scholarly journals A journey of a thousand miles begins with a single step: Applying evidence-based medicine to answer clinical questions.

2021 ◽  
Vol 16 (3) ◽  
pp. 132-132
Author(s):  
Peter Seah Keng Tok
Keyword(s):  
Evidence Based Medicine ◽  
Single Step ◽  
Evidence Based ◽  
Clinical Questions ◽  
Based Medicine

scholarly journals Answering Clinical Questions with Knowledge-Based and Statistical Techniques

2007 ◽  
Vol 33 (1) ◽  
pp. 63-103 ◽  
Author(s):  
Dina Demner-Fushman ◽  
Jimmy Lin
Keyword(s):  
Evidence Based Medicine ◽  
Information Needs ◽  
Semantic Processing ◽  
Question Answering ◽  
Clinical Medicine ◽  
Statistical Techniques ◽  
Evidence Based ◽  
Knowledge Based ◽  
Clinical Questions ◽  
Based Medicine

The combination of recent developments in question-answering research and the availability of unparalleled resources developed specifically for automatic semantic processing of text in the medical domain provides a unique opportunity to explore complex question answering in the domain of clinical medicine. This article presents a system designed to satisfy the information needs of physicians practicing evidence-based medicine. We have developed a series of knowledge extractors, which employ a combination of knowledge-based and statistical techniques, for automatically identifying clinically relevant aspects of MEDLINE abstracts. These extracted elements serve as the input to an algorithm that scores the relevance of citations with respect to structured representations of information needs, in accordance with the principles of evidence-based medicine. Starting with an initial list of citations retrieved by PubMed, our system can bring relevant abstracts into higher ranking positions, and from these abstracts generate responses that directly answer physicians' questions. We describe three separate evaluations: one focused on the accuracy of the knowledge extractors, one conceptualized as a document reranking task, and finally, an evaluation of answers by two physicians. Experiments on a collection of real-world clinical questions show that our approach significantly outperforms the already competitive PubMed baseline.

scholarly journals Bipolar disorder: clinical uncertainty, evidence-based medicine and large-scale randomised trials

2001 ◽  
Vol 178 (S41) ◽  
pp. s191-s194 ◽  
Author(s):  
John Geddes ◽  
Guy Goodwin
Keyword(s):  
Bipolar Disorder ◽  
Evidence Based Medicine ◽  
Large Scale ◽  
Bipolar Affective Disorder ◽  
Research Literature ◽  
Evidence Based ◽  
Drug Treatments ◽  
Clinical Questions ◽  
Collaborative Ventures ◽  
Based Medicine

BackgroundThe increasing use of the methods of evidence-based medicine to keep up-to-date with the research literature highlights the absence of high-quality evidence in many areas in psychiatry.AimsTo outline current uncertainties in the maintenance treatment of bipolar disorder and to describe some of the decisions involved in designing a large simple trial.MethodWe describe some of the strategies of evidence-based medicine, and how they can be applied in practice, focusing specifically on the area of bipolar disorder.ResultsOne of the key clinical uncertainties in the treatment of bipolar disorder is the place of maintenance drug treatments and their relative efficacy. A large-scale study, the Bipolar Affective Disorder: Lithium Anticonvulsant Evaluation (BALANCE) trial, is proposed to compare the effectiveness of lithium, valproate and the combination of lithium and valproate.ConclusionsProviding reliable answers to key clinical questions in psychiatry will require new approaches to clinical trials. These will need to be far larger than previously appreciated and will therefore need to be collaborative ventures involving front-line clinicians.

The Challenge of Evidence-Based Migraine Therapy

Cephalalgia ◽  
2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 1-4 ◽  
Author(s):  
WJ Becker
Keyword(s):  
Clinical Trials ◽  
Clinical Experience ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Academic Health ◽  
Migraine Therapy ◽  
Research Challenges ◽  
Health Centres ◽  
Clinical Questions ◽  
Based Medicine

It is important that physicians practise evidence-based medicine. Clinical experience is important, but there are a number of reasons why clinical experience can lead to the impression that ineffective treatments are effective. There are major educational and research challenges which must be met before clinicians can practice evidence-based migraine therapy more extensively than at present. Treating physicians will need to learn more about the principles of evidence-based medicine. Researchers will need to produce more and better clinical trials that address important clinical questions. The results of these trials will need to be reported clearly, and we need to improve the efficiency with which these results can be accessed. It is important that the pharmaceutical industry, clinicians, and academic health centres work together to meet these challenges.

