Dear martin and mailbase
I don't know if you have had a look at www.dynamicmedical.com or
www.uptodate.com but they are here and they are very evidence based and
clear when they are not. Last year uptodate said that their product had been
"endorsed" by Gordon guyatt. I checked with him and he felt that it was
reasonably evidence based and as you will know he is not the sort to easily
endorse anything. If you haven't seen these sites have a look. They all give
a free trial. I think the teaching of EBM needs to move forward and offer
front line clinicians the way to access comprehensive, valid and rapidly
acquired information and to know how to make sense of what is there. This is
not a turf war with librarians. Their task is to answer questions with
indepth searching and with a different time frame. Guideline developers,
Cochrane reviewers cannot do without them. But unless front line clinicians
get information quickly they won't do EBM. I am an editor for clinical
evidence and have suggested to them that they need to be more comprehensive.
I only go to clinical evidence if I know they have something on a topic. If
I don't I use dynamic medical or uptodate. As a challenge try and find out
in 5 minutes whether or not there is evidence about using coenzyme q10 in
patients with statin muscle aches. You can get that answer in 5 minutes on
uptodate. It would take a half day or longer to get that off medline. By
that time the next 20 patients will be waiting for you.
Regards
bruce
-----Original Message-----
From: Martin Dawes [mailto:[log in to unmask]]
Sent: Friday, 15 July 2005 11:31 p.m.
To: Bruce Arroll; [log in to unmask]
Subject: dinsoaurs can turn into birds given the correct triggers for gene
expression
Taking Bruce's penultimate sentence - every physician is already answering
all those questions but they just dont necessarily use the best sources BUT
they do use the most practical (colleagues,books and memory). Our job is to
develop, test and provide systems that do supply answers that are available
just as quickly and evidence transparent.
As medicine becomes more complex and as the knowledge increases we need
systems to deal with this. The systems are not here today but they will
come. It will need collaboration between publishers of books (on line or
paper) and journals, researchers, academics and clinicians. As a lot of
answers need to be context specific, eventually everyone is involved - even
the dinosaurs.
Martin
----- Original Message -----
From: "Bruce Arroll" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, July 15, 2005 5:38 AM
Subject: Re: Efficient retrieval - a means to "close evidence gap"?
Dear all
I think we need to seriously consider the evidence based electronic
textbooks and teach our students to know what is high quality evidence and
what is not. As a clinician in primary care I need answers in minutes. It is
not possible to spend hours trying to find an answer when I can go to
www.dynamicmedical.com or uptodate.com and get an evidence based answer
within minutes. Front line clinicians need comprehensive information (the
answer needs to have a high probability of being there), that is quick and
high quality. They also need critical appraisal skills to know what is good
but it is dinosaur country to expect front line clinicians to spend hours
looking for answers. That approach does not fit the workplace ok for
teaching but no go in the everyday world
Regards
Bruce Arroll
University of Auckland
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Dean Giustini
Sent: Friday, 15 July 2005 11:53 a.m.
To: [log in to unmask]
Subject: Efficient retrieval - a means to "close evidence gap"?
Dear list,
We are currently doing some research on the most efficient means of
closing the evidence to practice gap. Specifically we are interesting in
exploring whether efficient retrieval (or lack thereof) is a significant
barrier to evidence based practice. Your thoughts please.....!
Health librarians are arguably the experts at locating the right
information, at the right time, in the right format for users. (ie. See:
W Summerskill "Literature searches: look before you leap." Lancet. 2005
Jul 2;366(9479):13-4.) The question is: how practical is it to involve
librarians in answering ALL clinical questions? Is it likely that
clinicians can learn these skills and should librarians continue to
teach them - or could there be a better way?
One suggestion is that Google & Google Scholar might be ONE way. (I use
these examples of free, unfettered and currently unwieldy tools because
they are the most popular). Clinicians often begin their search for best
evidence with a tool that consumes the least amount of time (ie. ease of
use "availability heuristics"), and produces satisfactory, high quality
evidence.
If Google and Google Scholar's search features were optimized and
improved, and indexed content included the world's evidence, wouldn't
this be a step forward for the EBM movement? Are librarians afraid of
letting the search giant take on this role?
Dean Giustini
University of British Columbia
UBC Biomedical librarian
Vancouver Canada
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