Norwegian Physicians' Knowledge of and Opinions about Evidence-Based Medicine: Cross-Sectional Study

Objective: To answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources? Design: Cross sectional survey in 2006. Setting: Norway. Participants: 966 doctors who responded to a questionnaire (70% response rate). Results: In total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM. Conclusions: The results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library

Systematic reviews, systematic error and the acquisition of clinical knowledge

<p>Abstract</p> <p>Background</p> <p>Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources.</p> <p>Discussion</p> <p>The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge.</p> <p>Conclusions</p> <p>The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.</p

An exploration of secondary students' mental states when learning about acids and bases

This study explored factors of students’ mental states, including emotion, intention, internal mental representation, and external mental representation, which can affect their learning performance. In evaluating students’ mental states during the science learning process and the relationship between mental states and learning achievement, valid, reliable, and scalable measures of students’ mental states and learning achievement are needed. This paper presents the development of the Mental State Conceptual Learning Inventory (MSCLI) to identify students’ mental states before and after learning about acids and bases. This instrument is time efficient and convenient and can be administered to large student samples so that teachers and researchers can gain profound insights into their students’ learning of acids and bases in science class. The results of this study indicate that students’ mental states are highly correlated with their achievement. As a whole, low-achieving students tended to have negative emotions and low intentions, were not good at internal visualization, and were unable to interpret graphics and draw pictures. In contrast, high-achieving students had positive emotions and intentions when learning life-related topics about acids and bases, and were good at internal visualization and drawing and interpreting graphics

Evidence at a glance: error matrix approach for overviewing available evidence

Contains fulltext : 88651.pdf (publisher's version ) (Open Access)BACKGROUND: Clinical evidence continues to expand and is increasingly difficult to overview. We aimed at conceptualizing a visual assessment tool, i.e., a matrix for overviewing studies and their data in order to assess the clinical evidence at a glance. METHODS: A four-step matrix was constructed using the three dimensions of systematic error, random error, and design error. Matrix step I ranks the identified studies according to the dimensions of systematic errors and random errors. Matrix step II orders the studies according to the design errors. Matrix step III assesses the three dimensions of errors in studies. Matrix step IV assesses the size and direction of the intervention effect. RESULTS: The application of this four-step matrix is illustrated with two examples: peri-operative beta-blockade initialized in relation to surgery versus placebo for major non-cardiac surgery, and antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. When clinical evidence is deemed both internally and externally valid, the size of the intervention effect is to be assessed. CONCLUSION: The error matrix provides an overview of the validity of the available evidence at a glance, and may assist in deciding which interventions to use in clinical practice

The mismeasure of ape social cognition

In his classic analysis, The Mismeasure of Man, Gould (1981) demolished the idea that intelligence was an inherent, genetic trait of different human groups by emphasizing, among other things, (a) its sensitivity to environmental input, (b) the incommensurate pre-test preparation of different human groups, and (c) the inadequacy of the testing contexts, in many cases. According to Gould, the root cause of these oversights was confirmation bias by psychometricians, an unwarranted commitment to the idea that intelligence was a fixed, immutable quality of people. By virtue of a similar, systemic interpretive bias, in the last two decades, numerous contemporary researchers in comparative psychology have claimed human superiority over apes in social intelligence, based on two-group comparisons between postindustrial, Western Europeans and captive apes, where the apes have been isolated from European styles of social interaction, and tested with radically different procedures. Moreover, direct comparisons of humans with apes suffer from pervasive lapses in argumentation: Research designs in wide contemporary use are inherently mute about the underlying psychological causes of overt behavior. Here we analyze these problems and offer a more fruitful approach to the comparative study of social intelligence, which focuses on specific individual learning histories in specific ecological circumstances

The cognitive implications of intentional communication: a multifaceted mirror

There is a central concern in contemporary cognitive science with the validity of the use of epistemic and intentional terms to interpret the communication patterns of non-human animals. Here I argue (a) that the human developmental transition to intentional communication is a well-described phenomenon, from an empirical standpoint; (b) that the behavioural patterns that characterise intentional communication in our own species are also well-described in the communication of our nearest living relatives, the great apes; (c) that the presence of the behavioural markers for intentional communication in non-human primates does not unambiguously implicate any particular one of a large number of often mutually contradictory hypothetical psychological process models; and (d) that intentional communication by young humans is also consistent with hypothetical process models that are, themselves, mutually contradictory. Intentional communication is a class of behaviour that is open to public, objective measurement. In contrast, the hypothetical cognitive processes supporting intentional communication in both human and non-human animals are not specified by the fact that intentional communication has occurred—they could not be, except when there is an unambiguous behavioural index of invisible psychological processes, which is a contradiction in terms. In this chapter, I will examine a number of contemporary scientific practices that purportedly reveal aspects of psychological processes underlying intentional communication and demonstrate the deficiencies of these protocols. In general, these methodological infelicities support a systematic, discipline-wide double standard of interpretation of the communication of animals and humans. I will conclude that there is no convincing evidence extant of different psychological processes in the intentional communication of apes and preverbal humans