Ahmed…
I have been thinking about this for some time because the situation is
exactly as you describe with people I interact with also. I try showing
them about CASP which helps some. I originally attempted Equator
guidelines but they were too complex for the people and the time they
have. It is faster to do this for them but I am only beginning this
journey and taking this route doesn't solve the need it just shifts the
labor.
Added to this their patients are complex so it is frustrating and many
have no idea what even a nomogram is or how to use it. WE do need some
solutions because Up to Date is not enough…I used to think that if it was
in a good journal that was enough, I did notice the word and meted trend
bias without the requisite actions attached. If I got the feeling it was
inaccurate I considered it was only because I was a novice, it is a
complex problem…I am glad it has come up for discussion.
Neil you are so right, patients deserve better and so do clinicians
Amy
On 4/12/12 3:33 PM, "Ahmed Abou-Setta, M.D." <[log in to unmask]> wrote:
>Well Amy (and others), it's just a shift in the language used to describe
>research (in order to get it recognized and published). No one really
>writes
>narrative reviews, they are all now "systematic reviews", even if they are
>not systematic... but that's what the consumers want to read. Researchers
>are marketing their products (publications) to unfortunately unaware
>population of physicians who don't have time to critically appraise
>evidence. Most trials I review on a daily basis do not describe their
>methods in any real way to allow for a proper appraisal. They use big
>words
>like "random" and "double-blind" and the reader is expected to bow down to
>their highnesses and accept that they even know what the meaning of random
>is or how to properly blind participants/ investigators/ assessors. In the
>medical literature, researchers have to market their results so they can
>ride the publication bias wave and get published in top journals.
>Clinicians
>(like all humans) by nurture have been taught to be look for associations
>between objects. In this case, we associate 'good evidence' with top
>journals, systematic reviews, and 'level I evidence' even if we don't
>understand why one trial publication falls under one category versus
>another. My statements are general, and I know that there are some
>exceptional clinicians/researchers out there, but unfortunately the
>majority
>of clinicians don't have the protected time to do research or evaluate
>published research. I know of people who actually come into work an hour
>or
>two before everyone else just to have some quiet time for catching up on
>new
>research. Of course that's time away from the rest of their lives. It's a
>tough balance, but there has to be a better plan for teaching clinicians
>about what EBM/EBHC is, and how to incorporate this in their everyday
>practice.
>
>Ahmed
>
>-----Original Message-----
>From: Evidence based health (EBH)
>[mailto:[log in to unmask]] On Behalf Of Amy Price
>Sent: Thursday, April 12, 2012 1:10 PM
>To: [log in to unmask]
>Subject: Re: Definitions of EBM/EBP
>
>In the USA many I associate with or know from groups either make the false
>assumption that EBM EBHC is RCT level 1A or nothing. Or they call anything
>they produce evidence and say because we produced a study the product is
>evidence based. Finding evidence takes them weeks unless it is their
>specific topic and then they know this because they review for major
>journals. Expert, disciplined, accountable selection is the keyŠ
>
>Amy Price
>
>On 4/12/12 1:38 PM, "Djulbegovic, Benjamin" <[log in to unmask]>
>wrote:
>
>>
>>I was really referring to CONSCIOUS selection of evidence (obviously in
>>support of particular view, which is the main reason for such massive
>>overuse of treatments and tests)...
>>
>>
>>-----Original Message-----
>>From: Jim Walker [mailto:[log in to unmask]]
>>Sent: Thursday, April 12, 2012 1:33 PM
>>To: Djulbegovic, Benjamin; [log in to unmask]
>>Subject: Re: Definitions of EBM/EBP
>>
>>Although a cognitive psychologist or behavioral economist might point
>>to evidence that no practice or other thought is possible without
>>selection (both pre-conscious and conscious) from among the information
>available.
>>
>>
>>Perhaps the relevant distinction is between relatively expert,
>>disciplined, accountable selection and relatively naive, ad hoc,
>>implicit selection.
>>
>>
>>See Norretranders (1991) The User Illusion, which focuses on selection
>>directly or Kahneman (2012) Thinking, Fast and Slow for a more recent
>>and authoritative summary of the literature.
>>Jim
>>
>>James M. Walker, MD, FACP
>>Chief Medical Information Officer
>>Geisinger Health System
>>
>>The best way to predict the future is to invent it.
>> - Alan Kay
>>>>> "Djulbegovic, Benjamin" 04/12/12 1:18 PM >>>
>>
>>Indeed, SELECTIVE use of evidence is greater threat to the practice of
>>medicine than not consulting evidence resources at all!
>>bd
>>
>>From: Evidence based health (EBH)
>>[mailto:[log in to unmask]] On Behalf Of Ash Paul
>>Sent: Thursday, April 12, 2012 1:13 PM
>>To: [log in to unmask]
>>Subject: Re: Definitions of EBM/EBP
>>
>>Dear Rakesh,
>>
>>Your comment 'Is it possible that most practitioners would love to
>>understand EIP as (B) practice informed on the cumulation/totality of
>>research but unfortunately often end up with (A) practice informed by
>>any piece (or pieces) of evidence' is not only very interesting but
>>also very relevant, especially for healthcare commissioners.
>>
>>You might find this 2009 article published in the 'Journal of Health
>>Sceinces Education' interesting:
>>Educational strategies to reduce diagnostic error: can you teach the
>>stuff?
>>http://www.isabelhealthcare.com/pdf/EducationStrategiesToReduceDiagnost
>>icE
>>rror.pdf
>>
>>The author Mark Graber refers to (here we go again, I'm wading into
>>Biblical controversy once more!) The 10 Commandments To Reduce
>>Cognitive Errors 1. Thou shalt reflect on how you think and decide.
>>2. Thou shalt not rely on your memory when making critical decisions.
>>3. Thou shalt make your working environment information-friendly by
>>using the latest wireless technology such as the Tablet PC and PDA.
>>4. Thou shalt consider other possibilities even though you are sure of
>>your first diagnosis.
>>5. Thou shalt know Bayesian probability and the epidemiology of the
>>diseases in your differential diagnosis.
>>6. Thou shalt mentally rehearse common and serious conditions that you
>>expect to see in your specialty.
>>7. Thou shalt ask yourself if you are the right person to make the
>>final decision or a specialist after considering the patient¹s values
>>and wishes.
>>8. Thou shalt take time to decide and not be pressured by anyone.
>>9. Thou shalt create accountability procedures and follow up for
>>decisions made.
>>10. Thou shalt record in a relational data base software your patient¹s
>>problems and decisions for review and improvement.
>>
>>Leo Leonidas MD (Pediatrics, Maine)
>>Ref:
>>Trowbridge, R. (2008). Twelve tips for teaching avoidance of diagnostic
>>errors. Medical Teacher, 30, 496500.
>>
>>Regards,
>>
>>Ash
>>
>>
>>
>>From: Rakesh Biswas
>>To: [log in to unmask]
>>Sent: Thursday, 12 April 2012, 15:34
>>Subject: Re: Definitions of EBM/EBP
>>
>>Thanks Neil for this great discussion.
>>
>>Is it possible that most practitioners would love to understand EIP as
>>(B) practice informed on the cumulation/totality of research but
>>unfortunately often end up with (A) practice informed by any piece (or
>>pieces) of evidence.
>>
>>This is again possibly due to the fact that cumulation/totality of
>>research depends on 'as far as such cumulation exists' and is
>>accessible to the practitioner?
>>
>>regards, rakesh
>>
>>
>>
>>
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