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What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database.

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Presentation on theme: "What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database."— Presentation transcript:

1 What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database

2 Background Worked in information support for over ten years Started in primary care Q&A - answered over 10,000 clinical questions Developed the TRIP Database –searched over 50 million times Main interest – getting robust answers to clinicians queries!

3 Why am I annoyed? Evidence is not focussed on supporting clinical practice. For me this can be broken down into: ▫ Problems with the evidence ▫ Problems with search

4 Problems with evidence Frequently doesn’t answer clinical questions Methodological purity seems more important than clinical usefulness

5 Analysis of dermatology questions 357 Q&As analysed How many questions were answered by systematic reviews?  >50%  25-49%  10-24%  <10%

6 Analysis of dermatology questions Only 3 questions answered by a SR! 63% therapy, 9% diagnosis, 9% etiology 20% answered using secondary evidence alone Not much focus, DUETs aside, at feeding in coal-face information needs with production of evidence

7 Evidence Updates Run by Brian Haynes at McMaster via funding from the BMJ Examine 120 core clinical journals and rate them on:  Quality  Relevance  Newsworthiness Overall >95% rejected

8 Problems with search 100 clinicians Pain NHS Evidence

9 Problems with search – 100 Information seeking defined by the Google generation Ask 100 clinicians the support they’d want, how many would say – ‘Give me a search box where I add terms and then return 10 results which I need to read in the hope that they will answer my question’.

10 Problems with search – pain Pain

11 Problems with search – NHSE Nearly £25 million budget Around £15 million on non-content, including £730,000 marketing 385,000 searches per month or 4,620,000 annually (excludes CKS and SLs/SCs) >£3 per search TRIP Database < 1p

12 Summary of problems Evidence not fit for purpose Not findable Usefulness medical information = (relevance x validity)/ work (Slawson & Shaughnessy)

13 Solutions – better evidence Build on the work of DUETs and create a system to record clinical uncertainty Better understand the clinical information needs of ‘normal’ clinicians Better prioritisation of SRs and primary research Less is more

14 Solutions – improve search Work with clinicians and throw away the existing search paradigm Work better with the search intentions Break down full-text Be ambitious and not be constrained by the Google ‘mentality’.

15 TRIP’s experiments TILT – http://tilt.tripdatabase.com  Shared learning tool  Clinicians record their learning  Snippets of applicable evidence Blitter – http://blitter.tripdatabase.com  Curated list of clinicians that blog or tweet  Index of content clinicians feel are noteworthy  Clinicians added based on speciality

16 Ultimately... Need to give clinicians the: ▫The information they need ▫In the format they need ▫In the timeframe they need To me answering their questions is vastly superior to what we currently have

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