EBM or cases or both? - Tom Jefferson
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EBM or cases or both? - Tom Jefferson

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EBM or cases or both? - Tom Jefferson EBM or cases or both? - Tom Jefferson Presentation Transcript

  • EBM or cases or both? Tom Jefferson Cochrane Ari Group , Cochrane Vaccines Field etc Jefferson.tomail.com Thanks to Dr Massimo Arlotti, Sebastiano Leone, Fabio Franzetti, Evangelo Boumis, Angelo Pan Celebrating case reports and stories in health care
  • EBM
    • Mainly based on comparative studies (esp. their synthesis)
    • Randomised Controlled Trial/tightly controlled experimental paradigm
    • Non-randomised (comparative) studies
    Celebrating case reports and stories in health care
  • Problems
    • Inductive methods
    • Uniformity of nature
    • Abstraction and generalisation
    • Patients in front of you not quite the same as those in trials
    Celebrating case reports and stories in health care
  • Celebrating case reports and stories in health care Repeated observation across different contexts Induction Theories and general principles Deduction Conclusions and explanations The arch of knowledge
  • When do we need case knowledge?
    • Heavy contextualisation
    • Rare diseases
    • Harm monitoring
    • When controls are not available or not ethical
    • When other evidence is tainted
    Celebrating case reports and stories in health care
  • Guidelines for treating Serious Gram-Positive infections (Italian GISIG project)
    • Systematic reviews of cases of:
    • Endocarditis
    • Brain abscesses
    • Joint / prostheses infections
    Celebrating case reports and stories in health care
  • Infective endocarditis (Dr Boumis) Celebrating case reports and stories in health care Reporting variable No missing / 19 reports Age 1 Comorbidities/risk factors 1 Symptom duration 3 Symptom descr 4 Physical examination findings 7 Imaging data 3 Lab data 13 Which valve involved 1 Agente sensitivity (MIC) 2 Antibiotic dosage 11 Antibiotic tx duration 6 Outcome description 4 Follow up duration 5
  • Standardisation
    • Demographic/contextual variables
    • Prognostic profile
    • Diagnostic variables
    • Treatement
    • Harms
    • Outcome
    • Sufficient information to allow follow through by singles or groups of all these variables
    Celebrating case reports and stories in health care
  • Tom Jefferson B eware of red herrings How to read and listen to scientific items - Bufala spotting Case report quick assessment NO Is the topic of interest? YES Is presentation clear? YES NO Is the narrative logical? NO YES Is there a a declaration of conflicts? NO YES Is the sponsor identifiable? NO YES Can you reproduce the pathway? YES NO Are off-lables used Are there ethical Problems? No Yes
  • Warning
    • Standardisation required (“tell the story”)
    • Coordination desperately needed
    • Web 2.0 to Web 3.0
    • Huge numbers
    • Always interpret case evidence in the context of the current body of evidence
    Celebrating case reports and stories in health care