EBM --- Journal Reading Presenter ：蕭皓天 Date ： 2005/10/17

Users ’ Guides to the Medical Literature Editorials JAMA; Nov 3, 1993; 270, 17

Change and Challenge Rate of change ： accelerating 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 Problems ： valuable ？ biases ？ different suggestions ？

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

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  User’s guides

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

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 Reader’s Guides based on the author’s track record

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

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

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

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

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 ？

Users’ guide More clearly differentiated ： Clinical practices based on sound evidence from studies in human beings v.s. physiological rationale or standard practice Sense of empowerment ： when faced with enthusiastic reports of a new technique or approach to care, or with conflicting recommendations of experts

Conclusion User’s guide will meet the expectations of clinicians who want to base their clinical decisions on evidence rather than hope or authority.

Thank you ！