Escolar Documentos
Profissional Documentos
Cultura Documentos
Evidence-Based Medicine in
Everyday Practice
David C. Slawson, MD
Allen F. Shaughnessy, PharmD
The Medical Information Business
Producti
on
Original Research
Clinical
experience
Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools for lifelong learning?
British Medical Journal 1999 (13 Nov): www.bmj.com. (http://bmj.com/cgi/reprint/319/7220/1280.pdf)
The Medical Information Business
Productio
n
Systematic
reviews
Refinement
POEM Alert
System
The Medical Information Business
Production
Clinician-centered
Just-in-time
information
Hunting/foraging Refineme
tools nt
Distributi
on
The Medical Information Business
Production
Information
Sales & Mastery:
Marketing The Applied
Refineme
Science of nt
Clinical Medicine
Distributio
n
How do we learn?
Adults learn by solving problems
Our problems = clinical questions
CME can highlight advances and make us
aware of our deficits
120 studies, short term benefit to testing, but no
patient benefit to traditional lecture
Answering clinical questions at the point of
care is how we learn and improve outcomes
Clinical questions
Theyre common: Average 1 question for every other
patient
Theyre important
Only 1 in 3 questions pursued
Found answer 80% of time
Guess at 70-80% of information needs!
Journals only used to answer 2 of 1101 questions
Books, colleagues used most often
Average search time: 1 minute or less.
Ely JE. Analysis of questions asked by family doctors regarding patient care. BMJ
1999;319:358-61
Clinical Questions
Internal Medicine Residents
2 for every 3 patients
29% pursued
textbook (31%); journals (21%); attendings (17%)
Patient expectation, fear of malpractice
associated with seeking answer
Lack of time (60%), forgot (29%).
Am J Med 2000;109:218-33.
Information Sources for the
Point of Care
Clinicians
Patient Care
Flow of Information from
the UKPDS
Results of UKPDS Published
Clinicians
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tfo l
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Vijan S. Treatment of hypertension in type 2 diabetes mellitus: blood pressure goals, choice
of agents, and setting priorities in diabetes care. Ann Intern Med 2003; 138:593-602.
Drilling for the Best Information
Cochrane Library
EB Practice Guideline
Clinical Evidence
Clinical Inquiries
Specialty-specific
POEMs
Usefulness
Best Evidence
Textbooks, Up-to-
Date, 5-Minute
Clinical Consult
Medline
InfoRetriever 2005
Windows 95/98/NT/ME/2000/XP, PocketPC, Palm and Web
1900 short research
Cochrane Database
synopses (400 added
of Systematic Reviews:
per year)
over 1300 abstracts
5 Minute Clinical
Consult
Basic drug
info by class Key evidence-based
and cost for treatment guidelines
1200 drugs
www.InfoPOEMs.com
Characteristics of an Ideal
Clinical Awareness System
Specialty-specific
Comprehensive
Coordinated hunting and foraging tools
Specific and reproducible criteria for
relevance and validity
Available at the point-of-care
All backed up by levels of evidence
The Clinician of the Future
I know a lot, therefore I am
Replaceable by a computer
I think, therefore I am
Never replaceable by computer
Travel agent should they memorize
schedules?
Would you trust them?
How do you know?
Hand held computer = stethoscope of the
future
Take-Home Points
Confidence through information
Hunting & foraging tools providing
relevant and valid information when
needed
Focus on valid POEMs Patient-
Oriented Evidence that Matters
Effect on Patient-Oriented
Outcomes
Symptoms SORT SORT
Functioning
Quality of Life B A
Lifespan
Relevance of Outcome
Validity of Evidence
Take-Home Points
Clinicians will be/are valued by how
they think and not by what they know