Our history
BMJ Clinical Evidence was created in 1999 and has subsequently undergone countless redesigns and revisions. We convened an international advisory board, held focus groups of clinicians, talked to patient support groups, and adopted countless good ideas from early drafts by our contributors. However, throughout our development we have kept in mind an equation set out by Slawson et al.[1] This states that the usefulness of any source of information is equal to its relevance, multiplied by its validity, divided by the work required to extract the information. In order to be as useful as possible, we aimed for high relevance, high validity, and low work in terms of the reader's time and effort. We also kept in mind principles of transparency and explicitness. Readers needed to understand where our information came from and how it was assembled.
A unique resource
BMJ Clinical Evidence is one of growing number of sources of evidence-based information for clinicians. But it has several features that make it unique.
Its contents are driven by questions rather than by the availability of research evidence. Rather than start with the evidence and summarise what is there, we identify important clinical questions, and then search for and summarise the best available evidence to answer them.
It identifies but does not try to fill important gaps in the evidence. In a phrase used by Jerry Osheroff, who has led much of the research on clinicians' information needs,[2] BMJ Clinical Evidence presents the dark as well as the light side of the moon. We feel that it is helpful for clinicians to know when their uncertainty stems from gaps in the evidence rather than gaps in their own knowledge.
A work in progress
BMJ Clinical Evidence continues to evolve. We knew when we started that we were undertaking an enormous task, and the more we work on it, the more we realise its size. Although we have made every effort to ensure that the searches are thorough and the appraisals of studies are objective (see Searching and appraising the literature), we will inevitably have missed some important studies. In order not to make unjust claims about the accuracy of the information, we use phrases such as "we found no systematic review" rather than "there is no systematic review".
Accessibility
BMJ Clinical Evidence is currently available in three formats: in print (BMJ Clinical Evidence Handbook); via PDA; and online. The site has been redesigned and improved in response to user feedback, and further enhancements are planned.
Whichever the format, we recognise that accessing the sort of information contained in BMJ Clinical Evidence can be challenging, even for experienced users. We are therefore working on making the text as readable as possible. Further issues of BMJ Clinical Evidence will see more of the numbers presented in data tables rather than in the text, and more use of expert commentary to highlight the main clinical messages. We would welcome your views on other ways in which we can make the information as accessible as possible.
International reach
BMJ Clinical Evidence has an international circulation, reaching more than a million clinicians worldwide in seven languages. In the USA, 500,000 clinicians receive copies of the handbook thanks to the United Health Foundation. In the UK, the National Health Services in Scotland and Wales fund the provision of free online access to a total of over 660,000 clinical staff. The BMA send the the handbook to 10,500 UK medical students once a year. The governments of Norway and New Zealand now provide everyone in their countries with free online access, and thanks to the Italian Ministry of Health and the work of the Italian Cochrane Centre, 300,000 doctors in Italy receive a copy of BMJ Clinical Evidence Conciso [3] (BMJ Clinical Evidence Handbook translated into Italian).
BMJ Clinical Evidence is available in other non-English language editions. The Spanish translation (published in collaboration with the Iberoamerican Cochrane Centre and Legis) now comes in both handbook and online formats.[4] The full text is available in Russian [5] (seven broad speciality editions). The concise edition is also available in German [6], Hungarian [7] and Portuguese [8].
Finally, BMJ Clinical Evidence Online continues to be available free to people in developing countries as part of an initiative spearheaded by the World Health Organization and the BMJ Publishing Group. Details of the countries that qualify are available from the BMJ Clinical Evidence website.
References
- Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. J Fam Pract 1994;38:505–513.
- Ely JW, Osheroff JA, Ebell MJ, et al. Analysis of questions asked by family doctors regarding patient care. BMJ 1999;319:358–361.
- Clinical Evidence Conciso: La fonto delle miglioriprove de efficacia per la pratica clinica. Milan, Itlay: Centro Cochrane Italiano/Editore Itlaiano/ Editore Zadig, 2005.
- Evidencia Clinica. Barcelona, Spain/Bogotá, Colombia: Asociacon Colaboracion Cochrane Iberoamerican/ Legis, 2005.
- Dokazatel'naya meditsina. Moscow, Russia: Media Sphera Publishing Group, 2003
- Kompendium Evidenzbasierte Medizin. Bern, Switzerland Verlag Hans Huber, 2005.
- BMJ Clinical Evidence Handbook. Budapest, Hungary: Medition Kiadó Kft, 2005.
- Evidência Clínica Conciso. Porto Alegre, Brazil: Artmed Editora SA, 2005.