Items 1-82 of 82
1: Acad Emerg Med 1992 Apr;11(4):1493-501

Erratum in:
Penicillin binding protein 2 is dispensable in Escherichia coli when ppGpp synthesis is induced.

Vinella D, D'Ari R, Jaffe A, Bouloc P.

Institut Jacques Monod, Universite Paris 7, France.

Mecillinam, a beta-lactam antibiotic which specifically inactivates penicillin binding protein 2 (PBP2) in Escherichia coli, prevents lateral cell wall elongation, inducing spherical morphology and cell death. Two mecillinam resistant mutants, lov-1 and lovB, both able to dispense entirely with PBP2, are shown here to be affected in the aminoacyl-tRNA synthetase genes argS and alaS, respectively. Although the argS and alaS mutants grow slowly, we show that there is no correlation between mecillinam resistance and either growth rate or translation speed. A role of the ribosomes in mecillinam sensitivity, suggested by our earlier report that the lov-1 mutation is suppressed by certain rpsL(StrR) alleles affecting ribosomal protein S12, is supported by the present observation that a pseudo-streptomycin dependent mutant is mecillinam resistant in the presence of streptomycin. The argS and alaS mutants have high pools of the nucleotide ppGpp (effector of the stringent response) and the mecillinam resistance of both mutations is suppressed by a relA mutation, inactivating the ribosome-associated ppGpp synthetase and preventing ppGpp synthesis in response to aminoacyl-tRNA starvation. Furthermore, a ptacrelA' multicopy plasmid makes a wild type strain mecillinam resistant. The effect of ppGpp is probably mediated by RNA polymerase, since sublethal doses of the polymerase inhibitor rifampicin suppress mecillinam resistance in argS, alaS and ptacrelA'-bearing strains. We conclude that ppGpp regulates the transcription of a gene whose product is involved in mecillinam sensitivity, possibly as part of a chain of interacting elements which coordinate ribosomal activity with that of the PBPs.

PMID: 1563353 [PubMed - as supplied by publisher]

2: Med Clin (Barc) 2001 Feb 24;116(7):267-270
Evidence-based clinical practice guidelines development. From the bottom, until the top

Browman G, Gomez De La Camara A, Haynes B, Jadad A, Gabriel R.

Departamento de Epidemiologia Clinica y Bioestadistica. Facultad de Ciencias de la Salud. Universidad de McMaster. Hamilton. Ontario. Canada.

PMID: 11333737 [PubMed - as supplied by publisher]

3: CMAJ 2001 Jan 23;164(2):250

Evidence-based medicine in the palm of your hand.

Greiver M.

Publication Types:
PMID: 11332324 [PubMed - in process]

4: Saudi Med J 2001 Apr;22(4):299-305

Problem-based learning. A critical review of its educational objectives and the rationale for its use.

Azer SA.

Medical Education, Faculty Education Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria 3010, Australia. Tel. +61 (3) 83448035. Fax. +61 (3) 83440188. E-mail: s.azer@medicine.unimelb.edu.au

Over the past 30 years there has been an increasing interest in curriculum innovation in medical schools in North America, the United Kingdom, Netherlands, and Australia. Since the introduction of problem-based learning at McMaster University in Canada in 1969, several medical schools throughout the world have adopted problem-based learning as the educational and philosophical basis of their curricula. Several studies have shown that problem-based learning is an important educational strategy for integrating the curriculum, motivating the students and helping them to identify their learning issues and set their own learning goals. However, there is a great deal of concern regarding what problem-based learning means and the advantages of problem-based learning over traditional curriculum have not been clearly addressed. In this review, a broad range of the definitions of problem-based learning have been addressed and the rationale for problem-based learning and its educational objectives are discussed.

PMID: 11331485 [PubMed - in process]

5: Qual Lett Healthc Lead 2001 Apr;13(4):12-3, 1

Health care consumers say they want to know more objective measures about quality.

Contrary to popular belief, average health care consumers are focused on more than just service quality and access to care when evaluating health care systems, hospitals, and providers. Instead, consumers are more likely to want objective measures of evidence-based care and clinical performance to help them better evaluate their health care providers, according to a new report, "Consumer Demand for Clinical Quality: The Giant Awakens," from VHA, Inc.

PMID: 11330225 [PubMed - in process]

6: J Health Polit Policy Law 2001 Apr;26(2):439-46

The politics of evidence-based medicine.

Rodwin MA.

Indiana University, USA.

PMID: 11330089 [PubMed - in process]

7: J Health Polit Policy Law 2001 Apr;26(2):327-68

Evidence-based medicine and the law: the courts confront clinical practice guidelines.

Rosoff AJ.

University of Pennsylvania, USA.

This article examines how courts are likely to apply evidence-based medicine, and particularly clinical practice guidelines (CPGs), in healthcare litigation involving quality-of-care and entitlement-to-benefits (coverage) claims. Exploring the "politics" of the current situation, it observes that, just as clinicians have been reluctant to use CPGs in practice, courts have been, and likely will continue to be, slow to apply them in deciding cases., The article analyzes extant and proposed statutory approaches to legitimizing and promoting courts' use of CPGs. It concludes by renewing the author's earlier and controversial proposal to establish a voluntary federal program for certifying guidelines and directing courts to give certified CPGs greater weight in healthcare litigation.

PMID: 11330083 [PubMed - in process]

8: J Health Polit Policy Law 2001 Apr;26(2):249-66

Proof and policy from medical research evidence.

Mulrow CD, Lohr KN.

University of Texas Health Science Center-San Antonio, USA.

When judging the benefits and harms of health care and predicting patient prognosis, clinicians, researchers, and others must consider many types of evidence. Medical research evidence is part of the required knowledge base, and practitioners of evidence-based medicine must attempt to integrate the best available clinical evidence from systematic research with health professionals' expertise and patients' rights to be informed about diagnostic and therapeutic options available to them. Judging what constitutes sound evidence can be difficult because of, among other things, the sheer quantity, diversity, and complexity of medical evidence available today; the various scientific methods that have been advanced for assembling, evaluating, and interpreting such information; and the guides for applying medical research evidence to individual patients' situations. Recommendations based on sound research can then be brought forward as either guidelines or standards, and criteria exist by which valid guidelines and standards can be developed and promulgated. Nonetheless, gaps and deficiencies exist in current guidelines and in the methods for finding and synthesizing evidence. Interpreting and judging medical research involves subjective, not solely explicit, processes. Thus, developments in evidence-based medicine are an aid, but not a panacea, for definitively establishing benefits and harms of medical care, and the contributions that medical research evidence can make in any clinical or legal situation must be understood in a context in which judgment and values, understanding of probability, and tolerance for uncertainty all play a role.

PMID: 11330080 [PubMed - in process]

9: Cochrane Database Syst Rev 2001;1:CD002213

Interprofessional education: effects on professional practice and health care outcomes (Cochrane Review).

Zwarenstein M, Reeves S, Barr H, Hammick M, Koppel I, Atkins J.

