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Enhancing the retrieval, understanding, and use of clinical evidence at the point of care

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Defense Thèse de privat-docent : Univ. Genève, 2017
Abstract Since its birth about 20 years ago, Evidence-Based Medicine (EBM) has changed the way we teach and practice medicine. Yet, despite its large uptake and numerous developments, important gaps remain in the transfer of knowledge to the point-of-care. Clinicians still face major challenges, particularly in: (1) retrieving current best evidence, (2) understanding it, and then (3) using it in their daily practice in clinical encounters with patients. In this Privat-Docent thesis we outline some of the progress that EBM has made in these fields, as well as current limitations. We then present a compilation of 3 of our published manuscripts, each addressing specific aspects of these challenges. In the first article (evidence retrieval), we designed 15 search strategies in PubMed, and tested them on 30 clinical questions, for which a Cochrane Systematic Review defined the gold standard for the set of relevant articles to find. We identified search strategies that can help clinicians retrieve manageable-sized and relevant outputs and thus more easily spot sound evidence to answer their clinical questions. The second article (understanding the evidence) addressed one specific issue related to how clinicians understand diagnostic tests accuracy, and manage the task of updating their pre-test probability of the disease into post-test probability. Using a hypothetical scenario in which we randomized pre-test probability, we found that only about 10% of them seem able to correctly perform this task. Finally, the third paper (evidence use) reports on our attempt to translate evidence summaries using the GRADE methodology into consultation decision aids to support shared decision making between patients and clinicians. We implemented our framework and tools on our online authoring and publication platform (the MAGICapp – www.magicapp.org) and provided a proof-of-concept of how the production of tools for shared decision making can be streamlined and better linked with the evidence.
Keywords Evidence-Based MedicineGuidelinesCritical AppraisalDecision AidsDecision Support SystemsClinical Epidemiology.
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Research group Epidémiologie clinique (115)
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AGORITSAS, Thomas. Enhancing the retrieval, understanding, and use of clinical evidence at the point of care. Université de Genève. Thèse de privat-docent, 2017. https://archive-ouverte.unige.ch/unige:100290

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Deposited on : 2017-12-13

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