Your SlideShare is downloading. ×
  • Like
So much evidence
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply
Published

 

Published in Health & Medicine , Education
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
287
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
1
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. So Much Evidence
    What is Next
  • 2. 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)
  • 3. VALIDITY
    QUESTION:
    DESIGN:
    Participants
    Selection?
    Representative?
    Allocation? Randomised?comparable groups?
    Allocation?
    Intervention Group (IG) & Comparison Group (CG)
    IG
    CG
    Maintenance of allocation?
    +
    -
    Maintenance?treated equally? compliant?Measurementsblind subjective? ORobjective?
    B
    A
    Outcome
    +
    How Evidence Is Created
    D
    C
    -
    Measurement of outcomes?
  • 4. 5,000?
    per day
    1,500 per day
    55 per day
    Too much information
  • 5. The best evidence for different types of question
  • 6. systematic reviews - 20% done for therapy
    Alderson, 2005
  • 7. OBGYN in Pubmed
    563 meta-analysis
    7184 RCT
    258 guidelines
  • 8. Ready Made EBOG
    RCOG
    SOGC
    Cochrane Library
    UpTodate
  • 9. Still There is a Problem
    “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-GynResident
  • 10. Beyond the Linear Model
    Clinical
    Trial
    (Efficacy)
    Basic
    Research
    Treatment
    Development
    Effectiveness
    Trial
    Treatment
    Deployment
  • 11. Aware Accept Target Able Recall Agree Done
    Valid
    Research
    Many “Leaks” from research & practice
    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
  • 12. Another Problem : Which are
    (i) statistically significant * and (ii) Clinically significant +?
    (a*+)
    (b+)
    (c*)
    (d)
    Minimum clinical
    Important difference
    No difference
  • 13.
  • 14. Individual
  • 15. Practitioner’s Individual
    Expertise
    Best
    Evidence
    EBP
    Client Values and Expectations
    The EBMModel
    Sackett et al., 1997
  • 16. EBPModel
    Clinical state and circumstances
    Clinical Expertise
    Client Preferences and actions
    Research
    Evidence
  • 17. But still
    Knowledge needs to be managed much more effectively than it has been in the past
  • 18. “Evidence Base” Community
    “The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)
  • 19. “Evidence Base” Community
    Evidence mapping
    Mining the Research
    Missing Pieces: Identifying the Gaps in Evidence
  • 20. “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
  • 21. Moving Methodology Forward
    prognostic evidence in systematic reviews of interventions
  • 22. There’s Nothing Constant but Change
  • 23. Steps For Evidence Base Community Implementation
    Information sharing with decision Makers
    Organization preparation & Fund raising
    Engagement
    Strategic plan
    Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support
    Focus on outcomes that clients value.
    Clinicians, consumers, Stakeholers and Supervisors
    Feedback :Efficiency & Effectiveness
    Improved Women Health
  • 24. 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.