Health Systems Division, Centre for Epidemiological Research in Southern Africa, Medical Research Council, Fransie van Zyl Drive, PO Box 19070, Tygerberg, SOUTH AFRICA, 7505. merrick.zwarenstein@mrc.ac.za

BACKGROUND: As patient care becomes more complex, effective collaboration between health and social care professionals is required. However, evidence suggests that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way forward in this area. OBJECTIVES: To assess the usefulness of IPE interventions compared to education in which the same professions were learning separately from one another. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE (1968 to 1998) and Cinahl (1982 to 1998). We also hand searched the Journal of Interprofessional Care (1992 to 1998), the Centre for the Advancement of Interprofessional Education Bulletin (1987 to 1998), conference proceedings, the 'grey literature' held by relevant organisations, and reference lists of articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series studies of IPE interventions designed to improve collaborative practice between health/social care practitioners and/or the health/well being of patients/clients. The participants included chiropodists/podiatrists, complementary therapists, dentists, dietitians, doctors/physicians, hygienists, psychologists, psychotherapists, midwives, nurses, pharmacists, physiotherapists, occupational therapists, radiographers, speech therapists and/or social workers. The outcomes included objectively measured or self reported (validated instrument) patient/client outcomes and reliable (objective or validated subjective) health care process measures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the eligibility of potentially relevant studies. MAIN RESULTS: The total yield from the search strategy was 1042, of which 89 were retained for further consideration. However none of these studies met the inclusion criteria. REVIEWER'S CONCLUSIONS: Despite finding a large body of literature on the evaluation of IPE, these studies lacked the methodological rigour needed to begin to convincingly understand the impact of IPE on professional practice and/or health care outcomes.

PMID: 11279759 [PubMed - in process]

10: Cleve Clin J Med 2001 Apr;68(4):307, 311-3, 317

Finding evidence-based answers to clinical questions online.

Mehta N, Jain A.

Department of General Internal Medicine, Cleveland Clinic, USA.

You can find evidence-based answers to clinical questions quickly by searching online medical databases. The key is to be selective, on the basis of the type of information you need. Online textbooks, consensus guidelines systematic reviews, and MEDLINE are all available.

PMID: 11326810 [PubMed - in process]

11: J Calif Dent Assoc 2000 Feb;28(2):94

Evidence-based dentistry: a new tool for clinical decision-making.

Schonfeld SE.

PMID: 11323843 [PubMed - in process]

12: Arq Bras Cardiol 2001 Apr;76(4):343-6

Application of the principles of evidence-based medicine in programs to assess high-cost procedures and medications.

Bocchi EA, Marin Neto JA.

Universidade de Sao Paulo, SP, Brazil.

PMID: 11323739 [PubMed - in process]

13: Nurse Educ Today 2001 Apr;21(3):161-9

Meeting the challenge of problem-based learning: developing the facilitators.

Johnston AK, Tinning RS.

Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA, UK.

Problem-based learning methodologies are now extensively utilized within contemporary nursing curricula. One factor which has been found to be vital to the successful use of these methodologies is the effectiveness of the facilitator. For some teachers, the facilitation of problem-based learning tutorials demands a shift from teacher- to student-centred instruction; for others it requires continuing development of present practice. It is proposed that this transformation or modification of teacher practice can be achieved through the use of group reflection for teacher development. This paper suggests that a group reflective practice strategy for facilitator development is more likely to prepare teachers to meet the demands of problem-based learning than traditional forms of staff development.The strategy proffered for teacher development has two phases: phase one establishes the group and centres discussion on the practice of problem-based learning facilitation; phase two involves critical analysis of personal practice of facilitation in the context of problem-based learning with a view to increased self-knowledge, ultimately leading to a change in practice. Changes to personal practice will be sustained by repeated participation in phase two. Essential to this ongoing participation will be recognition and support from the host organization. Copyright 2001 Harcourt Publishers Ltd.

PMID: 11322806 [PubMed - in process]

14: J Am Med Inform Assoc 2001 May-Jun;8(3):289-90

Evidence-based nursing practice: a call to action for nursing informatics.

Bakken S, McArthur J.

Columbia University, New York, New York (SB).

PMID: 11320073 [PubMed - in process]

15: J Am Med Inform Assoc 2001 May-Jun;8(3):199-201

An informatics infrastructure is essential for evidence-based practice.

Bakken S.

Columbia University, New York, New York.

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.

PMID: 11320064 [PubMed - in process]

16: J Gen Intern Med 2001 Apr;16(4):244-9

Introduction of Evidence-based Medicine into an Ambulatory Clinical Clerkship.

Thomas PA, Cofrancesco J.

Received from the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md (PAT, JC).

Evidence-based medicine (EBM) has emerged has a critical clinical competency in the 21st century. Medical schools usually introduce students to critical appraisal in the preclinical years, but there have been few evaluated interventions in teaching EBM in the clinical years. We describe a strategy to encourage students to practice EBM during a required ambulatory medicine clerkship. During this clerkship, our students are required to submit an EBM report, which is prompted by an individual case, and structured with a 5-step approach. One small-group session is devoted to modeling this approach with a case of chest pain. Using a checklist to grade 216 consecutive EBM reports, we found that students were quite successful with the exercise, achieving on average 89.6% of possible checklist points. Students who followed the structure of the exercise closely were more likely to extend their discussions beyond that required and to suggest potential further areas of investigation or design.

PMID: 11318925 [PubMed - in process]

17: Cancer Nurs 2001 Apr;24(2):78-87

Research into practice: the foundation for evidence-based care.

Hunt J.

PMID: 11318265 [PubMed - in process]

18: Am J Ther 2000 May;7(3):149-50

Is the evidence right in evidence-based practice?

Somberg JC.

American Journal of Therapeutics, Lake Bluff, IL 60044, USA.

PMID: 11317162 [PubMed - in process]

19: J Indiana Dent Assoc 2000 Spring;79(1):6

Evidence-based care: a new formula for an old problem?

Steele DC.

PMID: 11314373 [PubMed - in process]

20: J Dent Hyg 2001 Winter;75(1):50-63

Evidence-based decision making in dental hygiene education, practice, and research.

Forrest JL, Miller SA.

National Center for Dental Hygiene Research, University of Southern California School of Dentistry, Los Angeles, California, USA.

PURPOSE: The purpose of this article is to highlight key aspects of the white paper prepared in 1999 for the American Dental Hygienists' Association (ADHA) Institute for Oral Health on Evidence-Based Decision Making and its Application to Dental Hygiene Education, Practice, and Research. These aspects include the need for evidence-based decision making, how it supports contemporary practice and education, basic evidence-based concepts, and strategies for integrating evidence-based decision making into dental hygiene. METHODS: A review of the biomedical literature, evidence-based Internet sites and textbooks, and clinical guideline development was systematically conducted to identify models of evidence-based practice, skills needed to practice and teach evidence-based decision making (EBDM), and challenges faced by those implementing an EBDM approach. These resources were then analyzed and synthesized to develop a model for initiating the development of evidence-based dental hygiene practice. RESULTS: The need for using an evidence-based decision making approach was well supported throughout the literature. Consistency was found in how EBDM methodology and levels of evidence were defined and in the skills required for evidence-based practice. Implied in the use of an evidence-based approach were corresponding requirements in three areas: 1) redesigning educational programs to better prepare students and current practitioners to integrate the most current knowledge into their clinical decision-making; 2) conducting research for areas in which evidence applicable to clinical practice is lacking or limited; and 3) designing more effective dissemination tools making relevant research findings more easily accessible and part of every day practice. CONCLUSIONS: Variations in practice patterns, difficulties in keeping current with the scientific literature, and providing students with knowledge, skills, and competencies necessary for contemporary practice are challenges facing the health care professions today, including dental hygiene. To address these problems, an evidence-based approach has been recommended by national organizations. This paper reviews the issues and proposes a model and strategies for engaging dental hygiene clinicians, educators, and researchers in EBDM. Those involved in each area will need training in EBDM concepts and skills before this approach can be fully integrated into education and practice or used to guide research activities. National leadership will be needed to coordinate and prioritize research strategies, promote curricular changes, and improve access to clinically relevant information so that an EBDM approach can become the norm in practice.

