BMJ Resources Training – BMJ Best Practice Dju-Lyn Chng Account Development Manager bestpractice.bmj.com

Types of Evidence-based Information Cohort Studies Case Control Studies Case Series Case Reports Ideas, Editorials, Opinion Full-Text Journal Articles Randomised Controlled Double Blind Studies Systematic Reviews and Meta-analyses Source: Medical Research Library of Brooklyn

The burden of evidence is significant …although figures vary 35,000 biomedical journal articles published annually 150,000 articles / month 120,000 RCT/year 500,000 articles are indexed in PubMed every year

Effectiveness of Full-Text – Study in China 2581 Clinicians were surveyed Study to show effectiveness of full-text for various purposes of a clinicians time 73% of responses: Even if read and understood all full-text, it is still not easily applied to clinical workflow. TaskTime SpentEffectiveness (1-5 rating) Conclusion Treatment79.2%1.72Not recommended CME11.1%2.88Limited Research8.6%4.69Recommended Others1.1%NA Research

Perception & Attention Knowledge Long Term MemoryExternal Information Knowledge Patient data Working Memory & Inference Patient data R B Elson, J G Faughnan, D P Connelly. An industrial process view of information delivery to support clinical decision making: implications for systems design and process measures.Journal of the American Medical Informatics Association : JAMIA 1997;4 (4) p

Knowledge Long Term MemoryExternal Information Knowledge Perception & Attention Working Memory & Inference Patient data

Long Term MemoryExternal Information Knowledge Perception & Attention ? Knowledge Patient data Working Memory & Inference

Long Term MemoryExternal Information Perception & Attention Working Memory & Inference Knowledge Patient data Knowledge Patient data

Long Term MemoryExternal Information Perception & Attention Knowledge Patient data Working Memory & Inference Knowledge Patient data

Long Term MemoryExternal Information Perception & Attention ? Knowledge Patient data Knowledge Patient data Working Memory & Inference

Steps to the solution …as proposed by Haynes and Haines in Generating evidence from research Synthesising the evidence Creating evidence based clinical policies Applying the policies 1. Brian Haynes, Andrew Haines. Education and debate: Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ 1998;317:

What is Best Practice? Clinical decision support Tool Structured around the patient consultation with advice on symptom evaluation, test ordering and treatment approach Includes over 10,000 diagnoses in Assessments and Differential Diagnosis to help clinicians answer questions quickly Provides NICE Guidelines and allows for adding of institutional guidelines locally Integrated evidence from Clinical EvidenceClinical Evidence Critical prescribing information with links to Martindale Patient support leaflets Remote Access and Mobile Phone Access

What’s in Best Practice? Condition Overview PreventionDiagnosisTreatment Clinical Evidence Follow-up

Three Key Monograph Types Condition Monograph –Provides comprehensive information on a specific condition or group of conditions

Three Key Monograph Types Assessment Monograph –How to evaluate a symptom (e.g., chronic cough) –Clinical finding (e.g., peripheral oedema) –Diagnostic test finding (e.g., metabolic acidosis)

Three Key Monograph Types Overview Monograph –Provides an overview of a category of conditions

Clinical Question: A 70-year-old man is discovered by a family member to have difficulty speaking and extreme balance difficulty. The family member brings him to you in the Emergency Ward. He was last known to be fully functional 1 hour ago when the family member spoke to him by phone. There is a history of treated hypertension and diabetes. How should you proceed with assessing and managing this patient?

Where to begin? - Symptom Searching

Find your results

Assessment Details

Differential Diagnosis

Condition Details

Diagnosis – History & Examination

Diagnosis – Tests

Diagnosis – Differential Diagnosis

Diagnosis – Step-by-Step

Treatment – Ordered by Patient Group

Treatment – Links to Martindale

Step-by-Step – Supported by Evidence Integrated with Clinical Evidence

Supported by Evidence

Guidelines – International and Institutional

What are the other features of Best Practice?

Images for reference

References – with full-text links

Patient Leaflets

Start using BMJ Best Practice on your mobile phone!

BMJ Best Practice Mobile Phone Access Use BMJ Best Practice on your mobile phone Register for a “My Best Practice” account from within your hospital computer or through your Athens Log-in Use your “My Best Practice” username and password to access Mobile phone URL: bp.bmjgroup.mobi

Registration Steps – IP User Click on “My Best Practice” while you are within your organisation’s IP. Go to “Register for your own personal account”. Enter an address you regularly check. Complete the registration form. Continue to Best Practice after successful registration. Log-out of Best Practice to complete the registration.

Personalisation Features Adding notes Bookmark pages that you regularly refer to Save your searches

“My Best Practice” Features Save Searches Save Bookmarks See your institution’s guidelines

Identifying Learning Needs Frequently occurs at the point of care The problem is recalling what the learning needs are Sackett et al 1 found that if a need was identified only 12% then sought the information later EBM tools at the point of care and ability to record learning 1. Sackett, D. L. (1998). Finding and Applying Evidence During Clinical Rounds: The "Evidence Cart". JAMA: The Journal of the American Medical Association, 280(15), doi: /jama

Use BMJ Portfolio to record your Learning Need

EBM & Learning Resources EBM & Learning Resources Knowledge Gap Actionable knowledge at point of care Referential knowledge resources Improve outcomes Identify and record learning needs Learning resources Record of learning activity Close knowledge gap

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April 2008 Thank you Dju-Lyn Chng © BMJ Publishing Group Ltd ("BMJ Group") All rights reserved. No part of this document may be reproduced, translated or adapted in any form or by any means without the express written permission of the BMJ Group. To the fullest extent permitted by law, this content is supplied "as is" without any warranty as to accuracy.