Dear All,
What do you think were the best EBM methods papers of last year? To
start the ball rolling, here are my two favourites: the first is now
our best evidence that EBM works (the E for EBM), and the second is a
major improvement in the "clinical queries" filters we use in PubMed.
1. Straus SE, Ball C, Balcombe N, Sheldon J, McAlister FA. Teaching
evidence-based medicine skills can change practice in a community
hospital. J Gen Intern Med. 2005 Apr;20(4):340-3.
OBJECTIVES: Several studies have evaluated whether evidence-based
medicine (EBM) training courses can improve skills such as literature
searching and critical appraisal but to date, few data exist on
whether teaching EBM skills and providing evidence-based resources
result in change in behavior or clinical outcomes. This study was
conducted to evaluate whether a multifaceted EBM intervention
consisting of teaching EBM skills and provision of electronic
evidence resources changed clinical practice. DESIGN: Before/after
study. SETTING: The medical inpatient units at a district general
hospital. PARTICIPANTS: Thirty-five attending physicians and 12
medicine residents. INTERVENTION: A multicomponent EBM intervention
was provided including an EBM training course of seven 1-hour
sessions, an EBM syllabus and textbook, and provision of
evidence-based resources on the hospital network. MEASUREMENTS AND
MAIN RESULTS: The primary outcome of the study was the quality of
evidence in support of therapies initiated for the primary diagnoses
in 483 consecutive patients admitted during the month before and the
month after the intervention. Patients admitted after implementation
of the EBM intervention were significantly more likely to receive
therapies proven to be beneficial in randomized controlled trials
(62% vs 49%; P= .016). Of these trial-proven therapies, those offered
after the EBM intervention were significantly more likely to be based
on high-quality randomized controlled trials (95% vs 87%; P= .023).
CONCLUSIONS: A multifaceted intervention designed to teach and
support EBM significantly improved evidence-based practice patterns
in a district general hospital.
2. Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR; Hedges
Team. Optimal search strategies for retrieving scientifically strong
studies of treatment from Medline: analytical survey. BMJ. 2005 May
21;330(7501):1179. Epub 2005 May 13.
OBJECTIVE: To develop and test optimal Medline search strategies for
retrieving sound clinical studies on prevention or treatment of
health disorders. DESIGN: Analytical survey. DATA SOURCES: 161
clinical journals indexed in Medline for the year 2000. MAIN OUTCOME
MEASURES: Sensitivity, specificity, precision, and accuracy of 4862
unique terms in 18 404 combinations. RESULTS: Only 1587 (24.2%) of
6568 articles on treatment met criteria for testing clinical
interventions. Combinations of search terms reached peak
sensitivities of 99.3% (95% confidence interval 98.7% to 99.8%) at a
specificity of 70.4% (69.8% to 70.9%). Compared with best single
terms, best multiple terms increased sensitivity for sound studies by
4.1% (absolute increase), but with substantial loss of specificity
(absolute difference 23.7%) when sensitivity was maximised. When
terms were combined to maximise specificity, 97.4% (97.3% to 97.6%)
was achieved, about the same as that achieved by the best single term
(97.6%, 97.4% to 97.7%). The strategies newly reported in this paper
outperformed other validated search strategies except for two
strategies that had slightly higher specificity (98.1% and 97.6% v
97.4%) but lower sensitivity (42.0% and 92.8% v 93.1%). CONCLUSION:
New empirical search strategies have been validated to optimise
retrieval from Medline of articles reporting high quality clinical
studies on prevention or treatment of health disorders.
Can you let us all know your favourites of 2005?
Best wishes,
Paul Glasziou
Department of Primary Health Care &
Director, Centre for Evidence-Based Practice, Oxford
ph: 44-1865-227055
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