PMID: 11314227 [PubMed - in process]

21: Can J Surg 2001 Apr;44(2):95-100

Users' guide to evidence-based surgery: how to use an article evaluating surgical interventions. Evidence-Based Surgery Working Group.

Urschel JD, Goldsmith CH, Tandan VR, Miller JD.

Surgical Outcomes Research Centre, McMaster University, Hamilton, Ont. urschelj@mcmaster.ca

Publication Types:
PMID: 11308245 [PubMed - in process]

22: Med Ref Serv Q 2000 Fall;19(3):1-18

Evidence-based librarianship: searching for the needed EBL evidence.

Eldredge JD.

Collections and Information Resources Development, University of New Mexico Health Sciences Center Library, Albuquerque, NM 87131, USA. eldredge@salud.unm.edu

This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

PMID: 11299606 [PubMed - in process]

23: Med Ref Serv Q 1999 Fall;18(3):1-14

Ovid's evidence-based medicine reviews: a review of a clinical information product.

Cavanaugh BB, Horne AS.

Biomedical Library, University of Pennsylvania, 3610 Hamilton Walk, Philadelphia, PA 19104-6060, USA.

Evidence-Based Medicine Reviews (EBMR) is a new full-text product from Ovid Technologies. EBMR supports the practice of evidence-based medicine (EBM) by providing access to two premiere EBM resources: the Cochrane Database of Systematic Reviews from the international Cochrane Collaboration, and Best Evidence from the American College of Physicians-American Society of Internal Medicine. Both resources alert health care professionals, researchers, and librarians to clinically relevant and methodologically sound studies by providing access to full-text reviews and meta-analyses of clinical literature. Value-added features include links to EBMR from MEDLINE, alerting MEDLINE users to available reviews. An "EBM Reviews" limit within MEDLINE facilitates access to the EBMR database contents.

PMID: 11299594 [PubMed - in process]

24: Med Ref Serv Q 1999 Winter;18(4):1-10

Getting started in evidence-based health care: a guide to resources.

Gallagher PE.

New York Academy of Medicine Library, 1216 Fifth Avenue, New York, NY 10029, USA. pgallagher@nyam.org

In response to the growing interest in evidence-based health care resources, available in print and electronically, a number of new "evidence-based" products have been developed to aid the busy clinician. This paper discusses resources that will assist the librarian in beginning the educational process about evidence-based health care, as well as building a network of informational links that will assist clinicians in evidence-based practice.

PMID: 11299526 [PubMed - in process]

25: Acad Med 2001 Apr;76(4):385-9

Mechanistic case diagramming: a tool for problem-based learning.

Guerrero AP.

Dr. Guerrero is assistant professor of psychiatry, director of medical student education in psychiatry, and assistant professor of pediatrics at the University of Hawaii John A. Burns School of Medicine, Honolulu.

Without appropriate learning tools to guide the application of knowledge to clinical situations, medical students in a problem-based learning (PBL) curriculum may revert to traditional modes of learning and hence deprive themselves of PBL's educational benefits. The author describes a technique involving the stepwise diagramming of pathophysiologic mechanisms leading from underlying causes to the symptoms and findings presented in a PBL case. This technique can guide clinical reasoning during an initial problem encounter, the identification of pertinent learning issues, and the subsequent integration of knowledge as relevant to the patient's case. The author suggests that training students and tutors to use this technique may allow the former to fully realize the benefits of PBL, including the ability to organize information for use in clinical contexts and the ability to critically reflect upon their own learning.

PMID: 11299157 [PubMed - in process]

26: Am J Orthod Dentofacial Orthop 2001 Apr;119(4):21A-2A

Comments on evidence-based teaching.

Meister M, Masella R.

Ft Lauderdale, Fla.

PMID: 11298304 [PubMed - in process]

27: N Z Med J 2001 Mar 9;114(1127):89-91

Evidence databases, the Internet, and general practitioners: the New Zealand story.

Kerse N, Arroll B, Lloyd T, Young J, Ward J.

Department of General Practice and Primary Health Care, University of Auckland. n.kerse@auckland.ac.nz

AIM: To determine self-reported access to and use of the Internet and the Cochrane Library by general practitioners (GPs) in New Zealand. METHODS: A national cross sectional postal and fax survey of randomly selected GPs. RESULTS: A total of 381 of 459 eligible GPs returned completed questionnaires (83%). The mean age of this sample was 45.7 years (SD 8.6) and average years in general practice was 15.7 years (SD 8.8 years). 74% (277) were male and 77% (289) in full-time practice. Internet access was present in 40% (95% CI 36-46%) of practices and 76% (72-81%) of GP's homes. The majority, 56% (51-61%), of GPs had used the Internet with regard to a patient. Younger GPs (<35 years old OR = 2.69, 95% CI 1.10-6.60) and male GPs (OR 1.72, 95% CI 1.02-2.90) were significantly more likely to report use of the Internet with respect to patients. 42% (95% CI 37-47%) of GPs were aware of the Cochrane Library but only 15% (11-19%) had used it. Those in group practice were more likely to be aware of the Cochrane database (adjusted OR 1.85, CI 1.09-3.12). CONCLUSIONS: Internet use is prevalent among GPs. Solo practitioners, older GPs and female GPs are least likely to avail themselves of this resource. Although half of GPs knew about Cochrane, a minority used it. Access and use of evidence databases can be improved in New Zealand. Strategies to assist those least likely already to use Cochrane may help our collective efforts towards evidence based practice.

PMID: 11297144 [PubMed - in process]

28: Med J Aust 2001 Mar 19;174(6):293-5

Evidence-based medicine: how good is the evidence?

Celermajer DS.

Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, NSW. davidc@card.rpa.cs.new.gov.au

The "evidence" in EBM must be of high quality in order to be useful, but this is not always the case. Even the "gold standard" of evidence-based medicine, the randomised clinical trial, is bedevilled by low inclusion rates and potentially important recruitment biases. "Real world" trials often do not give the same results as these highly artificial controlled clinical studies. Meta-analysis, the next most important level of evidence in EBM, may be unreliable, sometimes giving different results to subsequent large randomised trials. There is a bias in the hypotheses tested in large clinical trials, as the costs involved are usually covered by commercially interested companies. For this reason, trials of non-patentable compounds or therapies of no commercial interest may not be performed. The process of journal review and publication is capricious, slow and may have a selection bias towards positive studies, meaning that communication channels for the "evidence" are often unsatisfactory. For many rarer conditions and situations, there is simply no "high level" evidence, such as in paediatrics and subspecialty surgery.

