Vinod
I agree...
While it's true that it takes a commitment of time and
will to be "evidence-based" (as well as a commitment
to seek out the QUALITY of the evidence behind an
"evidence-based recommendation"), it is also true that
ALL doctors pursue some form of learning - passive
attendance at lectures, reading articles here and
there, etc.
Really, it's a matter of each doc making the personal
decision to stay up to date on how the new knowledge
that they are "consuming" is derived, and taking a
questioning attitude in the adoption of new knowledge
- and, as you mentioned, being involved w/ some sort
of evidence-based resource, whether as a reviewer or
writer, helps.
MORE is certainly an excellent resource...
OThers to get involved in:
FPIN
Dynamed
Writing for "Cochrane for clinicians" for AFP
And I'm sure there are others....
BC
--- "Vinod H. Srihari" <[log in to unmask]> wrote:
> 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 We have some (unpublished) data that may shed some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>
> >
> >
> >
> >
>
>
> --
>
>
> Office: (203) 974-7816
> Fax: (203) 974-7502
>
Bill Cayley, Jr, MD MDiv [log in to unmask]
Augusta Family Medicine Home Address
207 W Lincoln 3433 McIvor St
Augusta, WI 54722 Eau Claire, WI 54701
Work: 715-286-2270 Home: 715-830-0932
Page: 715-838-7940 Cell: 715-828-4636
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