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Wind Currents
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August 29, 2008
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A
brief description of the fundamentals of scientific literature review with
links to on-line resources Kirsti Bocskay, PhD, MPH Epidemiologist IV Office of Epidemiology Chicago Department of Public Health Evidence-Based Medicine Requires New Skills Evidence-based medicine (EBM) is when health practitioners treat patients
using their own clinical experience and the careful,
specific and prudent application of knowledge obtained from review of published
research. The Journal of the American Medical
Association (see
below) and the British Medical Journal
(see
below) have both published a series of articles outlining best practices for
reviewing research papers for use in clinical practice. Many online resources
have summarized and/or adapted these articles, principles and guides [see On-Line Citations below]. Three Guiding Principles EBM has generated considerable interest among health care professionals,
and consequently the how-tos of critically
evaluating scientific papers has become a hot topic. This article will briefly
review some of the basic fundamentals you need to know when evaluating scientific
literature for your practice and will also provide references and links when available
to more detailed articles and examples. Regardless of the type of study (clinical
trial, intervention, case-control, etc.), three guiding principles for critiquing
a paper are validity, reliability and applicability. An Evidence Based Medicine (EBM) Primer Pam Rodriquez Tobacco Control Manager Evidence Based Medicine
(EBM) is the integration of clinical expertise, patient values and the best evidence
into the patient care decision-making process. Three Legs Clinical expertise is to the clinician's cumulated experience, education and clinical skills. Patient values
are the patient's own personal concerns and expectations that he or she brings to the encounter. Best evidence
is most often the result of clinically relevant research conducted using sound
methodology. New Skills Evidence-based medicine requires new skills of the clinician,
including efficient literature-searching
and the application of formal rules of
evidence in evaluating the clinical literature. Six Steps 1. Start with the patient since a clinical
problem or question arises from patient care. 2. Construct
a well-built clinical question from the facts in the case. 3.
Select the appropriate resource(s) to search. 4. Appraise your search evidence for its validity and applicability. (see
article How To Evaluate A Scientific Study) 5. Integrate the evidence from your literature search with your clinical
expertise and the patient's values and apply it to the clinical situation. 6.
Evaluate your performance with this patient. For more information on Evidence Based
Medicine go to http://www.cebm.net/ EBM and Tobacco Dependence
Treatment Thomas
P. Houston, M.D., FAAFP Director
of Nicotine Dependence Programs at Clinical Professor of Family Medicine
and Public Health at Member of the AAFP Commission on
Health of the Public and the Tobacco Cessation Advisory Committee. In tobacco dependence treatment, evidence-based processes drove
the creation of the U.S. Public Health Service Clinical Practice Guideline, "Treating
Tobacco Use and Dependence." Using systematic reviews of the current scientific
literature, evidence from randomized controlled trials, and meta-analysis, the
Guideline identifies clinical recommendations for tobacco cessation with the appropriate
level or strength of evidence for its recommendations. The revised 2008 guideline
was developed from a body of evidence consisting of 8,700 peer-reviewed articles
and abstracts that were published between 1975 and 2007. This new guideline can
be found at: http://www.guideline.gov/summary/summary.aspx?doc_id=12520&nbr=6444&ss=6&xl=999 Time for Steven A. Schroeder, M.D. Distinguished Professor of Health and Health Care, Department of Medicine Director, For more information on Ask-Advise-Refer,
go to http://www.askadviserefer.org/ For more information on medications, go to http://www.mayoclinic.com/health/nicotine-dependence/DS00307/DSECTION=treatments%20and%20drugs For more information on the Illinois Tobacco Quitline, go to http://www.quityes.org/. For cessation resources, go to http://www.lungchicago.org 30
Seconds to Save a Life Ask – Advise – Refer Wind Currents Staff How Busy Clinicians Can Help Their Patients Quit Tobacco This protocol addresses
time pressures at practice sites to give busy clinicians a simple, practical plan
that can be implemented with all patients. ASK: All patients about tobacco use • What you can say: "Do you smoke or use any type of tobacco?" "I take the time to talk to all my patients
about tobacco use because it's important for me to provide you the best health care I can." "Smoking can interact with the medications
you are taking. We need to know your smoking status to make sure you are getting the correct dose." ADVISE: patients who smoke to quit immediately • What you can say: "I strongly recommend that you quit as soon as possible, and I can help." "Quitting is probably the single most
important action you can take to improve your health now and in the future." REFER: patients who smoke to appropriate cessation resources • What you can say: "Let's review the available resources and determine what's right for you." "Take this card and call the Illinois
Tobacco Quitline, 1- 866 – QUIT - YES, or visit online resources such as http://www.quitnet.com
or http://www.becomeanex.org Adopted from Treating Tobacco
Use and Dependence Course Link: http://www.medscape.com/viewprogram/8840 Release Date:
Valid for credit through Credits Available Physicians - maximum of 1.0
AMA PRA Category 1 Credit(s)™ Nurses - 1.0 ANCC contact hours It is the policy of the
University of Wisconsin School of Medicine and Public Health that the faculty
and sponsor disclose real or apparent conflict of interest relating to the topics
of this educational activity, and also disclose discussions of unlabeled/unapproved
uses of drugs or devices during their presentation(s). In keeping with recent JAMA recommendations, Dr. Fiore
does not accept honoraria nor does he consult for the pharmaceutical industry.
In 1998, The University of Wisconsin (UW) appointed Dr. Fiore to a named Chair,
made possible by an unrestricted gift to UW from Glaxo Wellcome. Module 1: Why Should I Treat Tobacco Dependence? In Module 2: How Do I Treat Tobacco Smokers Who Are Willing to Quit? Ask
– Advise – Assess – Assist – Arrange Module
3: How Can I Help Prevent Relapse? Clinicians should:
1) reinforce the patient's decision to quit; 2) review the benefits of quitting;
3) assist the patient in resolving any residual problems arising from quitting. Module 4: How Do I Treat Tobacco Users Who Are Not Willing To Make A Quit Attempt? These patients may a) lack information about the harmful effects of tobacco;
b) may lack the required financial resources; c) may have fears or concerns about
quitting or; d) may be demoralized because of previous relapses. Such patients
may respond to an intervention built around the "5 R's", Relevance, Risks, Rewards,
Roadblocks And Repetition. Module
5: Special Populations Pregnant
Women, Racial and Ethnic Minorities, Hospitalized Smokers, Smokers With Psychiatric
Co-Morbidity and/or Chemical Dependency, Children and Adolescents, Older Smokers | |||||||||||||||||||
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