the pace of change in practice-driving medical knowledge in new models of publishing
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The pace of change in practice-driving medical knowledge in new models of publishing. May 5, 2013 Brian S. Alper, MD, MSPH, FAAFP Editor-in-Chief, DynaMed Medical Director, EBSCO Publishing. Introduction/Disclosures. Rural family medicine in 1995 - PowerPoint PPT PresentationTRANSCRIPT
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The pace of change inpractice-driving medical knowledge
in new models of publishing
May 5, 2013Brian S. Alper, MD, MSPH, FAAFP
Editor-in-Chief, DynaMedMedical Director, EBSCO Publishing
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Introduction/Disclosures
Rural family medicine in 1995
Mission to provide most useful informationto healthcare professionals at point of care
Now working full-time asEditor-in-Chief, DynaMedMedical Director, EBSCO Publishing
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Half of what is taught in medical education is wrong, but we don’t
know which half.
Attributed to Dr. C. Sidney Burwell, Dean of Harvard Medical School 1935-1949, in Pickering GW. The purpose of medical education. BMJ 1956 Jul 21;2:113
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45 highly-cited original research publications
16%
16%
24%
16% contradicted by subsequent studies16% found to have smaller ef-fects24% remain un-replicated
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218-228
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124 original articles in NEJM in 2009
Prasad V, Gall V, Cifu A. The frequency of medical reversal. Archives of Internal Medicine 2011 Oct 10;171(18):1675-1676
49%
13%
49% present new prac-tice surpassing current care
13% reverse previosly accepted care
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The pace of change is accelerating. “Medicine will change more in the
next 20 years than it has in the past 2000.”
Smith R. Thoughts for new medical students at a new medical school. BMJ 2003 Dec 20;327(7429):1430-1433
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How quickly does core evidence change?• Management overviews of top DynaMed topics evaluated
- Maintained via 7-step evidence-based methodology- Updated daily- Standardized templates with outline format (overviews represent most important evidence and guideline for practice)
• Compared to 1-2 years ago, how many lines have changed (addition, deletion, modification)?
• Classify change due to
- New evidence
- New guidance
- External feedback
- Internal quality improvement
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How quickly does core evidence change? Interim results: 80 topics (mean time 1.5 years)
0%20%40%60%80%
100%
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Examples of new evidence changing overviews Dyspnea: midazolam may reduce unexplained dyspnea more than
morphine in advanced cancer
Gallstones: cholecystectomy within 48 hours in mild gallstone pancreatitis may safely reduce hospital stay
MS: dextromethorphan/quinidine sulfate may reduce frequency/severity of pseudobulbar affect episodes
MRSA: comparative efficacy for linezolid, telavancin, vancomycin
PE: Pulmonary Embolism Rule out Criteria (PERC)
PE: less bleeding with oral rivaroxaban vs. LMWH/warfarin
Stroke: graduated compression stockings do not appear to reduce DVT and may cause skin damage
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How quickly does core evidence change? Interim results: 4,411 lines, 2,532 lines changed
(mean time 1.5 years)
1160 modified 474 deleted 898 added0%
5%
10%
15%
20%
25%
30%
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Of 2,532 lines changed
How quickly does core evidence change?
0%
10%
20%
30%
40%
50%
60%
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How quickly does core evidence change?Interim results: 4,411 lines (mean time 1.5 years)
0%10%20%30%
Adjusted for 1-year timeframe:
16.2% practice-guiding information changes in 1 year due to
new evidence or guidance
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Questions?
Brian S. Alper, MD, MSPHEditor-in-Chief, DynaMed
Medical Director, EBSCO Publishing