Medical Search Engines

2008 ◽  
pp. 873-881
Author(s):  
Bob Badgett ◽  
Suresh Chalasani ◽  
Rajendra V. Boppana ◽  
Jacqueline A. Pugh
Keyword(s):  
Biomedical Research ◽  
Evidence Based Medicine ◽  
Clinical Care ◽  
National Institutes Of Health ◽  
Research Articles ◽  
The Internet ◽  
Free Access ◽  
Evidence Based ◽  
Clinical Questions ◽  
Based Medicine

Twenty years ago, researchers identified the difficulties physicians have in answering the clinical questions that arise during medical care (Covell, Uman, & Manning, 1985). Fifteen years ago, the “Evidence-based medicine” movement arose (Cohen, 2001) and exhorted clinicians to use computers to look up the answers to questions as they arise during clinical care. Fortuitously for the proponents of evidence-based medicine the Internet matured in the 1990s{Hersh 1996 #3370}, epitomized by the launching of PubMed by Al Gore in June, 1997. PubMed, developed by the National Institutes of Health, provided the first free access to millions of biomedical research articles at MEDLINE. Unfortunately, the Internet has not fulfilled its potential to assist physicians in answering clinical questions. A recent study found that physicians obtain answers to only 40% of questions that arise during patient care (Ely, Osheroff, Chambliss, Ebell, & Rosenbaum, 2004); this rate is not much different than the rate of 30% reported 20 years ago (Covell et al., 1985).

scholarly journals The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 2

2013 ◽  
Vol 40 (4) ◽  
pp. 475-481 ◽  
Author(s):  
Shashi S. Seshia ◽  
G. Bryan Young
Keyword(s):  
Cognitive Processes ◽  
Emerging Economies ◽  
Evidence Based Medicine ◽  
Statistical Tests ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Core Elements ◽  
Literature Evidence ◽  
Clinical Questions ◽  
Based Medicine

AbstractIn Part 2, we discuss the challenges of keeping up with the ‘literature,’ evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the ‘measurements’ for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.

scholarly journals Appraisal of meta-analysis

1998 ◽  
Vol 22 (11) ◽  
pp. 698-701
Author(s):  
Apu Chakraborty ◽  
James P. Warner ◽  
Robert Blizard
Keyword(s):  
Mood Disorders ◽  
Evidence Based Medicine ◽  
Journal Club ◽  
Meta Analysis ◽  
Clinical Implications ◽  
Evidence Based ◽  
Clinical Question ◽  
Ventricular Size ◽  
Clinical Questions ◽  
Based Medicine

Aims and methodPrompted by a clinical question, we critically appraised a meta-analysis of neuroimaging in our evidence-based journal club.ResultsThe results of the meta-analysis suggested differences in ventricular size and sulcal width between controls and people with schizophrenia and mood disorders. However, we were unable to answer the question that prompted this exercise.Clinical implicationsAlthough the evidence-based medicine approach facilitates appraisal of complex articles, some clinical questions are not yet answerable.

scholarly journals Orthopaedic Surgical Content Associated with Resources for Clinical Evidence

2014 ◽  
Vol 34 (1) ◽  
pp. 17
Author(s):  
Sarah L Turvey ◽  
Nasir Hussain ◽  
Laura Banfield ◽  
Mohit Bhandari
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Medical Literature ◽  
Evidence Based ◽  
Surgical Interventions ◽  
Surgical Practice ◽  
Large Scope ◽  
Clinical Questions ◽  
Based Medicine ◽  
Database Content

Introduction: As evidence-based medicine is increasingly being adopted in medical and surgical practice, effective processing and interpretation of medical literature is imperative. Databases presenting the contents of medical literature have been developed; however, their efficacy merits investigation. The objective of this study was to quantify surgical and orthopaedic content within five evidence-based medicine resources: DynaMed, Clinical Evidence, UpToDate, PIER, and First Consult. Methods: We abstracted surgical and orthopaedic content from UpToDate, DynaMed, PIER, First Consult, and Clinical Evidence. We defined surgical content as that which involved surgical interventions. We classified surgical content by specialty and, for orthopaedics, by subspecialty. The amount of surgical content, as measured by the number of relevant reviews, was compared with the total number of reviews in each database. Likewise, the amount of orthopaedic content, as measured by the number of relevant reviews, was compared with the total number of reviews and the total number of surgical reviews in each database. Results: Across all databases containing a total of 13268 reviews, we identified an average of 18% surgical content. Specifically, First Consult and PIER contained 28% surgical content as a percentage of the total database content. DynaMed contained 14% and Clinical Evidence 11%, whereas UpToDate contained only 9.5% surgical content. Overall, general surgery, pediatrics, and oncology were the most common specialty areas in all databases. Discussion: Our findings suggest that the limited surgical content within these large scope resources poses difficulties for physicians and surgeons seeking answers to complex clinical questions, specifically within the field of orthopaedics. This study therefore demonstrates the potential need for, and benefit of, surgery-specific or even specialty-specific tools.

