No answers to the important questions raised, but I wanted to second and perhaps
expand on the points made by Prof Biswas regarding the risk of a certain
misapplication of 'EBM-ology' wherein findings are often labeled and swallowed
as 'evidence-based' with a minimal appreciation for how the strength of the
evidence is determined. The Greeks had characterized this (someone here will
correct me I am sure, if the reference is wrong!) 'apistia' or despair that
results from a lack of engagement with the process of reasoning by which
conclusions are arrived at: practitioners who feel excluded and unable to
engage with critical appraisal are at risk of losing faith with the inevitably
changing 'evidence-based' conclusions. How to engage in this process within
time constraints is a challenge. My current solution is to sign on as a
sentinel reader for the McMaster MORE
system(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&do).
-Best,
Vinod Srihari, M.D.
Assistant Professor
Department of Psychiatry
Yale University School of Medicine
Staff Psychiatrist
Connecticut Mental Health Center
34 Park Street
New Haven, CT 06519
Quoting Rob Mullen <[log in to unmask]>:
> We have some (unpublished) data that may shed some fairly sobering light
> on some of these questions, particularly clinicians and math. Now,
> clinicians, in my context means Master's-degree-level speech-language
> pathologists in the U.S. I believe they are more commonly known as
> speech therapists in the UK. In 2005, we conducted a
> Knowledge-Attitudes-Practices survey (n = about 600), and some of the
> findings included:
>
>
>
> 12% were "very comfortable" in their ability to identify the study
> design in a journal article.
>
>
>
> 14% were "very comfortable" in their ability to assess the quality of a
> journal article. Yes, even basic math tells us that some folks feel
> their inability to identify the study design doesn't stand in their way
> of assessing the quality of a study!
>
>
>
> 13% felt that their "inability to interpret published research"
> constituted a "major barrier" to their ability to engage in
> evidence-based practice. One would have thought that this figure would
> have been closer to the 80%+ of respondents who had difficulty with the
> previous two items. Instead, there seems to be the view that
> peer-reviewed scientific evidence is somehow only at the margins of
> evidence-based practice.
>
>
>
> I'd add more, but suddenly am feeling very depressed and need to lie
> down!
>
>
>
> -Rob
>
>
>
>
>
>
>
> Rob Mullen
>
> Director
>
> National Center for Evidence-Based Practice in Communication Disorders
>
> American Speech-Language-Hearing Association
>
> 10801 Rockville Pike
>
> Rockville, MD 20852
>
> voice: 301-897-5700 ext. 4265
>
> fax: 301-468-9742
>
> e-mail: [log in to unmask]
>
>
>
>
>
>
>
> ________________________________
>
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Rakesh Biswas
> Sent: Wednesday, July 05, 2006 12:12 AM
> To: [log in to unmask]
> Subject: Re: Real world EBM
>
>
>
> Thanks Sachin, for your input. I agree with your views and the fact that
> EBM stands the danger of getting increasingly divorced from practical
> realities. One reason for this may be because most physicians treat the
> evidence in journals as black boxes and just gulp whatever is fed to
> them (again is it often just because of the time constraints?). What is
> needed is understandable evidence that is not only just dressed up fast
> food (like uptodate) but also tells us how the evidence was
> collected/synthesized in an "understandable real world language". Most
> clinicians are sceptical of evidence from studies because they keep
> changing so very rapidly almost turning 180 degrees at times that
> suggests that many of them were faulty or our interpretations were
> faulty to start with (all that observational beliefs getting swept away
> by rcts etc) . However clinicians are helpless as they are unable to
> interpret the evidence (exactly how the results were calculated--this is
> one area where the most astute evidence based clinician finally hands
> over the baton to the statistician-mathematician in effect perpetuating
> a grey area). But then how does one translate mathematical language into
> english?
>
> I may be wrong and would be happy to get corrected (especially about the
> clinician's weaknees in math part).
>
>
>
>
>
>
>
> Rakesh Biswas MD
> Associate professor,
> Department of Medicine,
> Melaka-Manipal Medical College
> Jalan Batu Hampar, Bukit Baru,
> 75150 Melaka, Malaysia
> Phone: 60-6-2925851-extn 1151 (office) and 2001 (residence)
> Fax: 60-6-2817977/60-6-2925852
> Mobile: 60-16-6434253
> Email: [log in to unmask]
> http://www.manipal.edu/melaka/departments/departments.htm
>
>
>
>
> On 7/5/06, Sachin Dave <[log in to unmask]> wrote:
>
> I had deeply drowned myself in to EBM (teaching EBM) as long as I was in
> an academic setting. Life changed when I joined a multi speciality group
> and a very busy practice. As a young physician and a father of 10 yr.