PMID: 11297118 [PubMed - indexed for MEDLINE]

29: J Contin Educ Health Prof 2001 Winter;21(1):55-60

Getting evidence into practice: the work of the Cochrane Effective Practice and Organization of care Group (EPOC).

Mowatt G, Grimshaw JM, Davis DA, Mazmanian PE.

Health Services Research Unit, University of Aberdeen.

Policy makers and continuing educators often face difficult decisions about which educational and quality assurance interventions to provide. Where possible, such decisions are best informed by rigorous evidence, such as that provided by systematic reviews. The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about health care by preparing, maintaining, and ensuring the accessibility of systematic reviews of the benefits and risks of health care interventions. International collaborative review groups prepare Cochrane reviews for publication in The Cochrane Library, a collection of databases available on CD-ROM and the World Wide Web and updated quarterly. The Cochrane Effective Practice and Organization of Care Group (EPOC) aims to prepare and maintain systematic reviews of professional, financial, organizational, and regulatory interventions that are designed to improve professional practice and the delivery of effective health services. EPOC has 17 reviews and 20 protocols published in Issue 3, 2000, of the Cochrane Library, with further protocols in development. We also have undertaken an overview of previously published systematic reviews of professional behavior change strategies. Our specialized register contains details of over 1,800 studies that fall within the group's scope. Systematic reviews provide a valuable source of information for policy makers and educators involved in planning continuing education and quality assurance initiatives and organizational change. EPOC will attempt to keep the Journal of Continuing Education in the Health Professions informed on an ongoing basis about new systematic reviews that it produces in the area of continuing medical education and quality assurance.

PMID: 11291587 [PubMed - in process]

30: Hosp Med 2001 Mar;62(3):164-8

Evidence-based medicine: putting theory into practice.

Irani M.

St Peter's Hospital, Middlesex TW15 3AA.

Evidence-based medicine is an essential tool to ensure the effective and efficient management of patients. A practical and unbiased assessment of clinical evidence can be achieved by asking simple questions about the data. Undertaking this process can reveal a new perspective on traditional treatment approaches.

Publication Types:
PMID: 11291467 [PubMed - indexed for MEDLINE]

31: Dtsch Med Wochenschr 2001 Mar 9;126(10):286-8

[Evidence-biased medicine--or: the deceptive safety of the evidence].

[Article in German]

Hense HW.

Publication Types:
PMID: 11285767 [PubMed - indexed for MEDLINE]

32: Dtsch Med Wochenschr 2001 Mar 9;126(10):285-8

[Evidence-biased medicine--or: deceptive safety of the evidence].

[Article in German]

Sertl K.

Publication Types:
PMID: 11285766 [PubMed - indexed for MEDLINE]

33: Health Expect 2000 Jun;3(2):145-150

Does provision of an evidence-based information change public willingness to accept screening tests?

Domenighetti G, Grilli R, Maggi JR.

Visiting Professor of Health Economics, Universities of Lausanne and Geneva, Switzerland; Director of Sezione Sanitaria, Dipartimento delle Opere Sociali, 6500 Bellinzona, Switzerland; Unity of Clinical Policy Analysis, Laboratory of Health Service Research, Istituto Mario Negri, Milano, Italy; Institute of Social Psychology, University of Geneva, Switzerland.

OBJECTIVE: To investigate whether the willingness of the general population to undergo a screening test of questionable effectiveness for pancreatic cancer is influenced by the quality and the extent of the information provided. DESIGN: Randomised study. SETTING: Switzerland. PARTICIPANTS: Representative sample (N=1000) of the general population aged over 20. INTERVENTIONS: Participants were randomly allocated into two groups (N=500 each), with one group to receive basic and the other extended quality of information. The information was presented in two hypothetical scenarios about implicit and explicit benefits and adverse events of the screening test. Response rates were, respectively, 80.2% (N=401) and 93.2% (N=466). MAIN OUTCOME MEASURES: Stated willingness to undergo the screening test. RESULTS: Out of the 401 participants receiving the basic information scenario, 241 (60%) stated their willingness to accept the test, as compared to the 63/466 (13.5%) exposed to the extended one (P < 0.001). After adjusting for respondent characteristics through a logistic regression model, the 'information effect', expressed in terms of odds-ratio (OR), shows that provision of additional information was related to a 91% (OR 0.09; 95CI: 0.07 - 0.13) relative reduction in the likelihood of accepting the screening test. CONCLUSION: The quality and the extent of the information provided about the implicit and explicit benefits and adverse events on hypothetical scenarios of a screening test may dramatically change the willingness of people to participate in the testing. This study suggests that provision of full information on the yield of health care interventions plays an important role in protecting the public from being exposed to procedures of questionable effectiveness.

PMID: 11281921 [PubMed - as supplied by publisher]

34: Health Expect 1998 Nov;1(2):134-135

Why DISCERN?

Shepperd S, Charnock D.

Programme Director Evidence Based Patient Choice, ETHOX, University of Oxford, UK; Research Officer, University of Oxford, Division of Public Health and Primary Health Care, Institute of Health Sciences, Old Road, Headington, Oxford, OX3 7LF, UK.

PMID: 11281867 [PubMed - as supplied by publisher]

35: Health Expect 1998 Jun;1(1):14-22

The use of evidence by health care user organizations.

Glenton C, Oxman AD.

Health Services Research Unit, National Institute of Public Health, Oslo, Norway.

OBJECTIVES: To explore the use of research evidence by consumer and patient organizations and the extent to which their goals and activities are consistent with evidence-based health care and patient-centred care. DESIGN: A mailed survey, telephone and face-to-face interviews of leaders of organizations representing health care users. SETTING: Norway. PARTICIPANTS: Sixty-nine of 109 questionnaires that were mailed were included in our analysis and approximately 20 interviews were conducted with representatives of general consumer and patient advocacy groups and interest groups that focus on particular diseases or disabilities. MEASUREMENTS: Information was collected on the goals of the organizations, the nature of their everyday work, the extent to which research information is required in this work and how research information is accessed and appraised. RESULTS: An important focus of many user groups is peer support. They tend to emphasize experience-based knowledge. A total of 82% of the respondents said that they often or sometimes had use for research results in their work. Research-based information is most often obtained indirectly through physicians or researchers. CONCLUSIONS: Norwegian health care user organizations do not appear to promote evidence-based health care. To the extent that they help to disseminate scientific information, they appear to do so uncritically, relying on few sources and traditional authorities.

PMID: 11281858 [PubMed - as supplied by publisher]

36: Wien Med Wochenschr 2001;151(1-2):39-40

[Meta-analyses and systematic errors in publications].

[Article in German]

Bias R.

PMID: 11281127 [PubMed - indexed for MEDLINE]

37: Med J Aust 2001 Mar 5;174(5):248-53

Comment in:
Evidence-based medicine: useful tools for decision making.

Craig JC, Irwig LM, Stockler MR.

