Presentation on theme: "What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database."— Presentation transcript:
What frustrates me about evidence and what changes I'd like to see! Jon Brassey, TRIP Database
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!
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
Problems with evidence Frequently doesn’t answer clinical questions Methodological purity seems more important than clinical usefulness
Analysis of dermatology questions 357 Q&As analysed How many questions were answered by systematic reviews? >50% 25-49% 10-24% <10%
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
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
Problems with search 100 clinicians Pain NHS Evidence
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’.
Problems with search – pain Pain
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
Summary of problems Evidence not fit for purpose Not findable Usefulness medical information = (relevance x validity)/ work (Slawson & Shaughnessy)
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
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’.
TRIP’s experiments TILT – Shared learning tool Clinicians record their learning Snippets of applicable evidence Blitter – Curated list of clinicians that blog or tweet Index of content clinicians feel are noteworthy Clinicians added based on speciality
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