Contributions of Clinical Epidemiologists and Medical Librarians to Developing Evidence-Based Clinical Practice Guidelines in Japan: A Case of the Treatment of Rheumatoid Arthritis / General Medicine

ABSTRACT

In Japan, a government-funded project to develop evidence-based guidelines for the treatment of rheumatoid arthritis started in 1999. Methodologists, including epidemiologists and medical librarians, were asked to participate in this project. Working as a team, the rheumatologists, clinical epidemiologists, and medical librarians reviewed the published evidence systematically. The process and the results, particularly systematic search and review of literature, were assessed from the viewpoint of epidemiology and evidence-based medicine (EBM) . The librarians, supervised by the clinical epidemiologists, searched the literature according to 30 key questions defined by the rheumatologists and classified the articles according to the“level of evidence”. Finally, 379 articles were selected (drug therapy, 207; surgical treatment, 108; rehabilitation/devices, 64) . Meta-analyses and randomized controlled trials accounted for more than 80% of the drug treatment and rehabilitation/device reports, while nearly 70% of the articles retrieved regarding surgical treatment were case series without relevant control groups. The rheumatologists wrote structured abstracts for each article so that they could be used as reference for developing practice guidelines. The literature search, individual original articles, and the PubMed system were examined from the viewpoint of research methodology; the lessons learned were described.<BR>In conclusions, clinical epidemiologists and medical librarians have contributed to developing evidence-based practice guidelines. Clinical epidemiologists were able to work as a coordinator between clinicians and medical librarians. The popularity of EBM requires that expertise in this field be strengthened and made available to a broader audience.