Dunja Dreesens

18 The world of knowledge A lot of research is carried out in health care. This research aims primarily to find out new knowledge that could lead to changes in treatments, policies or care. Many different types of research exist: from studies in a scientific laboratory to those that observe and examine people with different conditions, and to develop new treatments. Researchers look into preventing or curing disease, promoting good health, or finding out patients’ experience of different care services and support in the community (13). All this research leads to a vast knowledge base. And this knowledge base accumulates fast daily. Bastian, Glasziou and Chalmers showed in 2007 that every day 75 trials and 11 systematic reviews are published (see figure 2) (14). Since then, these numbers have been increasing steadily (15, 16). Articles and systematic reviews indexed in Medline (PubMed), 1994-2013 (17) Figure 2: The increasing volume of research evidence (based on: Grattan Institute, report Questionable care, 2015) For example, if a cardiac imaging specialist wants to stay up to date she or he needs to read 30 papers a week on echocardiography or 43 a week on multimodality imaging. Time that cannot be spent with patients. Sackett et al indicated already over 30 years ago that it would be impossible for clinicians to stay abreast of the developments in their field (16). That clinicians have been indicating for years that they feel overburdened by information should therefore be no surprise (18, 19). The ‘phrase information overload’ was already coined in 1970 (15); a more modern typology could be that healthcare professionals suffer from ‘info-besitas’ (20). One of the best-known responses to this information overload was the founding of the Cochrane Collaboration in 1993. It was named after the Scottish clinician and epidemiologist Archie Cochrane who called for a critical summary of all relevant randomised controlled trials (RCT) that is adapted periodically. Realizing that most of the information was of poor quality, to him it made no sense for healthcare professionals to try and read everything. Therefore, they should be able to rely on critical summaries (16, 21). Chapter 1