Users' Guides to the Medical Literature
TL;DR: The authors of this “how to” book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts.
Abstract: Guyatt G, Rennie D, editors and The Evidence-Based Medicine Working Group. Users' guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press, 2002
The JAMA series on how to use the medical literature has been expanded and put into book and CD-ROM format. The Evidence-Based Medicine Working Group along with editors Gordon Guyatt and Drummond Rennie have provided practitioners with a valuable resource for evaluating evidence relevant to their practice. The authors of this “how to” book have made certain that it includes challenges to all levels of users of evidence, from beginners to experts. The material is presented in 3 formats: a 700 page manual for evidence-based practice (EBP) (Manual) that is thorough and comprehensive; a 440 page pocket version of the essentials of EBP (Essentials) that provides an indepth discussion of the basics; and a hyperlinked CD-ROM that contains the contents of the Manual and is included with both hardcopy versions. The Essentials book is small enough to keep in a large pocket, although the print is small and may be difficult for really tired eyes to read. The Manual …
Citations
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Research Triangle Park1, Harvard University2, Yale University3, Robert Wood Johnson Foundation4, University of Pennsylvania5, Columbia University6, University of North Carolina at Chapel Hill7, Memorial Sloan Kettering Cancer Center8, University of Arkansas for Medical Sciences9, University of Southern California10, Janssen Pharmaceutica11, Johnson & Johnson12, Cedars-Sinai Medical Center13
TL;DR: The goal of this article is to articulate the 4 central challenges facing clinical research at present--public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a view to improving the overall performance of the US clinical research enterprise.
Abstract: Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation’s clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present—public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a viewtoimprovingtheoverallperformanceoftheUSclinicalresearchenterprise.
1,142 citations
Cites background from "Users' Guides to the Medical Litera..."
...Expansion of nascent but effective practice-based research networks may help in training and increasing the participation of a variety of health care professionals in clinical research.(106) Beyond this, greater penetration of the science of research synthesis is needed to speed the implementation of new findings into routine practice and to evaluate how new innovations fit into the existing armamentarium of clinical care....
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TL;DR: It is found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently, in addition to errors that they prevent.
Abstract: CONTEXT
Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.
OBJECTIVE
To identify and quantify the role of CPOE in facilitating prescription error risks.
DESIGN, SETTING, AND PARTICIPANTS
We performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders.
MAIN OUTCOME MEASURE
Examples of medication errors caused or exacerbated by the CPOE system.
RESULTS
We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.
CONCLUSIONS
In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.
937 citations
Additional excerpts
...Our multimethod, triangulated approach explored wider ranges of CPOE’s effects.(33,42,48,54) That CPOE use might increase the likelihood of medication errors was an unanticipated finding, which would not have surfaced without open-ended qualitative research....
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01 Jan 2008
927 citations
TL;DR: This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients to relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine.
Abstract: This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.
704 citations
TL;DR: There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews, and this criteria list should be regarded as a minimum standard.
Abstract: Objectives: The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. Methods: The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. Results: The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. Conclusions: There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.
664 citations
References
More filters
Research Triangle Park1, Harvard University2, Yale University3, Robert Wood Johnson Foundation4, University of Pennsylvania5, Columbia University6, University of North Carolina at Chapel Hill7, Memorial Sloan Kettering Cancer Center8, University of Arkansas for Medical Sciences9, University of Southern California10, Janssen Pharmaceutica11, Johnson & Johnson12, Cedars-Sinai Medical Center13
TL;DR: The goal of this article is to articulate the 4 central challenges facing clinical research at present--public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a view to improving the overall performance of the US clinical research enterprise.
Abstract: Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation’s clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present—public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a viewtoimprovingtheoverallperformanceoftheUSclinicalresearchenterprise.
1,142 citations
Book•
01 Jan 2002
TL;DR: The third edition of this landmark resource is now completely revised and refreshed throughout, with expanded coverage of both basic and advanced issues in using evidence-based medicine in clinical practice.
Abstract: The #1 guide to the principles and clinical applications of evidence-based medicine is better than ever! No other resource helps clinicians to put key evidence-based medicine protocols into daily clinical practice better than Users' Guides to the Medical Literature. An instant classic in its first edition, this detailed, yet highly readable reference demystifies the statistical, analytical, and clinical principles of evidence-based medicine, giving you a hands-on, practical resource that no other text can match. Readers will learn how to distinguish solid medical evidence from poor medical evidence, devise the best search strategies for each clinical question, critically appraise the medical literature, and optimally tailor evidence-based medicine for each patient. The third edition of this landmark resource is now completely revised and refreshed throughout, with expanded coverage of both basic and advanced issues in using evidence-based medicine in clinical practice. Completely updated with new medical studies, new chapters, and new methods for applying EBM principles to patient care Contributors represent the world's most prominent assembly of EBM experts Covers both basic principles and clinical application
1,140 citations
TL;DR: It is found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently, in addition to errors that they prevent.
Abstract: CONTEXT
Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.
OBJECTIVE
To identify and quantify the role of CPOE in facilitating prescription error risks.
DESIGN, SETTING, AND PARTICIPANTS
We performed a qualitative and quantitative study of house staff interaction with a CPOE system at a tertiary-care teaching hospital (2002-2004). We surveyed house staff (N = 261; 88% of CPOE users); conducted 5 focus groups and 32 intensive one-on-one interviews with house staff, information technology leaders, pharmacy leaders, attending physicians, and nurses; shadowed house staff and nurses; and observed them using CPOE. Participants included house staff, nurses, and hospital leaders.
MAIN OUTCOME MEASURE
Examples of medication errors caused or exacerbated by the CPOE system.
RESULTS
We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients' medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.
CONCLUSIONS
In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.
937 citations
TL;DR: This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients to relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine.
Abstract: This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.
704 citations
TL;DR: There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews, and this criteria list should be regarded as a minimum standard.
Abstract: Objectives: The aim of the Consensus on Health Economic Criteria (CHEC) project is to develop a criteria list for assessment of the methodological quality of economic evaluations in systematic reviews. The criteria list resulting from this CHEC project should be regarded as a minimum standard. Methods: The criteria list has been developed using a Delphi method. Three Delphi rounds were needed to reach consensus. Twenty-three international experts participated in the Delphi panel. Results: The Delphi panel achieved consensus over a generic core set of items for the quality assessment of economic evaluations. Each item of the CHEC-list was formulated as a question that can be answered by yes or no. To standardize the interpretation of the list and facilitate its use, the project team also provided an operationalization of the criteria list items. Conclusions: There was consensus among a group of international experts regarding a core set of items that can be used to assess the quality of economic evaluations in systematic reviews. Using this checklist will make future systematic reviews of economic evaluations more transparent, informative, and comparable. Consequently, researchers and policy-makers might use these systematic reviews more easily. The CHEC-list can be downloaded freely from http://www.beoz.unimaas.nl/chec/.
664 citations