Department of Public Health and Community Medicine, University of Sydney, NSW. jonc@health.usyd.edu.au

Evidence-based medicine (EBM) integrates clinical experience and patient values with the best available research information. There are four steps in incorporating the best available research evidence in decision making: asking answerable questions; accessing the best information; appraising the information for validity and relevance; and applying the information to patient care. Applying EBM to individual patients requires drawing up a balance sheet of benefits and harms based on research and individual patient data. The most realistic and efficient use of EBM by clinicians at the point of care involves accessing and applying valid and relevant summaries of research evidence (evidence-based guidelines and systematic reviews). The future holds promise for improved primary research, better EBM summaries, greater access to these summaries, and better implementation systems for evidence-based practice. Computer-assisted decision support tools for clinicians facilitate integration of individual patient data with the best available research data.

PMID: 11280698 [PubMed - indexed for MEDLINE]

38: Med J Aust 2001 Mar 5;174(5):214-5

Comment on:
Evidence-based medicine--time for a reality check.

Rubin GL, Frommer MS.

Publication Types:
PMID: 11280690 [PubMed - indexed for MEDLINE]

39: Med J Aust 2001 Mar 5;174(5):211-2

Comment on:
Time to move beyond clinical practice guidelines?

Thompson PL.

Publication Types:
PMID: 11280688 [PubMed - indexed for MEDLINE]

40: ACP J Club 2001 Mar-Apr;134(2):A11-3

Of studies, syntheses, synopses, and systems: the "4S" evolution of services for finding current best evidence.

Haynes RB.

Publication Types:
PMID: 11280129 [PubMed - indexed for MEDLINE]

41: Br J Sports Med 2001 Apr;35(2):79-80

Evidence-based sports medicine.

McCrory P.

PMID: 11273964 [PubMed - in process]

42: J Assoc Physicians India 2000 Aug;48(8):852

Medicine in the next millennium.

Menon A.

Publication Types:
PMID: 11273491 [PubMed - indexed for MEDLINE]

43: Teach Learn Med 2001 Winter;13(1):54-60

Toward setting a research agenda for systematic reviews of evidence of the effects of medical education.

Wolf FM, Shea JA, Albanese MA.

Department of Medical Education and Health Services, University of Washington, E-312 Health Sciences, Box 357240 Seattle, Washington, 98198-7240 USA. wolf@u.washington.edu

PURPOSE: To provide an update on, and a preliminary research agenda for, best evidence medical education (BEME). SUMMARY: Efforts related to evidence-based medical education are summarized briefly, including BEME, the newly formed Campbell Collaboration, and the Cochrane Collaboration's Effective Practice and Organization of Care review group. A list of topics and priorities for which evidence of effectiveness in medical education should be systematically reviewed is provided based on the results of a session at the July 2000 annual meeting of the Society of Directors of Research in Medical Education. The highest ranked topics clustered around four major conceptual areas: (a) curricular design, (b) learning and instructional methods, (c) testing and assessment, and (d) outcomes. CONCLUSIONS: BEME is gaining momentum with growing numbers of people becoming involved as well as an increased number of pertinent workshops, publications, and Web sites. The work of creating pertinent systematic reviews of the medical education literature is at hand.

PMID: 11273381 [PubMed - indexed for MEDLINE]

44: Teach Learn Med 2001 Winter;13(1):27-35

Measuring critical thinking in problem-based learning discourse.

Kamin CS, O'Sullivan PS, Younger M, Deterding R.

Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA. kamin.carol@tchden.org

BACKGROUND: Critical thinking (CT) is a composite of skills linked to problem-based learning (PBL). PURPOSES: This study has 3 purposes: (a) to determine if PBL discourse could be coded for CT, (b) to demonstrate reliable coding, and (c) to determine whether a CT ratio would provide a valid measure to compare 2 PBL groups. METHODS: Using prior research, we refined the code for a content analysis of PBL transcripts. Raters coded 6 hr of transcripts and computed CT ratios for each of the 5 CT stages. Average interrater agreement was 85.5%. CT ratios appeared to differ between 2 PBL groups delivered in 2 modalities. RESULTS: PBL discourse could be coded following a CT framework. Independent raters reliably applied the code, and the resulting CT ratios detected tenable differences. CONCLUSIONS: This approach could provide useful information about the effect of case modality.

PMID: 11273376 [PubMed - indexed for MEDLINE]

45: Teach Learn Med 2000 Fall;12(4):196-200

Assessing the measurement properties of a clinical reasoning exercise.

Wood TJ, Cunnington JP, Norman GR.

Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. twood@mcc.ca

BACKGROUND: A challenge for Problem-Based Learning (PBL) schools is to introduce reliable, valid, and cost-effective testing methods into the curriculum in such a way as to maximize the potential benefits of PBL while avoiding problems associated with assessment techniques like multiple-choice question, or MCQ, tests. PURPOSE: We document the continued development of an exam that was designed to satisfy the demands of both PBL and the scientific principles of measurement. METHODS: A total of 102 medical students wrote a clinical reasoning exercise (CRE) as a requirement for two consecutive units of instruction. Each CRE consisted of a series of 18 short clinical problems designed to assess a student's knowledge of the mechanism of diseases that were covered in three subunits located within each unit. Responses were scored by a student's tutor and a 2nd crossover tutor. RESULTS: Generalizability coefficients for raters, subunits, and individual problems were low, but the reliability of the overall test scores and the reliability of the scores across 2 units of instruction were high. Subsequent analyses found that the crossover tutor's ratings were lower than the ratings provided by one's own tutor, and the CRE correlated with the biology component of a progress test. CONCLUSION: The magnitude of the generalizability coefficients demonstrates that the CRE is capable of detecting differences in reasoning across knowledge domains and is therefore a useful evaluation tool.

Publication Types:
PMID: 11273369 [PubMed - indexed for MEDLINE]

46: Lancet 2001 Feb 10;357(9254):482

From protocol into practice: who needs the research?

Ogden J.

Publication Types:
PMID: 11273102 [PubMed - indexed for MEDLINE]

47: Lancet 2001 Feb 10;357(9254):448

Evidence-based prescribing made simple.

Larkin M.

Publication Types:
PMID: 11273073 [PubMed - indexed for MEDLINE]

48: Br J Gen Pract 2001 Jan;51(462):66

The future general practitioner.

Charlton R.

Publication Types:
PMID: 11271890 [PubMed - indexed for MEDLINE]

49: Lakartidningen 2001 Jan 17;98(3):174-6

[The case method--a new student-activating method in medical education].

[Article in Swedish]

Stjernquist M.

Institutionen for obstetrik & gynekologi, kvinnokliniken, Universitetssjukhuset MAS, Malmo. martin.stjernquist@obst.mas.lu.se

The case method is a student-activating method, used together with problem based learning (PBL) and traditional teaching methods in the curriculum for undergraduate medical education at the Faculty of Medicine in Lund/Malmo, Sweden. The case method provides training in the solving of clinical problems and is thus especially useful at the clinical level of medical education, and in an integrated and problem based curriculum. The case method consumes less teaching resources than PBL, and might thus be useful in a situation with increasing numbers of medical students.

PMID: 11271579 [PubMed - indexed for MEDLINE]

50: Nurse Pract 2001 Mar;26(3):11-2, 15

Providing the best for our patients: evidence-based practice.

