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 keyÐ
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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