Thanks Ben.
EBM is here to stay but we are constantly forced to challenge almost all aspects of its
Tenets.
The 5 A's recommended by Chris De Mar, Paul and Dan from last year's BMJ, i.e.,
Ask, access, appraise, apply and assess help in conceptualizing EBM, but it appears from current research that several of the tenets of EBM would be considered theoritical unless studied using the right methods( qualitative, educational research, complexity science, etc.). Applying quantitative methods may not adequately answer some of the questions.
We have found problems with applying facts all the A's at the field level, and for residents often UpToDate remains the fall back mechanism as they are unable to find answers quickly. Brian Haynes 4 S model is applicable though Decision aids are far from reality at presnet.Role modelling is also lacking in most centers.
Lots of material get published under the rubric of EBM and that remains a big issue.
I guess all of us are looking and working towards the next big break of, how to use EBM in clinical practice in a reliable, and consistent basis.
In the end we might be producing more physicians who are expert at critical appraisal but fall short in application of the information to their patients and result in variability of care. One can never treat a patient just by appraising a paper or knowing the evidence, the confidence comes with experience , a teachable skill called' meta-cognition,' in the ER literature. It would be interesting to get others thought on how they use EBM in clinical practice.
Amit K. Ghosh, MD
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Djulbegovic, Benjamin
Sent: Tuesday, August 09, 2005 11:28 AM
To: [log in to unmask]
Subject: Re: Is asking focussed clinical questions a waste of time?
not surprised at all- PICO is a normative concept, but MEDLINE or other major databases have not been developed to meet this requirement (I understand that the Cochrane Database will try to accommodate PICO concept, but I am not sure how far it is in development)
Benjamin Djulbegovic, MD,PhD
Professor of Oncology and Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Department of Interdisciplinary Oncology
SRB #4, Floor 4, Rm #24031 (Rm# West 31)
12902 Magnolia Drive
Tampa, FL 33612
Editor: Cancer Treatment Reviews (Evidence-based Oncology Section)
http://www.harcourt-international.com/journals/ctrv/
e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]]On Behalf Of Ben Skinner
Sent: Tuesday, August 09, 2005 11:34 AM
To: [log in to unmask]
Subject: Is asking focussed clinical questions a waste of time?
Dear all,
I have recently come across a piece of research by G Cheng looking at whether
there is a significant correlation between clinicians asking focussed clinical
questions (i.e. PICO format) and the success they have at finding the
information they need.
The reference is:
Cheng GYT (2004). A study of clinical questions posed by hospital clinicians.
Journal of the Medical Library Association, 92(4), pp. 445-457.
The conclusion that Cheng comes to is that whether clinicians structure their
query as a question or statement has no effect on their satisfaction with the
results, and neither does their use of the PICO structure. If this is true, it
strikes me as something that should have a big effect on the way people practice
and teach EBP. But I'm not sure that it's true.
I was wondering if anyone else out there had come across this paper, and whether
they had any comments? Has anyone thoroughly appraised the article? My
critical appraisal skills are not insignificant, but I don't have a research
background so tend to come unstuck once I reach a certain point. I suspect
there are some flaws with the validity of the conclusion, but I would love to
hear some viewpoints from those more experienced than me.
Thanks for your help,
Ben.
Ben Skinner
Evidence-Based / Knowledge Management Librarian
The Library
Audrey Emerton Building
Royal Sussex County Hospital
Eastern Road
Brighton BN2 5BE
(01273) 523 307 / RSCH x3307
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