Pearson L.

Publication Types:
PMID: 11270152 [PubMed - in process]

51: Z Arztl Fortbild Qualitatssich 2001 Feb;95(2):95-104

[How much is "evidence-based"? An overview of the state of the art in research].

[Article in German]

Neises G, Windeler J.

Medizinischer Dienst der Spitzenverbande der Krankenkassen e.V. (MDS), Essen. G.Neises@MDS-ev.de

The proportion of evidence-based health care gives rise to controversy. Estimates range from 4%-20%. Studies trying to ascertain the proportion of evidence-based healthcare show wide variations in the results depending on design, setting, subject, main outcome measures, methodology and definition of evidence from 11-82%. The results should not be generalized to community health care and should not be misused in public discussions.

Publication Types:
PMID: 11268884 [PubMed - indexed for MEDLINE]

52: Z Arztl Fortbild Qualitatssich 2001 Feb;95(2):88-93

[Evidence-based medicine in the further development of health care systems. Comments on a current discussion].

[Article in German]

Windeler J.

Medizinischer Dienst der Spitzenverbande der Krankenkassen e.V. (MDS), Essen. j.windeler@mds-ev.de

The concept of evidence-based medicine is applicable also in the field of guiding health care systems to overcome deficits in adequate patient care. EbM has already been used in this field and has passed first tests of its practical application. There are some obstacles against the future esteem of EbM. These include some misunderstanding concerning the concept itself, missing routine where external evidence has to be put into practice, and some general resistance. Details are presented and an adequate usage of EbM is argued for.

PMID: 11268883 [PubMed - indexed for MEDLINE]

53: Z Arztl Fortbild Qualitatssich 2001 Feb;95(2):131-6

[Patients' involvement in and and their demands on evidence-based medicine].

[Article in German]

Stotzner K.

SEKIS-Selbsthilfe Kontakt- und Informationsstelle, Berlin. www.sekis-berlin.de

Representatives of evidence-based medicine have repeatedly declared their goal of integrating patients and their demands on the health care system in discussions and networking forums. If one takes various indicators of consumer demands into consideration--like, for example, the Berliner Mangelliste (a list of inadequacies and deficiencies of the Public Health Care System compiled by members of the Berliner Selbsthilfe-Forum chronisch kranker und behinderter Menschen (a platform of discussion for chronically ill or handicapped participants in self-help groups) or, for example, the results of a study which researched consumer demands on information in decision-making situations, then a number of mutual fields of interest between patients and evidence-based medicine professionals can indeed be found. On the other hand there is a series of issues which patients repeatedly articulate, which are not among those most important to evidence-based medicine. Such issues include, for example, more personal attention, acceptance, holistic treatment methods, and the elimination of deficits in the quality of the Health Care System. To successfully involve patients in the networking process in a meaningful and permanent way and to make their involvement in the activities of evidence-based medicine more than a rhetorical aim, the discourse should not exclusively correspond to specialised interests of professionals, but rather should take up the issues given priority to by patients and should consider their working conditions, their stress-factors and their often limited resources. If it is seriously intended that patients and members of self-help groups take an active interest in promoting those parts of evidence based medicine helpful and efficient for them, then more effort must be made, on the one hand, to motivate them and to provide more comprehensive information and, on the other hand, patients and their initiatives must receive more support.

PMID: 11268879 [PubMed - indexed for MEDLINE]

54: Health Serv J 2001 Mar 1;111(5744):36-7

On the evidence. Patient information.

Sowden A, Forbes C.

NHS Centre for Reviews and Dissemination, York University.

PMID: 11268504 [PubMed - indexed for MEDLINE]

55: Health Educ Behav 2001 Apr;28(2):231-48

Searching for evidence about health education and health behavior interventions.

Rimer BK, Glanz DK, Rasband G.

National Cancer Institute, Bethesda, Maryland, USA. brimer@nih.gov

Evidence is fundamental to science, but finding the right evidence in health education and health behavior (HEHB) is often a challenge. The authors discuss some of the controversies about the types of evidence that should be considered acceptable in HEHB, the tension between the use of qualitative versus quantitative data, the need for measures of important but neglected constructs, and interpretation of data from experimental and nonexperimental research. This article discusses some of the challenges to the use of evidence and describes a number of strategies and some forces encouraging the use of evidence-based interventions. Finally, the authors suggest ways to improve the practice and dissemination of evidence-based HEHB. Ultimately, if evidence-based interventions are not disseminated, the interventions will not achieve their potential. The goal should be to develop more effective interventions and disseminate them to improve the public's health.

PMID: 11265831 [PubMed - in process]

56: J Bone Joint Surg Am 2001 Mar;83-A(3):464

Orthopaedic POEMS and reliable research.

Peacock KC.

Publication Types:
PMID: 11263655 [PubMed - indexed for MEDLINE]

57: J Aust Coll Midwives 2000 Jul;13(2):26-30

Does evidenced-based practice medicalise midwifery care? Part 2.

Thomson AM.

School of Nursing, Midwifery & Health Visiting, University of Manchester, Coupland III Building, Oxford Road, Manchester M13 9PL UK.

In this paper evidence-based care is defined. The evidence to support the provision of care by midwives is presented, as is the evidence to support home birth for those women at low obstetric risk. In conclusion midwives are challenged to be political and use this evidence to support changes to improve the quality of care provided to women and their families.

PMID: 11261199 [PubMed - in process]

58: Br J Perioper Nurs 2000 Aug;10(8):421-7

Using the Internet to enhance evidence-based practice.

Orson J.

Princess Alexandra Hospital, Harlow Essex.

Evidence-based healthcare requires reliable and validated research findings to aid improved clinical practice. The Internet, with its growing medical resources, is an invaluable tool for busy healthcare workers. However, as more material becomes available on the web, the quality and reliability of various information sites is a worry for many practitioners. The ability to evaluate web sites is becoming increasingly important and as a novice user, I was interested to discover the extent to which the Internet could assist me researching a specific topic. This article describes the process of conducting an Internet search, on a topic relevant to theatre nursing, and considers how the resources might best be evaluated.

PMID: 11261008 [PubMed - in process]

59: Med Teach 2001 Jan;23(1):99-101

The problem-based learning tutorial laboratory - a method for training medical teachers.

Vanhanen H, Pitkala K, Puolakkainen P, Strandberg TE, Lonka K.

Department of Medicine, Faculty of Medicine, University of Helsinki, Finland.

An extensive staff development program was started in 1998 in the Faculty of Medicine at the University of Helsinki. A problem-based learning method was introduced as a new style of teaching in the curriculum reform. This paper describes a teaching method 'Problem-based learning - tutorial laboratory' for training medical teachers to act as tutors and to understand their roles as facilitators of learning and the dynamics of a small group. The method was based on learning cycles: teachers had a possibility to experience tutoring, to get feedback about it from an educational expert and from a peer teacher and also they were able to reflect on their views in the group. The teachers were content with the training. Sessions improved teacher cooperation across the departments and brought new teaching ideas for shared use. It also helped to cope with the resistance related to the curriculum change process.

