So much evidence

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So much evidence

  1. 1. So Much Evidence <br />What is Next<br />
  2. 2. Hesham Al-Inany, M.D, PhD<br />Prof., Cairo UniversityEditor, RBMonline (since 2010)Editor, BJOG (since 2004)Editor, GOI (since 2006)Editor, Cochrane MDSG (since 2004)<br />
  3. 3. VALIDITY<br />QUESTION:<br />DESIGN:<br />Participants<br />Selection?<br />Representative?<br />Allocation? Randomised?comparable groups?<br />Allocation?<br />Intervention Group (IG) & Comparison Group (CG)<br />IG<br />CG<br />Maintenance of allocation?<br />+<br />-<br />Maintenance?treated equally? compliant?Measurementsblind subjective? ORobjective?<br />B<br />A<br />Outcome<br />+<br />How Evidence Is Created<br />D<br />C<br />-<br />Measurement of outcomes?<br />
  4. 4. 5,000?<br />per day<br />1,500 per day<br />55 per day<br />Too much information<br />
  5. 5. The best evidence for different types of question<br />
  6. 6. systematic reviews - 20% done for therapy<br />Alderson, 2005<br />
  7. 7. OBGYN in Pubmed<br />563 meta-analysis <br />7184 RCT<br />258 guidelines<br />
  8. 8. Ready Made EBOG <br />RCOG<br />SOGC<br />Cochrane Library<br />UpTodate<br />
  9. 9. Still There is a Problem<br />“I don’t know…”<br />“I don’t really care about <br />all of this research stuff…”<br />“I just want to take care of patients…”<br />Unnamed Ob-GynResident<br />
  10. 10. Beyond the Linear Model<br />Clinical <br />Trial<br />(Efficacy)<br />Basic <br />Research<br />Treatment<br />Development<br />Effectiveness<br />Trial<br />Treatment<br />Deployment<br />
  11. 11. Aware Accept Target Able Recall Agree Done <br />Valid<br />Research<br />Many “Leaks” from research & practice<br />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<br />
  12. 12. Another Problem : Which are<br /> (i) statistically significant * and (ii) Clinically significant +?<br />(a*+)<br />(b+)<br />(c*)<br />(d)<br />Minimum clinical<br />Important difference<br />No difference<br />
  13. 13.
  14. 14. Individual <br />
  15. 15. Practitioner’s Individual<br />Expertise<br />Best<br />Evidence<br />EBP<br />Client Values and Expectations<br />The EBMModel<br />Sackett et al., 1997<br />
  16. 16. EBPModel<br />Clinical state and circumstances<br />Clinical Expertise<br />Client Preferences and actions<br />Research<br />Evidence<br />
  17. 17. But still<br />Knowledge needs to be managed much more effectively than it has been in the past<br />
  18. 18. “Evidence Base” Community<br />“The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)<br />
  19. 19. “Evidence Base” Community<br />Evidence mapping<br />Mining the Research<br />Missing Pieces: Identifying the Gaps in Evidence<br />
  20. 20. “Evidence Base” Community<br />engaging patients in research<br />working with guideline developers<br />Reporting and discussing practice guidelines<br />Podcasting as a Dissemination Strategy<br />funding for Knowledge Translation and Dissemination<br />
  21. 21. Moving Methodology Forward<br />prognostic evidence in systematic reviews of interventions<br />
  22. 22. There’s Nothing Constant but Change<br />
  23. 23. Steps For Evidence Base Community Implementation<br /> Information sharing with decision Makers<br /> Organization preparation & Fund raising<br />Engagement<br />Strategic plan<br />Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support <br />Focus on outcomes that clients value.<br />Clinicians, consumers, Stakeholers and Supervisors<br />Feedback :Efficiency & Effectiveness<br /> Improved Women Health<br />
  24. 24. Elements Important (Fixsen et al, 2005)<br />Commitment of leadership to the implementation process.<br />“unfreezing” current organizational practices.<br />Resources for extra costs, effort, materials, recruiting, access to expertise, retraining.<br />

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