BMJ Resources Training –BMJ Best PracticeDju-Lyn Chng

Account Development Manager

bestpractice.bmj.com

Types of Evidence-based Information

Randomised Controlled Double Blind Studies

Systematic Reviews and Meta-analyses

Source: Medical Research Library of Brooklyn

The burden of evidence is significant

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.

Task Time Spent Effectiveness (1-5 rating)

Conclusion

Treatment 79.2% 1.72 Not recommended

CME 11.1% 2.88 Limited

Research 8.6% 4.69 Recommended

Others 1.1% NA NA

2009-2010 Research

Perception & Attention

Knowledge

Long Term Memory External 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. 266-78

Knowledge

Long Term Memory External Information

Knowledge

Perception & Attention

Working Memory

& Inference

Patient dataPatient data

Long Term Memory External Information

Knowledge

Perception & Attention

?? Knowledge

Patient dataPatient data

Working Memory

& Inference

Long Term Memory External Information

Perception & Attention

Working Memory

& Inference

Knowledge

Patient data

Knowledge

Patient data

Long Term Memory External Information

Perception & Attention

Knowledge

Patient data

Working Memory

& Inference

Knowledge

Patient data

Long Term Memory External Information

Perception & Attention

?? Knowledge

Patient data

Knowledge

Patient data

Working Memory

& Inference

Steps to the solution

…as proposed by Haynes and Haines in 1998 1

• 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;317:273-276.

http://bestpractice.bmj.com

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 Evidence

• Critical prescribing information with links to Martindale

• Patient support leaflets

• Remote Access and Mobile Phone Access

What’s in Best Practice?

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

Images for reference

References – with full-text links

Patient Leaflets

Start using BMJ Best Practice on your mobile phone!

http://bp.bmjgroup.mobi/

http://bp.bmjgroup.mobi/

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

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 al1 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), 1336-1338. doi: 10.1001/jama.280.15.1336.

Use BMJ Portfolio to record your Learning Need

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

copd

April 2008

Thank you

Dju-Lyn Chng

dlchng@bmjgroup.com

© BMJ Publishing Group Ltd ("BMJ Group") 2009. 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.