PMID: 11260754 [PubMed - as supplied by publisher]

60: Med Teach 2001 Jan;23(1):92-94

Assessments in evidence-based medicine workshops: loose connection between perception of knowledge and its objective assessment.

Khan KS, Awonuga AO, Dwarakanath LS, Taylor R.

Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, UK.

The outcome of continuing education programs is often based on self-assessment. We evaluated the relationship of self-assessment of knowledge based on rating scales with scores obtained on objective validated tests in evidence-based medicine workshops. In the West Midlands region (1998), 55 participants attended three workshops in critical appraisal of the medical literature.They completed two self-assessment questionnaires: one used a rating scale to subjectively examine the level of knowledge of six different literature appraisal issues; the other objectively assessed participants' literature appraisal knowledge in those issues using validated multiple true-false questions. Comparison of subjective scores reflecting understanding of specific literature appraisal issues with corresponding objective test scores revealed a poor correlation (r(s) ranged from -0.29 to 0.60 for the different knowledge issues assessed). Perception of ones level of knowledge did not always correlate with correctly possessed knowledge. In some instances, those who thought they were knowledgeable actually possessed incorrect knowledge. Therefore, continuing medical education programs should focus on objective, not subjective tests to assess outcome.

PMID: 11260751 [PubMed - as supplied by publisher]

61: Med Teach 2001 Jan;23(1):90-91

Teaching evidence-based medicine using literature for problem solving.

Mottonen M, Tapanainen P, Nuutinen M, Rantala H, Vainionpaa L, Uhari M.

Department of Pediatrics, University of Oulu, Finland.

PMID: 11260750 [PubMed - as supplied by publisher]

62: Med Teach 2001 Jan;23(1):55-58

Task-based learning (TBL) in undergraduate medical education.

Virjo I, Holmberg-Marttila D, Mattila K.

Medical School, Department of General Practice, University of Tampere, Finland.

Problem-based learning (PBL) is a proven method to learn medicine during the first years of studies. In the clinical phase the active, self-directive student may experience difficulties in adapting to the life of professionals in health care units, where students usually have to attend and work according to preplanned timetables. Task-based learning (TBL) can serve as an intermediary in the meeting of these two cultures. Here we describe a TBL study module for fourth-year medical students and experiences of implementing it at the University of Tampere in Finland. Eighty-five students participated in this study in 1998 and 1999. Our results show that this method works and that it leads to learning. Students evaluate their skills connected with the general practitioner's work in a health centre hospital as better after the study module than at the onset.

PMID: 11260741 [PubMed - as supplied by publisher]

63: Br J Gen Pract 2001 Mar;51(464):231

Evidence-based medicine.

Brooks MH.

Publication Types:
PMID: 11255914 [PubMed - indexed for MEDLINE]

64: Arch Inst Cardiol Mex 2000 Nov-Dec;70(6):531-5

[Evidence-based medicine. Science, paradigm or methodology]?

[Article in Spanish]

Vallejo M, Lopez Rodriguez MC.

Publication Types:
PMID: 11255712 [PubMed - indexed for MEDLINE]

65: Arch Dermatol 2001 Mar;137(3):345-6

Challenges to the hierarchy of evidence: does the emperor have no clothes?

Bigby M.

PMID: 11255336 [PubMed - indexed for MEDLINE]

66: Arch Dermatol 2001 Mar;137(3):332-5

How can hand searching the dermatological literature benefit people with skin problems?

Delamere FM, Williams HC.

Cochrane Skin Group, Dermatology Department, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, England. finola.delamere@nottingham.ac.uk

PMID: 11255334 [PubMed - indexed for MEDLINE]

67: Curr Atheroscler Rep 2001 Mar;3(2):97-8

The need for medicine-based evidence as well as evidence-based medicine.

Tonkin AM.

Department of Epidemiology and Preventive Medicine, Monash University, 553 St. Kilda Road, West Melbourne 3004, Australia. Andrew.Tonkin@heartfoundation.com.au

PMID: 11177652 [PubMed - in process]

68: J Gen Intern Med 2001 Feb;16(2):94-9

A web exercise in evidence-based medicine using cognitive theory.

Lloyd FJ, Reyna VF.

Department of Medicine, University of Arizona, Tucson, Arizona (FJL, VFR); Department of Surgery, University of Arizona, Tucson, Arizona (VFR).

Our aim was to improve clinical reasoning skills by applying an established theory of memory, cognition, and decision making (fuzzy-trace theory) to instruction in evidence-based medicine. Decision-making tasks concerning chest pain evaluation in women were developed for medical students and internal medicine residents. The fuzzy-trace theory guided the selection of online sources (e.g., target articles) and decision-making tasks. Twelve students and 22 internal medicine residents attended didactic conferences emphasizing search, evaluation, and clinical application of relevant evidence. A 17-item Likert scale questionnaire assessed participants' evaluation of the instruction. Ratings for each of the 17 items differed significantly from chance in favor of this alternative approach to instruction. We concluded that fuzzy-trace theory may be a useful guide for developing learning exercises in evidence-based medicine.

PMID: 11251760 [PubMed - in process]

69: BMJ 2001 Mar 17;322(7287):664-7

Patient choice modules for summaries of clinical effectiveness: a proposal.

Holmes-Rovner M, Llewellyn-Thomas H, Entwistle V, Coulter A, O'Connor A, Rovner DR.

College of Human Medicine, Michigan State University, East Lansing MI 48823, USA. mholmes@msu.edu

Publication Types:
PMID: 11250855 [PubMed - indexed for MEDLINE]

70: Lancet 2001 Mar 3;357(9257):724

Where to practise evidence-based medicine?

Volmink J, Swingler G, Siegfried N.

Publication Types:
PMID: 11247593 [PubMed - indexed for MEDLINE]

71: Lancet 2001 Mar 3;357(9257):723-4

Where to practise evidence-based medicine?

Pakenham-Walsh N, Mayosi BM.

Publication Types:
PMID: 11247592 [PubMed - indexed for MEDLINE]

72: Lancet 2001 Mar 3;357(9257):723

Where to practise evidence-based medicine?

Grace R, Everard L.

Publication Types:
PMID: 11247591 [PubMed - indexed for MEDLINE]

73: Lancet 2001 Mar 3;357(9257):699-703

Changing face of medical curricula.

Jones R, Higgs R, de Angelis C, Prideaux D.

Guy's, King's and St Thomas' School of Medicine, London, UK. roger.jones@kcl.ac.uk

The changing role of medicine in society and the growing expectations patients have of their doctors means that the content and delivery of medical curricula also have to change. The focus of health care has shifted from episodic care of individuals in hospitals to promotion of health in the community, and from paternalism and anecdotal care to negotiated management based on evidence of effectiveness and safety. Medical training is becoming more student centred, with an emphasis on active learning rather than on the passive acquisition of knowledge, and on the assessment of clinical competence rather than on the ability to retain and recall unrelated facts. Rigid educational programmes are giving way to more adaptable and flexible ones, in which student feedback and patient participation have increasingly important roles. The implementation of sustained innovation in medical education continues to present challenges, especially in terms of providing institutional and individual incentives. However, a continuously evolving, high quality medical education system is needed to assure the continued delivery of high quality medicine.

