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Paul
I think that these 2 papers should be in the running for best EBM methods papers for 2005:
(1) Chan AW, Altman DG Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ. 2005 Apr 2;330(7494):753. Abstract and full paper at http://jama.ama-assn.org/cgi/content/full/291/20/2457
(2) Peter Bogaty; James Brophy. Numbers needed to treat (needlessly?) The Lancet; Apr 9-Apr 15, 2005; 365, 9467.
ABSTRACT: We suggest a new index that is complementary to NNT. It could be called "numbers treated needlessly" (NTN). If NNT is 250, NTN would be 249; the higher the number, the greater the treatment burden. An NNT of 33 gives an NTN of 32, certainly better but a substantial burden nonetheless. Alternatively, NTN could be rendered as a percentage: if NNT is 250, 249 of 250 individuals or 99.6% are treated without benefit. This proportion could be called the "index of therapeutic impotence" (ITI). The ITI for an NNT of 33 would be 97.0%.
Michael Power
SCHIN
________________________________
From: Evidence based health (EBH) on behalf of EVIDENCE-BASED-HEALTH automatic digest system
Sent: Sat 04/03/2006 00:00
To: [log in to unmask]
Subject: EVIDENCE-BASED-HEALTH Digest - 27 Feb 2006 to 3 Mar 2006 (#2006-30)
There are 3 messages totalling 518 lines in this issue.
Topics of the day:
1. Best EBM methods papers for 2005?
2. Launch of the NLH Gastroenterology & Liver Diseases Specialist Library,
March 2006
3. Suggested EBM article per Paul Glasziou's suggestion
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Date: Fri, 3 Mar 2006 08:45:59 +0000
From: Paul Glasziou <[log in to unmask]>
Subject: Best EBM methods papers for 2005?
Dear All,
What do you think were the best EBM methods papers of last year? To
start the ball rolling, here are my two favourites: the first is now
our best evidence that EBM works (the E for EBM), and the second is a
major improvement in the "clinical queries" filters we use in PubMed.
1. Straus SE, Ball C, Balcombe N, Sheldon J, McAlister FA. Teaching
evidence-based medicine skills can change practice in a community
hospital. J Gen Intern Med. 2005 Apr;20(4):340-3.
OBJECTIVES: Several studies have evaluated whether evidence-based
medicine (EBM) training courses can improve skills such as literature
searching and critical appraisal but to date, few data exist on
whether teaching EBM skills and providing evidence-based resources
result in change in behavior or clinical outcomes. This study was
conducted to evaluate whether a multifaceted EBM intervention
consisting of teaching EBM skills and provision of electronic
evidence resources changed clinical practice. DESIGN: Before/after
study. SETTING: The medical inpatient units at a district general
hospital. PARTICIPANTS: Thirty-five attending physicians and 12
medicine residents. INTERVENTION: A multicomponent EBM intervention
was provided including an EBM training course of seven 1-hour
sessions, an EBM syllabus and textbook, and provision of
evidence-based resources on the hospital network. MEASUREMENTS AND
MAIN RESULTS: The primary outcome of the study was the quality of
evidence in support of therapies initiated for the primary diagnoses
in 483 consecutive patients admitted during the month before and the
month after the intervention. Patients admitted after implementation
of the EBM intervention were significantly more likely to receive
therapies proven to be beneficial in randomized controlled trials
(62% vs 49%; P= .016). Of these trial-proven therapies, those offered
after the EBM intervention were significantly more likely to be based
on high-quality randomized controlled trials (95% vs 87%; P= .023).
CONCLUSIONS: A multifaceted intervention designed to teach and
support EBM significantly improved evidence-based practice patterns
in a district general hospital.
2. Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR; Hedges
Team. Optimal search strategies for retrieving scientifically strong
studies of treatment from Medline: analytical survey. BMJ. 2005 May
21;330(7501):1179. Epub 2005 May 13.
