Evaluation of the Belgian Guidelines Website EBMPracticeNet in French General Practice.

EBMPracticeNet is a Belgian website of guidelines translated and adapted from the Finnish EBM guidelines. During the experimentation of the EBMPracticeNet website in France, physicians globally got an accurate answer and found the information provided by the website reliable and useful for practice. They perceived its ergonomics as good and wished to continue using it. Improvements should focus on the indexation and adaptation of the guidelines, and on physicians' training.

[Breast cancer screening: a better anamnesis and an informed choice]. / Dépistage du cancer du sein : une meilleure anamnèse et un choix informé.

The goal of this article is to compare breast cancer screening national and international guidelines for defining a pragmatic and evidence-based attitude for primary care professionals in Belgium. A literature review was made in the main guidelines databases and in the belgian epidemiological and reimbursement databases. The decrease in breast cancer mortality this last decade reduce the screening efficiency by the same extent. Finally, it is recommended to propose systematically mammotest screening between 50 and 70 and to inform the patients by messages developed for this purpose by the KCE. Based on a simple family history, we can define three risk groups (KCE - strong recommendation, moderate evidence level). Start this anamnesis from 30 years old, seems to be logical regards to the exams which have to be done if the risk is very elevated. If the risk is elevated, it is recommended to propose annual mammography between 40 and 49 (KCE - weak recommendation - very low evidence level). If the risk is very elevated, refer to the secondary care. Supplementary data are needed to appreciate the influence of social health determinant on the breast cancer morbidity and mortality and to improve our vision of the screening benefice-risk trade-off.

[From library to clinical decision support systems: access of general practitioner to quality information]. / De la bibliothèque aux systèmes d'aide a la décision: accéder a de l'information de qualité en médecine générale.

Since 2003, the following tools have been implemented in Belgium for improving the access of general practioners to the EBM literature: the Digital Library for Health and the evidence-linker of the CEBAM, the portal EBMPracticeNet.be and the multidimensional electronic clinical decision support EBMeDS. The aim of this article is to show the progress achieved in the information dissemination toward the belgian general practioners, particularly the access from the electronic health record. From the literature published these last years, the opportunities cited by the users are for using EBM and the strong willingness for using these literature access in the future; the limits are the medical data coding, the irrelevance of the search results, the alerts fatigue induced by EBMeDS. The achievements done and planned for the new EBMPracticeNet guidelines portal and the EBMeDS system are explained in the aim of informing belgian healthcare professionals. These projects are claiming for lauching a participatory process in the production and dissemination of EBM information. The discussion is focused on the belgian healthcare system advantages, the solutions for a reasonable implementation of these projects and for increasing the place of an evidence-based information in the healthcare decision process. Finally the input of these projects to the continuing medical education and to the healthcare quality are discussed, in a context of multifactorial interaction healthcare design (complexity design).