Presentation of presentations

Evidence-Based Practice April 8th 2013

Dr Carl Heneghan Clinical Reader, University of Oxford Director CEBM www.cebm.net www.cebm.net1

Developing Evidence-Based Practice?Carl Heneghan MA, MRCGPCentre for Evidence Based MedicineUniversity of Oxford www.cebm.net2Practice of Evidence-Based Health Care

Small groups

Group 1 (Room 012) Carl Heneghan & Khamis Elissi

Group 2 (Room 018) Sharon Mickan & Claire FriedemannGroup 3 (Room 310) Kamal Mahtani, David Nunan & Sadeesh Srinathan

I am here because?I wanted 3 days of work Formulate an answerable questions

www.cebm.net5The aim of this session To understand what is EBP To recognize questionsTo develop focussed clinical questions www.cebm.net6What is Evidence-Based Medicine?Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values

www.cebm.net7Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isnt. BMJ 1996;312:71-2.

This definition of what EBM is and isnt has gained wide acceptance and made it easier for us to get our points across.Just in Time learningThe EBM Alternative ApproachShift focus to current patient problems(just in time education)Relevant to YOUR practiceMemorableUp to dateLearn to obtain best current answers

Dave Sackett

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Reduction of perioperative deaths by antibiotic prophylaxis for colorectal surgery www.cebm.net12Would you ever have put babies to sleep on their tummies? www.cebm.net13

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Why do we need RANDOMIZED CONTROLLED TRIALS ?

In the early 1980s newly introduced antiarrhythmics were found to be highly successful at suppressing arrhythmias.

Not until a RCT was performed was it realized that, although these drugs suppressed arrhythmias, they actually increased mortality.

The CAST trial revealed Excess mortality of 56/1000.

By the time the results of this trial were published, at least 100,000 such patients had been taking these drugs.16

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18What does CEBM do?

The 5 steps of EBMFormulate an answerable questionTrack down the best evidence Critically appraise the evidence for validity, clinical relevance and applicability Individualize, based clinical expertise and patient concernsEvaluate your own performance www.cebm.netPRESENTATION ONE8/04/2013Introduction to Evidence-Based Practice24JASPA*(Journal associated score of personal angst)J: Are you ambivalent about renewing your JOURNAL subscriptions?A: Do you feel ANGER towards prolific authors?S: Do you ever use journals to help you SLEEP?P: Are you surrounded by PILES of PERIODICALS?A: Do you feel ANXIOUS when journals arrive?

YOUR SCORE? (0 TO 5)* Modified from: BMJ 1995;311:1666-16680 (?liar) 1-3 (normal range) >3 (sick; at risk for polythenia gravis and related conditions) www.cebm.net26Median minutes/week spent reading about my patients:Self-reports at 17 Grand Rounds:

Medical Students: 90 minutesHouse Officers (PGY1):0 (up to 70%=none)SHOs (PGY2-4):20 (up to 15%=none)Registrars:45 (up to 40%=none)Sr. Registrars 30 (up to 15%=none)Consultants:Grad. Post 1975:45 (up to 30%=none)Grad. Pre 1975:30 (up to 40%=none) www.cebm.net27This summarises the data from about 12 DGHs around the England and Scotland.

In summary, HOs (who dont read at all) are being taught by old farts (who read 30 minutes a week).Size of Medical KnowledgeNLM MetaThesaurus875,255 concepts2.14 million concept namesDiagnosis Pro11,000 diseases30,000 abnormalities (symptoms, signs, lab, X-ray,)3,200 drugs (cf FDAs 18,283 products)1 disease per day for 30 yearsTo cover the vast field of medicine in four years is an impossible task. - William Olser www.cebm.net28

How many randomized trials are published each year www.cebm.net29Changes in the past 12 months A Survey of 43 EBM practitioners at 2009 EBM practice workshop

www.cebm.net30But we are (currently) poorly equipped to tell good from bad researchBMJ study of 607 reviewers14 deliberate errors inserted

Detection ratesOn average 10,000 hours, >10 yearsDeliberate practice

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Any questions?

www.cebm.net60Day One(Monday)Day Two(Tuesday)Day Three(Wednesday)

Registration from 08:15 in ReceptionCoffee in the Common Rm

Session One09:00 10:30Welcome &Plenary: Intro into EBP (CH)

Plenary:Critical Appraisal of RCTs(KM)

Plenary:Appraising Diagnostic Studies(MT)

10:30 11:00COFFEEin the Common RoomCOFFEEin the Common RoomCOFFEEin the Common Room

Session Two11:00 12:30

Small Group WorkQs & Abstracts

Small Group Work

Small Group Work

12:30 13:30LUNCHIn the Dining RoomLUNCHIn the Dining RoomLUNCHIn the Dining Room

Session Three13:30 15:00

Plenary:Study Designs(JH)Plenary:Systematic Reviews(SM)Plenary:Ethical Issues and Critical thinking in EBHC (JH)

15:00 15:30TRANSFER TO OUCS13 Banbury RoadTEAin the Common RoomCOFFEE in the Tawney Room

Session 415:30 17:00

Plenary:SearchingFollowed by computer lab(Nia)

Small Group WorkDeveloping Evidence Based Practice(CH)

16:30 Close

18:30GALA DINNERQueens College

Centre for Evidence-Based Medicine