OBJECTIVE: To develop and test optimal Medline search strategies for
retrieving sound clinical studies on prevention or treatment of
health disorders. DESIGN: Analytical survey. DATA SOURCES: 161
clinical journals indexed in Medline for the year 2000. MAIN OUTCOME
MEASURES: Sensitivity, specificity, precision, and accuracy of 4862
unique terms in 18 404 combinations. RESULTS: Only 1587 (24.2%) of
6568 articles on treatment met criteria for testing clinical
interventions. Combinations of search terms reached peak
sensitivities of 99.3% (95% confidence interval 98.7% to 99.8%) at a
specificity of 70.4% (69.8% to 70.9%). Compared with best single
terms, best multiple terms increased sensitivity for sound studies by
4.1% (absolute increase), but with substantial loss of specificity
(absolute difference 23.7%) when sensitivity was maximised. When
terms were combined to maximise specificity, 97.4% (97.3% to 97.6%)
was achieved, about the same as that achieved by the best single term
(97.6%, 97.4% to 97.7%). The strategies newly reported in this paper
outperformed other validated search strategies except for two
strategies that had slightly higher specificity (98.1% and 97.6% v
97.4%) but lower sensitivity (42.0% and 92.8% v 93.1%). CONCLUSION:
New empirical search strategies have been validated to optimise
retrieval from Medline of articles reporting high quality clinical
studies on prevention or treatment of health disorders.
Can you let us all know your favourites of 2005?
Best wishes,
Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055
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Date: Fri, 3 Mar 2006 17:41:00 -0000
From: "Tucker, Laura (MedLib Hampstead)" <[log in to unmask]>
Subject: Launch of the NLH Gastroenterology & Liver Diseases Specialist Library, March 2006
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I am pleased to announce the launch of the National Library for Health
Gastroenterology & Liver Diseases Specialist Library. The
Gastroenterology & Liver Diseases Specialist Library is now available
via the National Library for Health (http://www.library.nhs.uk/).
=20
=20
=20
National Library for Health Gastroenterology & Liver Diseases Specialist
Library
=20
The National Library for Health Gastroenterology & Liver Diseases
Specialist Library (GLDSL) will be formally launched at the British
Society of Gastroenterology annual conference Tuesday, 21st March 2006.
The GLDSL is available now via http://www.library.nhs.uk/gastroliver/.=20
=20
The Specialist Libraries are an integral part of the National Library
for Health (NLH), a library and information service for the NHS, aiming
to deliver a range of services on a 24x7 basis to support patient care,
staff development and research. For further information visit
http://www.library.nhs.uk/about/.The NLH Gastroenterology & Liver
Diseases Specialist Library (GLDSL) draws together resources and
information that is relevant, best evidence and current within these
specialties. Although targeted at health professionals it also serves to
inform patients and their carers.=20
=20
The GLDSL project team is based at the Royal Free Hospital. It is led by
Dr Martyn Caplin and is supported by information specialists from the
Royal Free Hospital Medical Library, UCL Library Services. The project
team works closely with an editorial board, topic leads and key
stakeholders.
=20
The GLDSL relies on feedback from its users to help it develop. If you
would like to contribute to the GLDSL please contact Laura Tucker
[log in to unmask] For further information please visit the
Gastroenterology & Liver Diseases Specialist Library
http://www.library.nhs.uk/gastroliver/.
=20
=20
=20
=20
Laura Tucker
=20
NLH Gastroenterology & Liver Disease Specialist Library=20
Royal Free Hospital Medical Library
=20
T: +44 (0) 20 7433 8570
M: +44 (0) 7949 635032
F: +44 (0) 20 7794 3534
E: [log in to unmask]
W: www.library.nhs.uk/gastroliver/
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<p class=3DMsoNormal><font size=3D2 face=3DArial><span =
style=3D'font-size:10.0pt;
font-family:Arial'>I am pleased to announce the launch of the =
</span></font><b><font
size=3D2 face=3DArial><span lang=3DEN-US =
style=3D'font-size:10.0pt;font-family:Arial;
font-weight:bold'>National Library for Health Gastroenterology & =
Liver
Diseases Specialist Library</span></font></b><font size=3D2 =
face=3DArial><span
lang=3DEN-US style=3D'font-size:10.0pt;font-family:Arial'>. The =
Gastroenterology
& Liver Diseases Specialist Library is now available via the =
National
Library for Health (<a =
href=3D"http://www.library.nhs.uk/">http://www.library.nhs.uk/</a>).<o:p>=
</o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
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<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
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<p class=3DMsoPlainText><b><font size=3D2 face=3DArial><span =
lang=3DEN-US
style=3D'font-size:10.0pt;font-weight:bold'>National Library for Health
Gastroenterology & Liver Diseases Specialist =
Library<o:p></o:p></span></font></b></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'>The National Library for Health =
Gastroenterology &
Liver Diseases Specialist Library (GLDSL) will be formally launched at =
the
British Society of Gastroenterology annual conference Tuesday, 21st =
March
2006. The GLDSL is available now via <a
href=3D"http://www.library.nhs.uk/gastroliver/">http://www.library.nhs.uk=
/gastroliver/</a>.
