Clinical Evidence and how it relates to Best Practice

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Clinical Evidence and how it relates to Best
Practice Steve Thorpe Regional Manager Europe
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About BMJ Group

• Limited company - wholly owned by the British
  Medical Association
• One of the worlds best known and most respected
  evidence-based medical publishers
• Reputation for excellence in medical publishing
  through over 150 years of commitment to the
  highest standards
• The BMJ brand represents medical credibility
  trust it brings with it a sense of heritage,
  reliability and authority.
• Approx. 300 staff located in UK, Europe,
  Asia-Pacific USA
• Customers in over 90 countries with approx. 70
  revenue from overseas
• Revenue growth of 20 in 2008
• 1.3 million distinct users a month across our
  products

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Evidence Based Medicine

• "Evidence based" is a phrase that has become
  widely used in medicine and surgery. It refers to
  the process of making use of the best research
  evidence, combined with your own clinical
  expertise, integrated with an individual
  patient's situation to provide the best possible
  care.
• Sackett DL, Rosenberg WM, Gray JA, Haynes RB,
  Richardson WS. Evidence based medicine what it
  is and what it isn't. BMJ 1996312(7023)71-2.

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Today we will cover the following

• Overview of BMJ.com BMJ Journals
• How Best Practice relates to Clinical Evidence
• Live demonstration of Clinical Evidence
• Live demonstration of Best Practice
• Questions Answers

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PRODUCT OVERVIEW (bmj.com)
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BMJ KEY FEATURES

• Continual publication publish oblivious of
  print for online version
• Whats new in the BMJ email alerts, plus
  podcasts etc.
• 4 main channels Research, Education, News and
  Comment
• Rigorous, accessible entertaining material

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BMJ
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PRODUCT OVERVIEW (Journals)
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BMJ Specialist Journals

• http//journals.bmj.com
• 22 journals in specialist areas
• Mainly clinical titles, focusing on helping
  doctors and medical students improve their day to
  day practice
• International editors and associate editors from
  all over the world
• Innovative Education sections, case-based
  learning, Patient columns
• Influential many are at the top of their
  specialty

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BMJ Specialist Journals

• Gut
• Heart
• Journal of Clinical Pathology
• Journal of Medical Ethics
• Journal of Medical Genetics
• Journal of Neurology, Neurosurgery and Psychiatry
• Postgraduate Medical Journal
• Quality and Safety in Health Care
• Sexually Transmitted Infections
• Thorax
• Archives of Disease in Childhood
• Annals of the Rheumatic Diseases
• BJO British Journal of Ophthalmology
• British Journal of Sports Medicine
• Emergency Medicine Journal
• Evidence-Based Medicine
• Evidence-Based Mental Health
• Evidence-Based Nursing
• Occupational and Environmental Medicine

Specialist
Evidence Based
Public Health
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BMJ Specialist Journals

• All journals have individual websites and
  full-text hosted by HighWire Press
• Full-text back to volume 1, issue 1
• Online First
• Reference links included
• CiteTrack alerting service, author and citations
• Search across all journals via HighWire

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BMJ Evidence Centre current products (2009)

• Best Practice
• Clinical Evidence
• BMJ Learning
• BMJ Best Health
• BMJ Case Reports
• On Examination
• DTB (Drug Therapeutics Bulletin)
• Evidence-based to support decision making
• Point of care information to reduce information
  overload
• Content fits into workflow needs of clinicians
  and patients

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Advantages of using BMJ Evidence Centre resources

• Encouraging best practice by preventing overuse
  and misuse of treatments
• Increasing the quality of care for patients
• Quality information - rigorous search and
  appraisal process
• Trusted based on an internationally recognised
  evidence-based editorial process
• Clinically lead information rather than research
  lead

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Frequently Asked Questions

• Question
• Will Best Practice replace Clinical Evidence and
  will you stop working on/adding content?
• Answer
• No, Clinical Evidence is a crucial part of the
  BMJ Evidence Centre. Clinical Evidence will
  continue to increase the number of conditions
  available and function as a stand-alone product
• Question
• How much information from Clinical Evidence is
  there in Best Practice?
• Answer
• The evidence within Best Practice is based on
  Clinical Evidence and is roughly 10 of the Best
  Practice content.

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Frequently Asked Questions (cont.)

• Question
• What is the difference between Clinical Evidence
  and Best Practice?
• Answer
• Clinical Evidence is a Evidence Based reference
  tool. For example, Clinical Evidence might be
  consulted several times a week, as and when
  needed, for guidance, educational purposes and
  reassurance
• Best Practice is a decision-support tool for use
  at the point of care. Best Practice will be used
  several times a day to look for Information to
  support treatment options often during the
  consultation period itself

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Clinical Evidence and Best Practice share the
same target audience

• Hospital Doctors GPs
• Nurses
• Researchers
• Pharmaceutical companies
• Government organisations
• Medical Associations
• Private persons

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What do Clinical Evidence and Best Practice have
in Common?

