Bridging the gaps between evidence-based and experience-based medicine in a Swiss Cochrane Symposium

Article type
Authors
Dorffler Melly J, Bleuer J
Abstract
Background: The Cochrane Collaboration has gained world-wide acceptance as a non-profit organization providing information mainly on therapeutic decision making. To what extent the Cochrane Library presently is perceived as a helpful tool for the clinical practitioner in every day life in Switzerland and how accurately epidemiologists and Cochrane Collaborators do meet the clinicians needs in their bridging-the-gap activities still seems to be a controversial issue.

Objective: The aim of this presentation is to identify gaps between the practise of Swiss clinical physicians in selected relevant clinical settings and recommendations of epidemiologists and/or members of the Cochrane Collaboration.

Methods: Basic source of information used to identify controversial issues is an interactive Cochrane Symposium organised by the Swiss Cochrane Working Group and the University Hospital of Berne, Switzerland on April 30, 2004. The symposium covers three levels of information transfer: 1. Presentation of evidence-based data covering items such as stroke prevention following carotid thrombendarterectomy by platelet inhibitors, antithrombotic therapy following carotid dissection, evidence for lipid lowering measures, the duration of treatment with VKA in symptomatic venous thromboembolism, antithrombotic therapy in patients with PAD, and the treatment with magnesium of patients with coronary heart disease; 2. Discussion of controversial issues including pitfalls of meta-analysis, high rates of inconclusive analyses, missing evidence and validity of personal experience; 3. Impartion of knowledge of the most important statistical measures communicated in an easily comprehensible way, how to write a review protocol, and the development of a systematic review. Attendants of the symposium are asked to answer a questionnaire including general information on personal characteristics (specialisation, interests, age, gender, location), accessibility and type of EBM-information sources (databases, libraries), frequency of use, average time spent in information retrieval, limitations by inaccessibility of information and reasons for adoption of the EBM-methodology in daily practise. The second part of the questionnaire focuses on specific information regarding the performance of the interactive symposium.

Results and Conclusion: Information collected from the questionnaires and discussions during the symposium will be analysed and presented. Sequences of the discussion will be shown in short video-clips to illustrate the communication level and interactions. The approach chosen for the symposium and the resulting feed-back will be discussed. If appropriate, new strategies for bridging the gaps between Swiss clinicians and the Cochrane Collaboration shall be developed.