 |
 |
Hello. These recent references might answer, in part, some of the questions below... Alper BS, White DS, Ge B. Physicians answer more clinical questions and change clinical decisions more often with synthesized evidence: a randomized trial in primary care.Ann Fam Med. 2005 Nov-Dec;3(6):507-13 Coumou HC, Meijman FJ. How do primary care physicians seek answers to clinical questions? A literature review. J Med Libr Assoc. 2006 Jan;94(1):55-60. Best wishes, Sharon Sanders University of Queensland Australia -----Original Message----- From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of K Mendis Sent: Wednesday, 22 November 2006 4:38 AM To: [log in to unmask] Subject: Re: Accounts of Clinical Bases for weighing evidence 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] ************************************************************************ **** ----------------------------------------- CONFIDENTIALITY NOTICE: This email and any attachments may contain confidential information that is protected by law and is for the sole use of the individuals or entities to which it is addressed. If you are not the intended recipient, please notify the sender by replying to this email and destroying all copies of the communication and attachments. Further use, disclosure, copying, distribution of, or reliance upon the contents of this email and attachments is strictly prohibited. To contact Albany Medical Center, or for a copy of our privacy practices, please visit us on the Internet at www.amc.edu.