COMMENTARY: DINA TBAISHAT

This chapter focuses on managing clinical data, to get the research evidence to those who need to use it for decision making. The chapter complements Chapter 13, which discusses electronic data capture and clinical document architecture. Policy makers and clinicians need research evidence to help make health-carerelated decisions on behalf of populations or individuals. Therefore, organisations such as the international Cochrane Collaboration work to gather, summarise and synthesise the best evidence from research, making the task of practitioners and policy makers easier. The evidence-based practice movement has moved from medicine to other health care disciplines and further into other areas of social science (including library and information practice). Evidence-based practice has always had its critics, who often note that a rules-based approach was not in accordance with the way professionals practise, denying any value to professional judgement (Pope, 2003) or how clinicians, for example, appear to learn to make decisions quickly, using ‘illness scripts’, or that the popularity of published case reports and care studies demonstrates the value of the ‘story’ – just as in knowledge management (Urquhart, 1998). Greenhalgh, Howick and Maskrey (2014), writing on behalf of the Evidence-Based Medicine Renaissance Group, note some current problems. For example, there is too much evidence in the form of guidelines and the possible solution of clinical decision support aids does not help practitioners make decisions for, and more importantly with, individuals who cannot be compartmentalised so easily into neat boxes, and who often have multiple (and interacting) problems.

The chapter explains what a systematic review is and how practitioners use them – or maybe just the summaries – to answer queries quickly. The searching strategy types are then introduced briefly, with the conclusion that subject or keyword searches are used most often, and sometimes simpler strategies across several databases might be as effective as the more comprehensive searches, particularly if there are text mining tools to help with screening. Various tools are suggested to improve the systematic review process, and the pros and cons for these tools considered, which may help in later decisions on when each of these tools is most appropriate. Integration with other systems is another issue that might be of interest, as data management systems should reflect site workflow, a difficult task and an obstacle when attempting to exploit their full electronic system capabilities.