Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> OBJECTIVE ::: To develop a taxonomy of doctors' questions about patient care that could be used to help answer such questions. ::: ::: ::: DESIGN ::: Use of 295 questions asked by Oregon primary care doctors to modify previously developed taxonomy of 1101 clinical questions asked by Iowa family doctors. ::: ::: ::: SETTING ::: Primary care practices in Iowa and Oregon. ::: ::: ::: PARTICIPANTS ::: Random samples of 103 Iowa family doctors and 49 Oregon primary care doctors. ::: ::: ::: MAIN OUTCOME MEASURES ::: Consensus among seven investigators on a meaningful taxonomy of generic questions; interrater reliability among 11 individuals who used the taxonomy to classify a random sample of 100 questions: 50 from Iowa and 50 from Oregon. ::: ::: ::: RESULTS ::: The revised taxonomy, which comprised 64 generic question types, was used to classify 1396 clinical questions. The three commonest generic types were "What is the drug of choice for condition x?" (150 questions, 11%); "What is the cause of symptom x?" (115 questions, 8%); and "What test is indicated in situation x?" (112 questions, 8%). The mean interrater reliability among 11 coders was moderate (kappa=0.53, agreement 55%). ::: ::: ::: CONCLUSIONS ::: Clinical questions in primary care can be categorised into a limited number of generic types. A moderate degree of interrater reliability was achieved with the taxonomy developed in this study. The taxonomy may enhance our understanding of doctors' information needs and improve our ability to meet those needs. <s> BIB001 </s> Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> If implemented, evidence-based medicine (EBM) in general practice will improve health outcomes for patients. This paper examines the views of 60 Australian general practitioners about EBM. While 57% of respondents had a computer in their surgery, 15% had Internet access and only 3% had access to the Cochrane Library at work. The most commonly cited barrier to EBM was 'patient demand for treatment despite lack of evidence for effectiveness' (45%). The next three most highly rated barriers related to lack of time. For each of three tasks of EBM, namely searching for evidence, appraising evidence and discussing the implications of evidence with patients, lack of time was rated as a 'very important barrier' by significantly more participants than lack of skills (McNemar's tests: chi2(1) = 7.1, P = 0.008, chi2(1) = 14.0, P = 0.001 and chi2(1) = 9.0, P = 0.003, respectively). Preferred resources for EBM included clinical practice guidelines (rated as 'very useful' by 55%) and journals that summarize research evidence, for example Evidence-based Medicine (52%). Systematic reviews were considered 'very useful' by only 15% of respondents, consistent with our finding that 30% did not understand the term 'systematic review'. Furthermore, 43% did not understand 'meta-analysis'. A minority indicated they understood the terms 'relative risk' (23%), 'absolute risk' (28%) and 'number needed to treat' (15%) sufficiently to explain to others. Skills development is crucial to achieve EBM in general practice. <s> BIB002 </s> Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> OBJECTIVE ::: To describe the obstacles encountered when attempting to answer doctors' questions with evidence. ::: ::: ::: DESIGN ::: Qualitative study. ::: ::: ::: SETTING ::: General practices in Iowa. ::: ::: ::: PARTICIPANTS ::: 9 academic generalist doctors, 14 family doctors, and 2 medical librarians. ::: ::: ::: MAIN OUTCOME MEASURE ::: A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions. ::: ::: ::: RESULTS ::: 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover the topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement. ::: ::: ::: CONCLUSIONS ::: Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources. <s> BIB003 </s> Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> OBJECTIVE ::: To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information resources. ::: ::: ::: DESIGN ::: Qualitative analysis of questions asked by 48 randomly selected generalist physicians during ambulatory care. ::: ::: ::: MEASUREMENTS ::: Frequency of reported obstacles to answering patient-care questions and recommendations from physicians for improving clinical information resources. ::: ::: ::: RESULTS ::: The physicians asked 1,062 questions but pursued answers to only 585 (55%). The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed (52 questions, 11%). Among pursued questions, the most common obstacle was the failure of the selected resource to provide an answer (153 questions, 26%). During audiotaped interviews, physicians made 80 recommendations for improving clinical information resources. For example, they requested comprehensive resources that answer questions likely to occur in practice with emphasis on treatment and bottom-line advice. They asked for help in locating information quickly by using lists, tables, bolded subheadings, and algorithms and by avoiding lengthy, uninterrupted prose. ::: ::: ::: CONCLUSION ::: Physicians do not seek answers to many of their questions, often suspecting a lack of usable information. When they do seek answers, they often cannot find the information they need. Clinical resource developers could use the recommendations made by practicing physicians to provide resources that are more useful for answering clinical questions. <s> BIB004 </s> Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> PURPOSE ::: Physicians fail to pursue answers to most of their clinical questions, despite exhortations to practice evidence-based medicine (EBM). While studies have revealed several barriers practicing physicians experience in answering clinical questions, residents may encounter unique obstacles. The authors conducted a qualitative study to explore residents' experience in trying to answer their clinical questions. ::: ::: ::: METHOD ::: In 2003, the authors studied a convenience sample of 34 residents, representing 54% of the residents in a university-based internal medicine program. A professional facilitator convened and audiotaped three focus groups with the residents, following a discussion guide. The key question elicited the barriers residents encountered in attempting to answer their clinical questions. A thematic analysis of the transcripts was performed, using the constant comparison method of analysis. Two investigators met after independently analyzing each of the transcripts to compare coding structures, review theme exemplars, and reach consensus for differences. ::: ::: ::: RESULTS ::: Eight main themes emerged that characterize the EBM barriers, including access to medical information, skills in searching information resources, clinical question tracking, time, clinical question priority, personal initiative, team