Hi All,
I was about to ask a question somewhat related to Matt's so might as well
ask now:
Have there been any studies done to ascertain what type of evidence
CLINICIANS use?
To make it more specific - do they use synopsis, synthesized or studies in
real-time?
We see the immense popularity of the 'high-end synopsis' type sources such
as UpToDate. (some wonder whether they are more 'Eminence Based')
Has there been any studies comparing the above with integrated search
environments such as OVID where you can search Medline, EMBASE, EBMR
(including Cochrane), PsycInfo at once?
Or
if you are thinking of public domain resources - PubMed Clinical queries
(either systematic reviews or a specific study category?
Dan just wrote:
"How about if we call EBM just another way of saying that we are improving
the abilities of physicians to be good critical thinkers?....
The more critically we approach our own interpretation of the evidence, and
know when to let someone else (EBM leaders, drug companies, textbook
publishers) inform our thoughts about that, the better we can serve our
patients."
With TIME as a limiting factor can we expect the practising clinicians to
use at least 'PubMed Clinical Queries' / OVID? Or Does it matter very much
if they depend on UpToDate type of resources to advice the patients?
Kumara
-----------------------------------------------------
Dr. Kumara Mendis
MBBS, MSc (Medical Informatics), MD (Family Medicine)
Senior Lecturer
School of Rural Health
University of Sydney
Tel: +61 6885 7996
Mob:+61 427 141 112
-----------------------------------------------------
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Dan Mayer
Sent: Wednesday, 22 November 2006 2:09 AM
To: [log in to unmask]
Subject: Re: Accounts of Clinical Bases for weighing evidence
Hi Matt,
This is probably the BIG question in EBM. Is there an absolute value of any
evidence? Can we define it with a single number or classification system?
Or, as the postmoderns say, is all evidence so value laden as to be
basically meaningless EXCEPT in context, and then (in the extreme)
interpretable by anyone in any way.
Having said it this way, I tend to lean towards the postmodernists (never
thought that I would hear myself saying that) in that the value of any
evidence lies in the context in which it is interpreted and used.
Two IIa level studies may look at slightly different populations, slightly
different outcomes, or slightly different interventions. How we decide to
use them will depend on the context of our patient, and the values of our
patient, ourselves, and our society.
EBM cannot be a one size fits all. I have heard it said that "EBM does not
define truth, truth defines EBM". But what is truth? The eternal
philosopher's dilemma, or some objectivized outcome. After all, EBM is not
"paint by numbers", it is Renoir (or Seargent, Turner, Picasso, DaVinci,
etc.).
Not to be too nihilistic, but I think of EBM as a tool to reduce
uncertainty. To try to make a single definition of what is certain and not,
is doomed to failure. This is why the three (or four) intersecting circles
model of EBM (clinical evidence, clinical predicament, patient values and (+
/ -) clinical experience) works best for me. After all, it is our patients
who are going to be most affected by how we interpret the evidence and our
society that will pay for it. Even the idolized
(almost) RCT is prone to problems from lack of generalizability or
manipulation of input or output variables to improper interpretation of the
results.
How about if we call EBM just another way of saying that we are improving
the abilities of physicians to be good critical thinkers?
Does that help? We must all be able to interpret the overload of
information that we get every day and put it into perspective. Should
we use Recombinant Factor VIIa in non-hemopheliac patients with bleeding
(anywhere, but specifically in the head, or Iraq), or is the pro thrombotic
risk (heart attacks or strokes) too great? How about Silicone Breast
Implants, which are now off the FDAs banned list? These were both in the
news this week (and it is only Tuesday). What should we tell our patients?
Our interpretations of the evidence will inform
that discussion. The more critically we approach our own
interpretation of the evidence, and know when to let someone else (EBM
leaders, drug companies, textbook publishers) inform our thoughts about
that, the better we can serve our patients.
Sorry for this rant, but I had not said anything for a while, so I guess it
is about time.
Best wishes,
Dan
>>> Matt Williams <[log in to unmask]> 11/21/2006 9:36 AM
>>>
Dear List,
I was wondering if anyone knows (& could tell me) of any work that explores
how clinicians weigh evidence.
I am well aware of the levels of evidence, but there are times when this is
too blunt (e..g studies are both 2b but disagree) and I am looking fro any
evidence of how clinicians weigh up the options and what they consider
important (e.g. study size, journal of publication, etc.)
Thanks a lot,
Matt
--
http://acl.icnet.uk/~mw
http://adhominem.blogsome.com/
+44 (0)7834 899570
****************************************************************************
Dan Mayer, MD
Professor of Emergency Medicine
Albany Medical College
47 New Scotland Ave.
Albany, NY, 12208
Ph; 518-262-6180
FAX; 518-262-5029
E-mail; [log in to unmask]
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