Elaine makes great points. The key thing is how to make librarians an integral part in the EBM process, in a timely fashion and who gets to decide what is the most important article ( generalist versus specialist versus librarians ).
The matter is more complex and the regular GP who has to see a battery of patient doesn't have that kind of time!
I thought Bill's article provided more insights in this process and having more questions is always helpful. Recent advances including using practice and system based approach and using the Chronic care Model will mane the practice of EBM both more important and challenging. While we figure out the different trees in the forest , I think approach to the whole forest remain the critical art of practicing EBM. A friendly dialogue would not only be idealistic but probably the most appropriate in this case.
Bottom line librarians remain the backbone of research and literature retrieval, but who helps the GP?
Amit K. Ghosh, MD, FACP
Associate Program Director
General Internal Medicine Research Fellowship
Mayo Clinic
W-17 B, GIM
200 1st ST. SW
Rochester, MN
507-538-1128 (Phone)
507-284-4959 (Fax)
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Alligood, Elaine C
Sent: Friday, July 15, 2005 9:30 AM
To: [log in to unmask]
Subject: Re: dinsoaurs can turn into birds given the correct triggers for gene expression
Gentlemen,
Martin Dawes mentions the need for collaboration between several groups of
people & roles in dealing with this information chaos. BUT no where does he
mention the MOST key role, that of the experienced medical librarian as a
member of the team. Call us informationist, information specialist, or
librarian, whatever--we are the GO-TO people for access to what you need to
know and what you don't know. WE do know where to go (it is our job!), how
to get there, and how to manage what is retrieved, and how to train you to
know when to do it yourself or call on us. Our profession has been an
integral part of the health care team for over 75 years.
And, I submit, we are even more critical to the HTA & EBM worlds as we do
rigorous research (and we publish it) on what works, what doesn't, what's
really in a resource, and what's not. Google Scholar being a fine example
of what is NOT a useful resource
http://www.cmaj.ca/cgi/content/full/172/12/1549?etoc
There is simply too much information out there to do it yourselves, the
information specialist's role is to train you how to do some of it
yourselves and how to know when you can't...AND then to provide it "just in
time" when you need us to do it. There will be no info panacea anytime soon
not from Google (who's revenue is from advertising not good deeds) or from
the for-profit publishers. In my opinion we need more information
specialists and librarians...NOT LESS.
And trust me on this...Summerskill's article is going to generate a storm of
responses in this vein. He is way off the mark and way out of touch with
the world of the HTA information specialists!
Elaine Alligood, MLS
Chair, HTAi Information Resources Group 2004,2005
[Medical Librarian for over 30 years]
VA Technology Assessment Program
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Martin Dawes
Sent: Friday, July 15, 2005 7:31 AM
To: [log in to unmask]
Subject: dinsoaurs can turn into birds given the correct triggers for gene
expression
Taking Bruce's penultimate sentence - every physician is already answering
all those questions but they just dont necessarily use the best sources BUT
they do use the most practical (colleagues,books and memory). Our job is to
develop, test and provide systems that do supply answers that are available
just as quickly and evidence transparent.
As medicine becomes more complex and as the knowledge increases we need
systems to deal with this. The systems are not here today but they will
come. It will need collaboration between publishers of books (on line or
paper) and journals, researchers, academics and clinicians. As a lot of
answers need to be context specific, eventually everyone is involved - even
the dinosaurs.
Martin
----- Original Message -----
From: "Bruce Arroll" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, July 15, 2005 5:38 AM
Subject: Re: Efficient retrieval - a means to "close evidence gap"?
Dear all
I think we need to seriously consider the evidence based electronic
textbooks and teach our students to know what is high quality evidence and
what is not. As a clinician in primary care I need answers in minutes. It is
not possible to spend hours trying to find an answer when I can go to
www.dynamicmedical.com or uptodate.com and get an evidence based answer
within minutes. Front line clinicians need comprehensive information (the
answer needs to have a high probability of being there), that is quick and
high quality. They also need critical appraisal skills to know what is good
but it is dinosaur country to expect front line clinicians to spend hours
looking for answers. That approach does not fit the workplace ok for
teaching but no go in the everyday world
Regards
Bruce Arroll
University of Auckland
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Dean Giustini
Sent: Friday, 15 July 2005 11:53 a.m.
To: [log in to unmask]
Subject: Efficient retrieval - a means to "close evidence gap"?
Dear list,
We are currently doing some research on the most efficient means of
closing the evidence to practice gap. Specifically we are interesting in
exploring whether efficient retrieval (or lack thereof) is a significant
barrier to evidence based practice. Your thoughts please.....!
Health librarians are arguably the experts at locating the right
information, at the right time, in the right format for users. (ie. See:
W Summerskill "Literature searches: look before you leap." Lancet. 2005
Jul 2;366(9479):13-4.) The question is: how practical is it to involve
librarians in answering ALL clinical questions? Is it likely that
clinicians can learn these skills and should librarians continue to
teach them - or could there be a better way?
One suggestion is that Google & Google Scholar might be ONE way. (I use
these examples of free, unfettered and currently unwieldy tools because
they are the most popular). Clinicians often begin their search for best
evidence with a tool that consumes the least amount of time (ie. ease of
use "availability heuristics"), and produces satisfactory, high quality
evidence.
If Google and Google Scholar's search features were optimized and
improved, and indexed content included the world's evidence, wouldn't
this be a step forward for the EBM movement? Are librarians afraid of
letting the search giant take on this role?
Dean Giustini
University of British Columbia
UBC Biomedical librarian
Vancouver Canada
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