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Introducing the accumalator BET
Best evidence topic reports (BestBETs) were first described by the emergency department at the Manchester Royal Infirmary.1 They were originally developed as an educational tool to focus teaching of competencies in the practice of evidence based medicine to junior doctors,2 but soon developed into a means of identifying the need for evidence based changes in practice and of helping to effect these changes. BestBETs have been published regularly in peer reviewed journals (currently this journal3 and the Archives of Disease in Childhood4), and are listed and updated on a dedicated web site.5 This web site (www.bestbets.org) has been enthusiastically reviewed both nationally6 and internationally,7 and is recognised as an important resource for evidence based practice.8 The web site has been upgraded to allow the underpinning critical appraisals to be posted, thus further increasing its educational and reference value.9
At the time of writing this editorial there were 609 BETs in various stages of completion on the web site, 203 of which had been published in peer reviewed journals. This is quite an impressive output for five years and far exceeds any expectations we had at the outset. Can we do better still?
Initially all the BETs were researched and checked in the Manchester Royal Infirmary. Now authorship of the BETs has widened with contributors from all around the world. Some of this work has been undertaken in a focused way, with projects run for Rural and Remote Practice for the Scottish Executive and for prehospital care with the Joint Royal Colleges Ambulance Liaison Committee. The core, however, remains the individual efforts of clinicians inspired to find out an answer to conundrums and conflicts in their practice. If every reader of this journal contributed one BET and checked one other then the shared evidence base for our specialty would be hugely increased. As those of you who have undertaken these short cut reviews will have found they are not as easy as they look, but the outcome is definitely worth the effort. We will make an effort to ensure that courses are available to support acquisition of the basic skills needed for BET production; then there will be no excuses for non-participation in this underpinning project.
Unexpected success has brought unexpected problems. The sheer number of BETs has meant that keeping these reviews current has become a huge problem. Our stated aim was to ensure that each BET was re-searched and re-edited every six months so that the web version was always up to date. We have struggled to get anywhere near this standard but, with the help of our new BestBETs web editors (acknowledged at the end of this editorial) we hope to do better. If any of you feel you have the skills and time to help with this glamorous, but unpaid, task then please join up today.
This issue of the journal includes the first of an occasional series of “Accumulator BETs”. It struck us that with so many BETs now completed it should be possible to put some together to explore particular pathways of care. Our first effort is for atraumatic pleuritic chest pain; some of the BETs to support this are published in this issue of the journal, some have been published already while yet others are currently just available on the web site. We will publish other Accumulator BETs as the number of reviews in particular areas increase. If you have particular requests or suggestions then please let us know.
The BestBETs have become one of the most popular features in this journal, probably because they fulfil their aim of allowing practising clinicians to find real answers to real life problems. Of course they are not perfect but, with your help, we can make them even BetterBETs. Sign up today.
BestBETs web editors
Howard Simpson, Steve Jones, Magnus Harrison, Bob Phillips (Arch Dis Child), Ian Maconochie, Ian Crawford
Introducing the accumalator BET
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