EBM --- Journal Reading

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• EBM --- Journal Reading

Presenter??? Date2005/10/17
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Users Guides to the Medical Literature
Editorials
JAMA Nov 3, 1993 270, 17
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Change and Challenge

• Rate of changeaccelerating
• How can physicians learn about new information,
  and decide how they should modify their practice?
• Review articles, practice guidelines, editorials,
  summary articles, original articles in
  journals......
• Problemsvaluable?biases?different suggestions?

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Choose and Decide

• Choose to believe the most authoritative expert
  or the trusted colleague ? but have difficulty
  exercising independent judgement
• 1981McMaster University ? Readers guides ?
  allow physicians to make their own assessments of
  the original literature
• Although scientifically sound and clinically
  useful ? can be improved

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Break point

• Inspired by the need of using medical literature
  to solve real patient problems
• Clinicians at McMaster University and colleagues
  across North America ? create new guides
• Reflects an approach to medical practice that has
  been called evidence-based medicine
• Readers guides ? Users guides

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What differences?

• Keep up-to-date in their clinical disciplines
• Find the best way to manage a particular clinical
  problems
• Introduces strategies for efficiently searching
  the medical literature

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What differences?

• Expanded sections on interpreting results of
  clinical studies, and on deciding how to apply
  them in patient care
• Rejected the criterion for reading an article
  from the Readers Guides based on the authors
  track record

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What differences?

• Revolution In the application of scientific
  approaches to summarizing information form
  medical research
• Put much greater emphasis on integrative studies,
  including systemic overviews, practice
  guidelines, decision analysis, and economic
  analysis

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Recommendation

• Begins with a search for a valid overview or
  practice guideline ? most efficient in deciding
  best patient care

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Clinicians now

• Relying less on sources of information like
  throwaway journals, pharmaceutical detailing
  personnel, symposia and medical advertising
• Restrict their browsing of the medical literature
  to summaries

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Clinicians now

• How to address clinical dilemma?
• A careful definition of the problem
• An efficient literature research
• A brief and efficient screening of the articles
• To find the most relevant and valid information

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Ask ourselves

• How big an effect can I expect from my treatment
  in this patient?
• How much does the probability of disease increase
  as a result of this diagnostic test result?

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Users guide

• More clearly differentiatedClinical practices
  based on sound evidence from studies in human
  beings v.s. physiological rationale or standard
  practice
• Sense of empowermentwhen faced with enthusiastic
  reports of a new technique or approach to care,
  or with conflicting recommendations of experts

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Conclusion

• Users guide will meet the expectations of
  clinicians who want to base their clinical
  decisions on evidence rather than hope or
  authority.

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Thank you!