Biomedical subjects
Allen F Shaughnessy
Publications and source records attributed to Allen F Shaughnessy.
Disseminating drug prescribing information: the cox-2 inhibitors withdrawals.
This case study examined the recent withdrawal of valdecoxib to determine the timeliness of updates in commonly used information sources used by healthcare professionals. The method included assembling a purposive sample of 15 drug reference and warning systems that were then systematically monitored for several months after the withdrawal of valdecoxib to determine the time to update this information. These information sources were classified and described qualitatively. A time to diffusion curve was plotted and the average number of days to report the drug withdrawal or update reference databases was calculated. Only 2 of 15 information systems reported the drug withdrawal on the actual date of the FDA announcement. Institutional electronic textbooks took an average of 109.8 days (+/-14 days) to report the withdrawal. In addition, one pharma-sponsored dissemination source (Peerview Press) had not updated their information as of this publication.
Teaching evidence-based medicine: should we be teaching information management instead?
To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients as well as being valid. The authors discuss the need to teach the applied science of information management along with, or perhaps even instead of, teaching the basic science of evidence-based medicine. All students, residents, and practicing physicians need three skills to practice the best medicine: the ability to select foraging--"keeping up"--tools that filter information for relevance and validity, the skill to select and use a hunting--"just in time"--information tool that presents prefiltered information easily and in a quickly accessible form at the point of care, and the ability to make decisions by combining the best patient-oriented evidence with patient-centered care, placing the evidence in perspective with the needs and desires of the patient. This teaching of information management skills will prepare students and residents for a practice of medicine that requires lifelong learning.
Easy ways to resist change in medicine.
Explore the source record for details and available documents.
Blowing the whistle on review articles.
Explore the source record for details and available documents.
Combination therapy with ACE inhibitors and angiotensin-receptor blockers in heart failure.
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers have different pharmacologic mechanisms for blocking the effect of the renin-angiotensin-aldosterone system on the cardiovascular system. Pharmacologically, the combination of these drug classes completely blocks the deleterious effect of angiotensin in patients with heart failure. However, clinical trials have not shown a marked benefit from using this combination compared with using angiotensin-converting enzyme inhibitors alone. Patients who take combination therapy do not live longer, although they are less likely to be hospitalized for worsening symptoms. Most patients who take combination therapy will not experience marked improvement in symptoms or quality of life.
Research was evidence based.
Explore the source record for details and available documents.
What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes.
OBJECTIVE: To evaluate systematically the review literature on type 2 diabetes to assess transmission of the findings of the United Kingdom prospective diabetes study (UKPDS), an important source of recent valid patient oriented evidence that matters (POEMs). DESIGN: Inception cohort analysis of the recent medical literature. STUDIES REVIEWED: Thirty five reviews on treatment of type 2 diabetes. MAIN OUTCOME MEASURES: Presentation of three types of information from UKPDS in review articles: recommendations based on patient oriented outcomes of study; recommendations contradicted by patient oriented outcomes of study; and recommendations based on disease oriented outcomes for which no patient oriented evidence exists. RESULTS: Only six of the reviews included the POEM that tight blood glucose control had no effect on diabetes related or overall mortality. Just seven mentioned that metformin treatment was associated with decreased mortality. Most (30) of the reviews did not report that diabetic patients with hypertension benefit more from good blood pressure control than good blood glucose control. No review pointed out that treatment of overweight patients with type 2 diabetes with insulin or sulphonylurea drugs had no effect on microvascular or macrovascular outcomes. Thirteen reviews recommended drugs as first line treatment for which we do not have patient oriented outcomes data. The average validity assessment score was 1.3 out of a possible score of 15 (95% confidence interval 0.9 to 1.8). CONCLUSIONS: Review articles on the treatment of type 2 diabetes have not accurately transmitted the valid POEM results of the UKPDS to clinicians. Clinicians relying on review articles written by experts as a source of valid POEMs may be misled.
Saw palmetto for prostate disorders.
Saw palmetto is an herbal product used in the treatment of symptoms related to benign prostatic hyperplasia. The active component is found in the fruit of the American dwarf palm tree. Studies have demonstrated the effectiveness of saw palmetto in reducing symptoms associated with benign prostatic hyperplasia. Saw palmetto appears to have efficacy similar to that of medications like finasteride, but it is better tolerated and less expensive. There are no known drug interactions with saw palmetto, and reported side effects are minor and rare. No data on its long-term usage are available. The herbal product also has been used to treat chronic prostatitis, but currently there is no evidence of its efficacy.
How to write an evidence-based clinical review article.
Traditional clinical review articles, also known as updates, differ from systematic reviews and meta-analyses. Updates selectively review the medical literature while discussing a topic broadly. Non-quantitative systematic reviews comprehensively examine the medical literature, seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment. Meta-analyses (quantitative systematic reviews) seek to answer a focused clinical question, using rigorous statistical analysis of pooled research studies. This article presents guidelines for writing an evidence-based clinical review article for American Family Physician. First, the topic should be of common interest and relevance to family practice. Include a table of the continuing medical education objectives of the review. State how the literature search was done and include several sources of evidence-based reviews, such as the Cochrane Collaboration, BMJ's Clinical Evidence, or the InfoRetriever Web site. Where possible, use evidence based on clinical outcomes relating to morbidity, mortality, or quality of life, and studies of primary care populations. In articles submitted to American Family Physician, rate the level of evidence for key recommendations according to the following scale: level A (randomized controlled trial [RCT], meta-analysis); level B (other evidence); level C (consensus/expert opinion). Finally, provide a table of key summary points.
Teaching information mastery: the case of baby Jeff and the importance of Bayes' theorem.
Explore the source record for details and available documents.
In patients with diabetes and hypertension, should treatment start with an ACE inhibitor instead of a diuretic or beta blocker?
Explore the source record for details and available documents.
Right ballpark, wrong base: assessing safety of NSAIDs.
Explore the source record for details and available documents.
When less is more: a practical approach to searching for evidence-based answers.
The information needs of practicing clinicians are distinct from the needs of students, researchers, or nonclinical personnel. Clinicians seek information to stay current with new relevant medical developments and to find answers to patient-specific questions. The volume of available information makes clinicians' tasks of rapidly identifying high-quality studies daunting. New tools evaluate the rigor and relevance of information and summarize it in the form of synthesized clinical answers. These sources have the opposite focus of many other information tools in that they strive to provide less information rather than more. With the development of these sources of validated and refined information, a new search approach is needed to locate clinical information in which speed is the benchmark. The existing medical literature, including these new refinement tools, can be conceptualized as a pyramid, with the most useful information, based on validity and relevance, placed at the apex. Use of this hierarchy allows searchers to drill down through progressive layers until they find their answers. Librarians can play a significant role in evaluating the ever-increasing variety of these synthesized resources, placing them into the searching hierarchy, and training clinicians to search from the top down.