dynamics, and institutional culture. The analysis suggested a conceptual model in which residents may encounter different barriers in every step of the EBM process. Furthermore, attitudinal or cultural barriers may lead a resident to abandon the pursuit of a question before some of the technical barriers would be encountered. ::: ::: ::: CONCLUSION ::: Residents face several EBM barriers, some of which are unique to their status as trainees. While increased informatics training and reliable, rapid, and point-of-care access to electronic information resources remain necessary, they are not sufficient to help residents practice EBM. Educators must also attend to their attitudes toward learning and to the influence of programmatic and institutional cultures. <s> BIB005 </s> Automated text summarisation and evidence-based medicine: A survey of two domains <s> Obstacles to the Practice of EBM <s> In a domain such as medicine, it is important that individuals' infor- mation needs are met with information on a suitable level of difficulty and ex- pertise. This paper focuses on facilitating medical information access through reformulating queries and re-ranking result lists utilizing features typical for the language written for professionals or for laypersons. The aim is to produce re- sult lists where the ranking is better suited for the expertise level of the user. We will explore the possibility of using features such as trigger phrases for que- ry reformulation and document length, average word length or compound ratio for re-ranking. The Swedish medical IR test collection, MedEval, from Sprakbanken, Uni- versity of Gothenburg, will be used to find features specific for professional language and lay language and to study the effectiveness of these features in re- formulating queries and re-ranking search results based on the target group. The test collection contains 42,250 documents from the medical corpus MedLex , collected from all types of written medical information found in electronic for- mat, except patient records. The collection contains 62 topics. In total, 7,044 documents have been assessed both for relevance to these topics and for tar- get group. Our experiments will be based on earlier explorative studies on medical ex- pert and lay language where some features were identified. It was found that documents written for professionals tended to have more tokens per document, longer words, and more compounds than lay documents The assessed documents were run through a perl program which counted the frequencies of occurring multiword units (MWUs). The frequencies of individ- ual MWUs were much higher in the expert documents. For the doctors, medical phrases dominate the MWUs while the patients' documents mostly contained general language units. The most frequent patient MWUs from the medical do- main, were more frequent in the doctor documents and could therefore not be said to be typical for patient documents. Many frequently recurring MWUs are not specific for any topic. However, they may be seen as trigger phrases indicat- ing target group. Such trigger phrases will be used in the reformulation of the queries. We believe that the phrases typical for a user group can be used to reformu- late queries and that the likewise typical features can be useful for calculating <s> BIB006
Ely et al. [2002] conducted a well known research to identify and explain the obstacles practitioners face when they attempt to answer clinical questions using evidence. The study revealed fifty-nine obstacles which were divided into the following five broad categories (i) recognising that there is a void in the knowledge of a practitioner on a specific topic, (ii) formulating a clinical query that accurately and comprehensively encapsulates the information needs of the practitioner, (iii) performing efficient searches for the relevant information, (iv) synthesising multiple and incomplete evidences to formulate the final response, (v) and using the formulated answer to make decisions about patient care, taking into account other relevant information such as the medical history of the patient. From the fifty nine obstacles, BIB003 also identified a few that are considered to be critical by practising doctors, which are as follows: (1) The amount of time needed to find information is commonly seen as the most crucial obstacle in EBM practice. Most busy doctors lack the time or skills to track down and evaluate evidence, and when searching for evidence, practicing doctors do not have time to search multiple resources. Literature search and appraisal may take hours and even days. According to  , it takes more than 30 minutes on average for a practitioner to search for an answer. But usually practitioners spend about 2 minutes BIB001 . Hence, many questions go unanswered. BIB004 classify this problem as a 'resource-related' problem and state that physicians want rapid access to concise answers that are easy to find and tell them what to do in specific terms. (2) It is often difficult to structure a question that includes all the important information and is not vague. Recent research in medical information retrieval has focused on query formulation and other aspects of information retrieval to aid practitioners BIB006  . (3) It is difficult to select an optimal strategy to search for information as the medical literature is unwieldy, disorganised and biased  ], and although electronic databases facilitate searching, the procedure requires skill and expertise. Even for an experienced librarian, the search to find a comprehensive set of documents related to a clinical query may take hours. Other difficulties related to information seeking include the presence of large numbers of irrelevant material in search results, and the difficulty in finding correct search terms  ]. (4) An identified resource may not cover the specific topic, and often practitioners may not have timely access to the necessary resources required to answer a question BIB002 . (5) It is often difficult to tell when all the relevant evidence associated with a topic has been found. The number of relevant documents can vary significantly between topics, and, therefore, physicians are often left unsure as to when they should stop searching BIB003 BIB005 . (6) The synthesis of information-once all the relevant information has been found, it is a daunting task to synthesise the information from different sources. Studies carried out have shown that practitioners frequently mention difficulties with generalising research findings and applying evidence to individual patient care BIB002 . The reasons behind this include the incapability of any of the sources to completely answer the clinical question, the selected articles not directly answering the clinical question, and different articles providing contradictory information BIB004 BIB003 .