PMID: 11247568 [PubMed - indexed for MEDLINE]

74: N Z Med J 2001 Jan 26;114(1124):20

Evidence based clinical guidelines: are they effective?

Walker T.

Publication Types:
PMID: 11243671 [PubMed - indexed for MEDLINE]

75: Acad Med 2001 Mar;76(3):221-3

Alternative medicine: the importance of evidence in medicine and in medical education. Is there wheat among the chaff?

Grollman AP.

Publication Types:
PMID: 11242569 [PubMed - indexed for MEDLINE]

76: Acad Med 2001 Mar;76(3):215-6

Are qualitative studies of the PBL tutorial process indicated?

Colliver JA.

Publication Types:
PMID: 11242565 [PubMed - indexed for MEDLINE]

77: Cad Saude Publica 2001 Jan-Mar;17(1):205-14

[Dr. Sackett & "Mr. Sacketeer"... enchantment and disenchantment in the land expertise in evidence-based medicine].

[Article in Portuguese]

Castiel LD, Povoa EC.

Departamento de Epidemiologia e Metodos Quantitativos em Saude, Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, Brasil. castiel@ensp.fiocruz.br

In May 2000, Prof. David L. Sackett, one of the founders of the evidence-based medicine movement (EBM), published an article in the British Medical Journal in which he renounced writing, teaching, or serving as a referee for topics related to EBM. He justified his stance based on his frustration over what he considered the harmful effects of an alleged excess of experts in this field. Sackett's position was the raw material whereby we approached aspects linked to the definition and scope of EBM as well as related critiques. We also stress the movement's various rhetorical strategies. In addition, we discuss both the notion of expertise and the role of "expert systems" and "specialized competence" in our societal milieu, developed respectively by Anthony Giddens and Zygmunt Bauman. The main focus of this commentary is to emphasize that while we are dealing with a progressive trend towards acquiring control and intelligibility vis-a-vis the objects of our research, we must consider the possibility of dimensions that cannot be reached by way of the rationalistic Western mode of thought.

PMID: 11241943 [PubMed - in process]

78: Qual Health Care 2001 Mar;10(1):10-6

Involvement of consumers in the development of evidence based clinical guidelines: practical experiences from the North of England evidence based guideline development programme.

van Wersch A, Eccles M.

Centre for Health Services Research, School of Health Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA, UK.

BACKGROUND:-Consumer involvement in clinical guidelines has long been advocated although there are few empirical accounts of attempts to do so. It is therefore not surprising that there is a lack of clarity about how and when to involve consumers and what to expect from them within the process of guideline development. METHODS:-The North of England evidence based guideline development programme has used four different methods of consumer involvement. RESULTS:-When individual patients were included in a guideline development group they contributed infrequently and had problems with the use of technical language. Although they contributed most in discussions of patient education, their contributions were not subsequently acted on. In a "one off" meeting with a group of patients there were again reported problems with medical terminology and the group were most interested in sections on patient education and self management. However, their understanding of the use of scientific evidence in order to contribute to a more cost effective health care remained unclear. In a workshop it was possible to explain the technical elements of guideline development to patients who could then engage with such a process and make relevant suggestions as a consequence. However, this was relatively resource intensive. A patient advocate within a guideline development group felt confidence to speak, was used to having discussions with health professionals, and was familiar with the medical terminology. CONCLUSIONS:-Consumers should be involved in all stages of guideline development. While this is possible, it is not straightforward. There is no one right way to accomplish this and there is a clear need for further work on how best to achieve it.

PMID: 11239138 [PubMed - in process]

79: Qual Health Care 2001 Mar;10(1):4-9
Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model.

Timmermans D, van Bockel H, Kievit J.

Medical Decision Making Unit, Leiden University Medical Center, K6-R, PO Box 9600, 2300 RC Leiden, The Netherlands Department of Surgery, Leiden University Medical Center.

OBJECTIVES:-The purpose of this study is to demonstrate to what extent an evidence based decision model can improve physicians' decisions and whether a selective use of the decision model is feasible. METHODS:-Four experienced vascular surgeons were asked to make a treatment decision for 137 "paper patient" cases with asymptomatic abdominal aneurysms. Their decisions were compared with the optimal treatment as calculated by a computerised evidence based decision analytical model. RESULTS:-Surgeons agreed with the model's advice based on life expectancy in 81% of the cases, and decided to operate in only 12% of the cases for which there was no agreement. Surgeons' decisions differed from the decision model's calculated optimal treatment, in particular, for older patients with aneurysms of intermediate size and with many risk factors, and for younger patients with small aneurysms and few risk factors. Not all these decisions, however, were reported to be more difficult. CONCLUSION:-Use of a decision analytical model might lead to more appropriate decisions and a better quality of care. Selective use of the decision tool for difficult decisions only would be more efficient but is not yet feasible because reported decision difficulty is not strongly related to disagreement with the decision tool.

PMID: 11239137 [PubMed - in process]

80: Psychiatr Serv 2001 Mar;52(3):313-22
Implementing Supported Employmentas an Evidence-Based Practice.

Bond GR, Becker DR, Drake RE, Rapp CA, Meisler N, Lehman AF, Bell MD, Blyler CR.

Supported employment for people with severe mental illness is an evidence-based practice, based on converging findings from eight randomized controlled trials and three quasi-experimental studies. The critical ingredients of supported employment have been well described, and a fidelity scale differentiates supported employment programs from other types of vocational services. The effectiveness of supported employment appears to be generalizable across a broad range of client characteristics and community settings. More research is needed on long-term outcomes and on cost-effectiveness. Access to supported employment programs remains a problem, despite their increasing use throughout the United States. The authors discuss barriers to implementation and strategies for overcoming them based on successful experiences in several states.

PMID: 11239097 [PubMed - in process]

81: West J Med 2001 Mar;174(3):158-9

How to practice evidence-based pediatrics.

Moyer V, Elliott E.

Publication Types:
PMID: 11238333 [PubMed - in process]

82: Eff Clin Pract 2001 Jan-Feb;4(1):24-33

How effective is the computer-based clinical practice guideline?

Eytan TA, Goldberg HI.

University of Washington, Seattle, Wash., USA. eytan.t@ghc.org

CONTEXT: The primary prevention of coronary artery disease in patients with diabetes could have a large impact on health care costs and outcomes. Guidelines for improving diabetic health indices are common, but significant challenges exist in implementing them. GENERAL QUESTION: How does integrating an evidence-based guideline into an electronic medical record affect patient care? SPECIFIC RESEARCH CHALLENGE: How can we implement the new guideline-enhanced medical record in a controlled manner and measure its impact on physician satisfaction, diabetes process measures, and the risk for cardiovascular disease? PROPOSED APPROACH: All patients in the University of Washington system have an electronic Web-based medical record. Patients with diabetes will be randomly assigned to a guideline-enhanced or standard electronic medical record. The electronic medical record allows measurement of most clinical process measures and outcomes. Physician satisfaction will be measured by survey. POTENTIAL DIFFICULTIES: Contamination may occur when guideline recommendations are applied to control patients as physicians gain experience with the guideline-enhanced record.

PMID: 11234183 [PubMed - in process]