Perhaps it does depend on who's seeking the answer to a question and the
environment in which the answer is sought.  With limited time at the point
of care the user will in practice often go straight to the information
source that seems reasonably trustworthy and that's perceived to provide the
quickest answer.  For the inexperienced/trainee clinician in this situation
with incomplete background knowledge, a more 'textbook' type of resource
with an answer set in the context of such background knowledge will often
seem more useful, whether or not we think the answer is truly
evidence-based.  More leisurely searching away from the heat of the moment
is another matter.

Ray

-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Lesley Kay
Sent: 25 October 2006 22:57
To: [log in to unmask]
Subject: Re: searching in EBM

I think this would be true for primary care probably not in a specialist
field where you have more context and background knowledge because you are
dealing with a much narrower set of facts/situations Lesley

On 25 Oct 2006, at 13:16, Underhill Jonathan wrote:

> Interesting stuff
>
> I actually think a slide based on this link:
>
> http://www.healthsystem.virginia.edu/internet/library/collections/ebm/
> pyramid.cfm
>
> may be more useful for practising clinicians (or students who want to 
> be able to apply this to their working lives). Here we start at the 
> top of the information pyramid with sources such as Cochrane and NICE 
> (where we 'trust' their methodology) and if we find the answer to our 
> clincial question we can stop there. Even if a new paper has been 
> published, how do we know it changes our practice without having the 
> time and effort to locate it (takes too long), appraise it (cant do
> it) and then put it into the context of the rest of the evidence.
>
> If the first step doesnt answer it, then 'drill' down to the next 
> level, and so on. The last port of call for busy clinicians looking 
> for information on common condiitions should be Medline (as you 
> usually end up with too much information and not enough time to assess 
> its relevance and validity)
>
> Thoughts?
>
>
> Cheers (8(|)
>
> Jonathan
>
> ---------------------------------------------------------------------
> Jonathan Underhill MRPharmS
> Assistant Director, Education and Development National Prescribing 
> Centre The Infirmary 70 Pembroke Place Liverpool
> L69 3GF
>
> Tel: 0151-794-8143
> Fax: 0151-794-8067
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>
> email: [log in to unmask]
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>
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> -----Original Message-----
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Jo Hunter
> Sent: 25 October 2006 12:19
> To: [log in to unmask]
> Subject: Re: searching in EBM
>
> I absolutely agree - without recognising what constitutes a "good" or 
> even appropriate primary study for your search question it would be 
> difficult to appraise a secondary source, which itself summarises and 
> evaluates primary studies. It would be slightly foolhardy to assume 
> that their methods are always completely unbiased. Also it may be 
> necessary to search for primary studies that have been written after 
> any secondary source(s) that you find, in case anything new has been 
> discovered since.
>
> Bibliographic databases (Medline, Embase etc..) support the use of a 
> search strategy  more effectively than a search engine, and  focus on 
> studies - both primary and secondary -  that have been published in 
> academic journals. Forgive these obvious points, but I'd certainly go 
> to the bibliographic databases and tripdatabase.com  before a search 
> engine if time is an issue.
>
> It's difficult to be prescriptive about resources, as that depends on 
> the nature of your search question. Perhaps searching in EBM is too 
> complex for a single slide?!
>
> Best wishes,
> Jo
>
> *******************************
> Jo Hunter
> Clinical Outreach Librarian
> (Emergency and Acute Care, Gastroenterology, Geratology, Paediatrics) 
> Oxford University Health Care Libraries John Radcliffe Hospital 
> [log in to unmask] [log in to unmask]
> 01865 740363
>
>
>
>>>> Rob Mullen <[log in to unmask]> 25/10/2006 04:50 >>>
> I certainly agree with the points raised by Dr. Basu. My first  
> reaction is that the slide is rather too complex for a PowerPoint  
> presentation. If your intention, though, is to use it as a handout to  
> which your students can refer, I think that might be more appropriate.
>
> You've certainly "opened a can of worms", to use some English slang,  
> in referring to "the most useful medical information". Many people,  
> and I definitely include myself, will want to engage in a prolonged  
> discussion of what that most useful information is, before we can even  
> get to the point of strategies to locate it. In my field, we typically  
> don't find our traditional paper textbooks terribly useful because of  
> the lengthy periods between updates and because they tend to reflect  
> the perspective of a single or small group of individuals rather than  
> a rigorous and objective assessment of all of the scientific evidence.
>
> My group tends to start out, in teaching EBM, with a focus on primary  
> studies, particularly how one can find and assess them. We certainly  
> acknowledge and encourage utilization of secondary sources when  
> available, but we think that's best done only after a thorough  
> grounding (or, more pragmatically, at least some exposure to) working  
> with individual primary studies. Certainly, the reality of clinical  
> life often makes reliance on these secondary sources - and thank  
> goodness for them - a necessity, but I would be reluctant to use them  
> as a jumping-off point.
>
> Best Wishes,
>
> Rob
>
>
> Rob Mullen
> Director
> National Center for Evidence-Based Practice in Communication Disorders  
> American Speech-Language-Hearing Association Rockville, Maryland,  
> United States
>
> ________________________________
>
> From: Evidence based health (EBH) on behalf of Dr. Carlos Cuello
> Sent: Tue 10/24/2006 6:37 PM
> To: [log in to unmask]
> Subject: searching in EBM
>
>
>
> I would like some feedback about this slide. Is for my class on how to  
> find
> the most useful medical information in my EBM courses.
>
> Comments are welcome.
>
> Carlos Cuello, MD
> Evidence-Based Medicine Group
> Tecnologico de Monterrey
> Escuela de Medicina, Campus de la Salud
> Morones Prieto 3000 pte. Col. Doctores 64710
> Monterrey NL, México
>
>
Lesley Kay	
Consultant Rheumatologist and Honorary Senior Lecturer
Freeman Hospital
Newcastle upon Tyne
NE7 7DN
0191 233 6161 x 37867 (Carole)