• Evidence
• Guidelines
• References
• Patient leaflets
• Drug reference databases (BNF or Martindale)

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The aim of Clinical Evidence is to summarise
evidence on medical interventions from high
quality systematic reviews and large
well-designed randomised controlled trials.
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Reasons for using Clinical Evidence
Survey based on 566 CE subscribers, from across
the world, mix of academic/primary
care/secondary, 20 in-depth phone interviews and
two mini focus-groups http//clinicalevidence.bmj.
com/downloads/BMJCEMRP0508.pdf
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Clinical Evidence facts

• A compendium of the best available research
  evidence findings on common and important
  clinical questions (systematic reviews)
• Covers over 3000 interventions and answers more
  than 570 clinical questions
• Describes the questions, summary and background
  of a condition then the benefits harms of
  preventative and therapeutic interventions
• Emphasis on the outcome for patients
• Findings based on expert knowledge evidence
  collected from detailed research using Cochrane
  Library, Medline, Embase and evidence based
  journals
• Contributors, advisors and editors are all
  specialist expert clinicians

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Clinical Evidence covers the following categories

• Interventions Summary / Benefits / Harms /
  Comments
• Key points Concise summary of condition
• About this condition Definition / Incidence
  Prevalence / Aetiology Risk factors / Prognosis
  / Aim of intervention / Outcomes / Methods
• Updates Comprehensive listing of relevant
  litterature across 120 evidence based journals
• Guidelines Country/continent specific guideline
• References References and Links to PubMed where
  possible

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A completely new concept for decision-support
delivered at the point of care. Structured
around the patient consultation, it covers
diagnosis, prognosis, treatment and prevention.
Your instant second opinion.
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Some reasons to use Best Practice

• With emphasis on Patients, Best Practice adds
  expert opinion and guidelines to cover diagnosis,
  prognosis, treatment and prevention to the
  conditions
• As such it is specifically designed as a
  practical tool to support decision making at the
  point of care.
• Where appropriate content from Clinical Evidence
  is incorporated directly into Best Practice
  monographs
• It has 3000 images specific to the conditions

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Best Practice facts and functionality

• Best Practice is a single decision-support source
  combining latest research evidence, guidelines
  and expert opinion
• Presented as a step-by-step approach, covering
  prevention, diagnosis, treatment and prognosis
• Its patient-focused approach represents a major
  new advancement in information delivery at the
  point of care
• The ability to change the language of the
  interface and navigation to selected local
  language
• A drug formulary (Martindale or BNF (UK Only))
  included for quick checking of prescription
  guidance
• Clinical Evidence inside brings together the
  best current evidence with expert guidance

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Best Practice covers the following categories

• Highlights Summary / Overview
• Basics Definition / Epidemiology / Aetiology /
  Pathophysiology / Classification
• Prevention Primary / Screening / Secondary
• Diagnosis History Examination / Tests /
  Differential / Step by Step / Criteria
  /Guidelines / Case History
• Treatment Details / Step by Step / Emerging /
  Guidelines / Evidence (powered by BMJ Clinical
  Evidence)
• Follow-up Recommendations / Complications /
  Prognosis
• Resources References and Links / Images / Online
  resources / Patient Leaflets/Credits

26th June 2008
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Clinical Evidence and Best Practice
Evidence relating to Treatment
Background to conditions
Treatment details
History and exam
Drug information
Prevention
Diagnostic tests
Point of care support tool
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Example of Clinical Evidence content in Best
Practice
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Example of Clinical Evidence content in Best
Practice
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Clinical Evidence Home page
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Clinical Evidence front page (continued)
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Case Scenario

• You are an inexperienced junior hospital doctor.
  A 55 year old asthmatic man who has heart failure
  attends the out-patient clinic. Despite taking an
  ACE inhibitor his heart failure is inadequately
  controlled. You discuss the case with your senior
  who advises that you add an Angiotensin II
  reception blocker to his treatment.
• BUT - you are worried, having never combined
  these two types of drugs before, and would like
  reassurance that this is a reasonable course of
  action

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Access via search
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Access via search
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Systematic review Heart failure
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Systematic review Heart failure
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Live Web Demonstration

• http//clinicalevidence.bmj.com/ceweb/index.jsp

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A completely new concept for decision-support
delivered at the point of care. Structured
around the patient consultation, it covers
diagnosis, prognosis, treatment and prevention.
Your instant second opinion.
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Live Web Demonstration

• http//bestpractice.bmj.com/best-practice/welcome.
  html

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Contact Details

• Albertina icome Praha, s.r.o.
• Jakub Petrik
• Sales Manager
• jakub.petrik_at_aip.cz
• BMJ Group
• Steve Thorpe
• Regional Manager Europe
• sthorpe_at_bmjgroup.com