<o:p></o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'>The Specialist Libraries are an integral part =
of the
National Library for Health (NLH), a library and information service for =
the
NHS, aiming to deliver a range of services on a 24x7 basis to support =
patient
care, staff development and research. For further information visit <a
href=3D"http://www.library.nhs.uk/about/">http://www.library.nhs.uk/about=
/</a>.The
NLH Gastroenterology & Liver Diseases Specialist Library (GLDSL) =
draws
together resources and information that is relevant, best evidence and =
current
within these specialties. Although targeted at health professionals it =
also
serves to inform patients and their carers. =
<o:p></o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
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<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'>The GLDSL project team is based at the =
<st1:place
w:st=3D"on"><st1:PlaceName w:st=3D"on">Royal</st1:PlaceName> =
<st1:PlaceName w:st=3D"on">Free</st1:PlaceName>
<st1:PlaceType w:st=3D"on">Hospital</st1:PlaceType></st1:place>. It is =
led by Dr
Martyn Caplin and is supported by information specialists from the Royal =
Free
Hospital Medical Library, UCL Library Services. The project team works =
closely
with an editorial board, topic leads and key =
stakeholders.<o:p></o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'><o:p> </o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'>The GLDSL relies on feedback from its users =
to help it
develop. If you would like to contribute to the GLDSL please contact =
Laura
Tucker <a =
href=3D"mailto:[log in to unmask]">[log in to unmask]
</a>.
For further information please visit the Gastroenterology & Liver =
Diseases
Specialist Library <a =
href=3D"http://www.library.nhs.uk/gastroliver/">http://www.library.nhs.uk=
/gastroliver/</a>.<o:p></o:p></span></font></p>
<p class=3DMsoPlainText><font size=3D2 face=3DArial><span lang=3DEN-US
style=3D'font-size:10.0pt'><o:p> </o:p></span></font></p>
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Disease Specialist Library <o:p></o:p></span></font></p>
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face=3DArial><span
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<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3DArial><span
style=3D'font-size:10.0pt;font-family:Arial'>T: +44 (0) 20 7433 =
8570<o:p></o:p></span></font></p>
<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3DArial><span
style=3D'font-size:10.0pt;font-family:Arial'>M: +44 (0) 7949 =
635032<o:p></o:p></span></font></p>
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3534<o:p></o:p></span></font></p>
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Date: Fri, 3 Mar 2006 14:18:13 -0500
From: donald stanley <[log in to unmask]>
Subject: Suggested EBM article per Paul Glasziou's suggestion
To list server,
Alper BS, White DS, Ge B. Physicians answer more clinical questions and
>> change clinical decisions more often with synthesized evidence: a
> randomizedtrial in primary care. Ann Fam Med. 2005 Nov-Dec;3(6):507-13.
>>
>> PURPOSE: Clinicians need evidence in a format that rapidly answers their
>> questions. DynaMed is a database of synthesized evidence. We investigated
>> whether primary care clinicians would answer more clinical questions,change
>> clinical decision making, and alter search time using DynaMed in addition to
>> their usual information sources. METHODS: Fifty-two primary care
> clinicians naive to DynaMed searched for answers to 698 of their own clinical
> questions using the Internet. On a per-question basis, participants were
randomized to have access to DynaMed (A) or not (N) in addition to their usual
> information sources. Outcomes included proportions of questions answered,
proportions of questions with answers that changed clinical decision making, and
median search times. The statistical approach of per-participant analyses of
>> clinicians who asked questions in both A and N states was decided before
>> data collection.
RESULTS: Among 46 clinicians in per-participant
analyses, 23 (50%) answered a greater proportion of questions during A than
N, and 13 (28.3%) answered more questions during N than A (P = .05).
Finding answers that changed clinical decision making occurred more often
during A (25 clinicians, 54.3%) than during N (13 clinicians, 28.3%) (P =
.01).
Search times did not differ significantly. Overall, participants found
answers for 263 (75.8%) of 347 A questions and 250 (71.2%) of 351 N
questions.
Answers changed clinical decision making for 224 (64.6%) of the A questions
and 209 (59.5%) of the N questions.
CONCLUSIONS: Using DynaMed, primary care
>> clinicians answered more questions and changed clinical decisions more
>> often, without increasing overall search time. Synthesizing results of
>> systematic evidence surveillance is a feasible method for meeting
Clinical information needs in primary care.
>>
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End of EVIDENCE-BASED-HEALTH Digest - 27 Feb 2006 to 3 Mar 2006 (#2006-30)
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