Contemporary Approaches for Evidence-Based Pharmacotherapy

2013 ◽  
Vol 26 (2) ◽  
pp. 95-102
Author(s):  
Suzanna Gim ◽  
William R. Vincent
Keyword(s):  
Evidence Based Medicine ◽  
Patient Specific ◽  
Evidence Based ◽  
Valid Evidence ◽  
Clinical Questions ◽  
Based Medicine

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. This article provides simple ways to practice everyday EBM by (1) asking patient-specific clinical questions, (2) finding the most relevant, best evidence, (3) critically appraising evidence to ensure validity, (4) applying evidence to practice, and (5) using available tools to stay abreast of relevant and valid evidence as it becomes available.

scholarly journals TEACH Cards: Teaching Evidence-Based Medicine and Clinical Topics in the Hospital

PRiMER ◽  
2018 ◽  
Vol 2 ◽  
Author(s):  
Thomas W. Hahn ◽  
Caitlin D'Agata ◽  
Jennifer Edgoose ◽  
Jennifer Mastrocola ◽  
Larissa Zakletskaia ◽  
...  
Keyword(s):  
Medical Education ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Question ◽  
Medicine Service ◽  
Inpatient Medicine ◽  
Adult Inpatient ◽  
Survey Results ◽  
Clinical Questions ◽  
Based Medicine

Introduction: Inpatient training and evidence-based medicine (EBM) curricula are fundamental components of medical education. Teaching EBM And Clinical topics in the Hospital (TEACH) Cards is an inpatient curricular tool developed to help guide efficient, discussion-based teaching sessions. TEACH Cards aims to increase frequency of inpatient teaching, improve exposure to the breadth of inpatient topics, advance EBM skills, and improve efficiency in answering clinical questions. Methods: TEACH Cards is a set of 25 topic-based cards, each addressing an adult inpatient medicine topic by asking background questions and encouraging learners to write and answer foreground questions. Residents and faculty from a family medicine residency rotating on an adult inpatient medicine service during the 6-month study period were invited to complete a prerotation survey, use the TEACH Cards, and then complete a postrotation survey. Results: Out of 54 potential participants, 35% completed both the pre- and postrotation surveys. Respondents used TEACH Cards on average three times per week, reporting significantly stronger agreement that they were both learning (P=0.034) and teaching (P=0.006) core inpatient topics. Respondents reported greater confidence in using EBM resources (P=0.006) and significantly shorter time to find an evidence-based answer to a clinical question (pretest median=6-10 minutes vs posttest median=2-5 minutes, P=0.002). Conclusion: Use of TEACH Cards increased self-reported exposure to the breadth of core inpatient topics, confidence with EBM skills, and efficiency in finding answers to clinical questions.  

From science to practice

2012 ◽  
pp. 122-130
Author(s):  
John R. Geddes
Keyword(s):  
Evidence Based Medicine ◽  
Real Life ◽  
Clinical Problem ◽  
Research Articles ◽  
Evidence Based ◽  
Clinical Tool ◽  
Biomedical Journals ◽  
Assessment And Treatment ◽  
Clinical Questions ◽  
Based Medicine

Clinicians need accurate and up-to-date information about emerging knowledge on assessment and treatment as well as other developments in practice. The presentation of this knowledge needs to be timely, accurate, and unbiased. In an ideal world, every psychiatrist would have instantaneous access to the original scientific articles. As this is not feasible because clinicians are busy and the skills needed for an adequate systematic search, critical appraisal, and interpretation of research articles are not routinely available. Further, the volume of research articles is staggering: about 2 million papers are published in 20 000 biomedical journals every year, and even if a psychiatrist restricted her reading to those clinical psychiatry journals it would be necessary to read about 5500 papers each year—equivalent to 15 papers every day. Clearly, a strategy is required for efficient and timely identification of research that is both methodologically sound and clinically relevant. A coherent set of strategies designed as a clinical tool to link the best available evidence directly to the care of individual patients was first formulated at McMaster University in Canada—an approach called evidence-based medicine. Evidence-based medicine is problem-based and splits the process of linking research to practice into five stages (formulating a structured clinical question, finding evidence and advances in the organization of clinical knowledge, using a systematic approach to searching for the best available evidence, applying the evidence to the clinical problem, and assessing and improving the process) plus the identification of clinical questions in need of more research. To make evidence-based practice feasible in real-life clinical practice, a number of problems need to be solved at each stage of the process.

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