> old and 8 yr. old life is hectic in private practice.
>
>
>
> I am a physician who had studied EBM well and valued it ( published a
> meta-analysis in SGM journal). I find EBM loosely and widely abused by
> many including academically well placed techers and pharmaceutical
> industry.
>
>
>
> I strongly feel the following:
>
>
>
> 1. Practicing EBM in a private practice by 80-90% of the physicians is
> practically impossible. Unfortunately the reality is there is no
> reimbusement for the time and effort a physician has to place in
> 'application' of EBM. In real world a phyisician does not have time to
> keep up with latest advances in Medicine, let alone read and critic a
> paper. Resources like UptoDate and ACP online though not perfect come
> close to allow a physician to practice as much of a EBM as possible.It
> is the responsibility of Academic Centers to design and conduct sound
> clinical trials or act as watch dogs for the evolving science and
> provide a 'map' of practice of EBM. I sometimes doubt the integrity of
> responsibe watch dogs in serving as a guiding light for the practice of
> EBM-- gloring example being vioxx.
>
>
>
> 2. As you see more and more patients and volume of patient load
> increases, the "Art of Medicine" takes precedence over the science. The
> same art that our forefathers developed over the centuries (when EBM
> was non existent). And practically speaking the science many times DOEs
> Not and WILL NOT replace the 'art of patient care'. The science learned
> with astute observations made by a clinician at the bedside, learning
> from it, over and over again and applying it with various modifications
> to patient care is non replaceable. EBM serves to provide general
> guidelines, the art of science differentiates a clever and astute
> physician form a ordinary one. However smart a person is , 'the
> experience of the practice of medicine'- the art cannot be acquired
> without the repetitive bedside practice (eyes and mind open for learning
> and innovations) of medicine.
>
>
>
> Let a debate take place as to how best can EBM be taken form Ivory
> Towers of Academic Centers in to the "heart" of real life practice of
> EBM. Let a debate take place as to how the term EBM not be abused by
> sales reps., the respected faculty members of academic institutions and
> private practice paid as consultats to enhance what is exactly opposite
> of EBM in name of EBM. Let a debate take place as to create honest
> centers of excellence of EBM with total integrity who can go and observe
> a busy practicing physician and develop ways to let them integrate EBM
> to their extremely important art of medicine.
>
>
>
> Sachin Dave, MD.
>
>
>
>
>
> Anne Peticolas <[log in to unmask]> wrote:
>
> Why is EBM important? So we don't have to read
> uncritically-presented
> stupid stories like this one:
>
> http://mp.medscape.com/cgi-bin1/DM/y/e4om0ItiQo0F6D0HfWO0G2
>
> ASBS MEETING COVERAGE
> Morbid Obesity Much More Risky Than Bariatric Surgery
> Morbidly obese patients who do not undergo weight-loss surgery
> face a
> substantially greater mortality risk than patients who undergo
> bariatric
> surgery, according to a presentation this week at the 23rd
> annual
> meeting of the American Society for Bariatric Surgery in San
> Francisco.
> Reuters Health Information 2006
>
> If one goes to the Medscape link, the presentation relies on
> comparing
> mortality among people who showed up at a clinic and eventually
> had
> bariatric surgery to those who came and were evaluated and did
> not.
> "Dr. Reinhold, chairman of the Department of Surgery at the
> Hospital of
> Saint Raphael in New Haven, Connecticut, and his colleagues
> reviewed the
> records of patients who were morbidly obese and had been seen in
> their
> clinic between 1997 and 2004. According to their meeting
> abstract, 1438
> patients were evaluated, and 207 never returned for surgery.
> During
> follow-up the investigators were able to contact 101 patients or
> their
> family members to document outcomes of those who went untreated.
> . ."
>
> regards,
> Anne Peticolas
> Austin, Texas
>
>
>
>
>
> ________________________________
>
> Do you Yahoo!?
> Everyone is raving about the all-new Yahoo! Mail Beta.
> <http://us.rd.yahoo.com/evt=42297/*http:/advision.webevents.yahoo.com/ha
> ndraisers>
>
>
>
>
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