So much evidence
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    So much evidence So much evidence Presentation 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)
    • 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?
    • 5,000?
      per day
      1,500 per day
      55 per day
      Too much information
    • The best evidence for different types of question
    • systematic reviews - 20% done for therapy
      Alderson, 2005
    • OBGYN in Pubmed
      563 meta-analysis
      7184 RCT
      258 guidelines
    • Ready Made EBOG
      RCOG
      SOGC
      Cochrane Library
      UpTodate
    • 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
    • Beyond the Linear Model
      Clinical
      Trial
      (Efficacy)
      Basic
      Research
      Treatment
      Development
      Effectiveness
      Trial
      Treatment
      Deployment
    • 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
    • Another Problem : Which are
      (i) statistically significant * and (ii) Clinically significant +?
      (a*+)
      (b+)
      (c*)
      (d)
      Minimum clinical
      Important difference
      No difference
    • Individual
    • Practitioner’s Individual
      Expertise
      Best
      Evidence
      EBP
      Client Values and Expectations
      The EBMModel
      Sackett et al., 1997
    • EBPModel
      Clinical state and circumstances
      Clinical Expertise
      Client Preferences and actions
      Research
      Evidence
    • 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
      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
    • 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.