and
updated regularly and have valid information and that is what we should be
showing trainees otherwise they will continue to ignore evidence based
practice in every day life. I don't know if you have looked at the above 2
sites but I expect you would be pleasantly surprised
Regards
Bruce Arroll
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jon Brassey
Sent: Monday, 18 July 2005 8:39 p.m.
To: [log in to unmask]
Subject: Re: dinsoaurs can turn into birds given the correct triggers for
gene expression
The simple fact is that the secondary literature, although large, still
scarsely covers the range of clinical questions.
I run 2 Q&A services for primary care (www.attract.wales.nhs.uk and
www.clinicalanswers.nhs.uk) and we've examined what resources were used in
our answer. In two separate evaluations (on the different services and 18
months apart) the number of questions that could be answer solely by
secondary material was 21%.
Cheers
jon
Dear All,
I agree with the comment about EBM teaching moving forward.
I have developed an EBM teaching programme for a graduate entry course. They
are training to be users of EBM (at the moment) so it made sense to start
with how to find relevant material. Hence we decided to start with
consideration of evidence-based guidelines and other ready appraised
sources, eg Clinical Evidence. There is now a wealth of ready appraised
sources so why expect clinicians to search primary literature? Would they
change their practice based on a single study found after a search in
Medline?
We have very limited teaching time for EBM so confine this to teaching a few
points about interpreting NNTs and sensitivity/specificity for example,
which are clinically useful (rather than say, the finer points of type 1
errors). Critical appraisal is extremely important for researchers and
specialists and those who are developing policies, but I wonder how
necessary this is in order to access ready appraised literature that can be
applied immediately? (or is that a sacrilegious comment?)
Incidently we also include our medical librarian in our teaching sessions
and she offers appropriate IT training if required. I'd be interested to
know if others use this strategy.
Elaine Bentley
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