so much evidence
TRANSCRIPT
So Much Evidence
What is Next
Hesham Al-Inany, M.D, PhD
• Prof., Cairo UniversityEditor, RBMonline (since 2010)Editor, BJOG (since 2004)Editor, GOI (since 2006)Editor, Cochrane MDSG (since 2004)
Too much information
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500000
1000000
1500000
2000000
2500000
Biomedical MEDLINE Trials Diagnostic?
Med
ical
Art
icle
s p
er Y
ear
5,000?per day
1,500 per day
55 per day
The best evidence for different types of question
Level Treatment Prognosis Diagnosis
I Systematic Review of …
Systematic Review of …
Systematic Review of …
II Randomised trial
Inception Cohort
Cross sectional
III
systematic reviews - 20% done for therapy
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New protocols
Existing protocols
New reviews
Updated reviews
Existing reviews, not incl updates
Reviews and protocols for reviews on The Cochrane Database of Systematic Reviews
Issue 1/2005Alderson, 2005
OBGYN in Pubmed
• 563 meta-analysis • 7184 RCT• 258 guidelines
Ready Made EBOG
• RCOG• SOGC• Cochrane Library• UpTodate
“I don’t know…”
“I don’t really care about all of this research stuff…”
“I just want to take care of patients…”
Unnamed Ob-Gyn Resident
Still There is a Problem
Beyond the Linear Model
Basic Research
TreatmentDevelopment
EffectivenessTrial
TreatmentDeployment
Clinical Trial(Efficacy)
Many “Leaks” from research & practice
Aware Accept Target Able Recall Agree Done
ValidResearch
If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
(a*+) (b+)
(c*) (d)
Minimum clinicalImportant difference
No difference
Another Problem : Which are (i) statistically significant * and (ii) Clinically significant +?
Read EBM sources
Start Journal
club
Engage colleagues
Record ur practice
Write a Letter to
BMJ
Individual
EBP
The EBM Model
BestEvidence
Client Values and Expectations
Practitioner’s IndividualExpertise
Sackett et al., 1997
EBP Model
Clinical state and
circumstances
Clinical Expertise
Client Preferences and actions
ResearchEvidence
But still
Knowledge needs to be managed much
more effectively than it has been in
the past
“Evidence Base” Community
• “The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)
“Evidence Base” Community
• Evidence mapping• Mining the Research• Missing Pieces: Identifying the Gaps in
Evidence
“Evidence Base” Community
• engaging patients in research• working with guideline developers• Reporting and discussing practice guidelines• Podcasting as a Dissemination Strategy• funding for Knowledge Translation and
Dissemination
Moving Methodology Forward
• prognostic evidence in systematic reviews of interventions
There’s Nothing Constant but Change
Steps For Evidence Base Community Implementation
Information sharing with decision Makers
Organization preparation & Fund raising
Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support
Engagement Strategic planFocus on outcomes that clients value.
Improved Women Health
Clinicians, consumers, Stakeholers and Supervisors
Feedback :Efficiency & Effectiveness
Elements Important (Fixsen et al, 2005)
• Commitment of leadership to the implementation process.
• “unfreezing” current organizational practices.• Resources for extra costs, effort, materials, recruiting,
access to expertise, retraining.