Introducing the cochrane library in central and eastern Europe

Article type
Authors
Axelsson I(
Abstract
Background: Twelve countries are negotiating for membership in the European Union (EU); nine of them are situated in Central and Eastern Europe (CEE) or are Baltic countries. Doctors and nurses in the countries gaining membership in EU will be able to access the common job market. The medical culture in the CEE, the Baltic countries, and the present EU must therefore be harmonized. EU (the Leonardo da Vinci fund) supports several projects for harmonization of the health sectors.

Methods: Since 1997, I have 1. participated in Hungarian-Spanish-Swedish work to improve the continuing medical education (CME) in pediatrics for family physicians and community pediatricians in Hungary, including an introduction of "evidence-based medicine" (EBM) and the Cochrane Library; 2. had informal discussions on CME and EBM with physicians in other CEE countries, the Baltic countries, and Russia; 3. tried to introduce EBM and the Cochrane Library among physicians - especially junior doctors - in a Swedish rural county.

Results: Searching Medline for EBM results in 3,799 hits in all languages, 103 in German, but only 3 in Russian. This probably reflects a combination of insufficient coverage of Russian journals by Medline and insufficient knowledge of EBM in Russia and CEE. EBM was almost unknown in Hungary 1998. However, computer literacy, access to Internet, and use of English are fastly improving among MDs. Meetings regarding EBM and the Cochrane Library have now been arranged. The systematic reviews by Davis, Thomson et.al. on the ability of lifelong learning to change physician behavior or health care outcomes (JAMA 1995;274:700-705, 1999;282:867-874) are very useful. This means that traditional, didactic sessions should be minimized. Instead, we focus on practical use of the Cochrane Library by participants in everyday clinical work, and winning opinion leaders for the message.

Conclusions: The rate of progress in the medical field differs vastly between different countries, regions and individual MDs, and between "haves" and "have nots" (i.e. between those who have knowledge of English and those who do not). We are therefore now writing papers for national journals and a basic textbook in "Evidence-based child health", co-authored by national opinion-leaders and translated to the national language. The development and ingenuity are more impressive in parts of CEE than in Scandinavia and a truly bilateral or mutilateral exchange of ideas and experiences could be most fruitful for all involved. The Canadian systematic evaluation of methods of learning must be considered. The author wishes to discuss this with colleagues from CEE, the Baltic countries and the Commonwealth of Independent States at the colloquium.