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Showing EBM databases Cochrane, Clinical Evidence and EBM Guidelines.

Showing EBM databases Cochrane, Clinical Evidence and EBM Guidelines.

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Evidence-based medicine databases Evidence-based medicine databases Presentation Transcript

  • Evidence-based medicine databases 15-16.30 14 March 2006 Medical Library, Umeå UB Lars Iselid
  • How does a clinician choose the best intervention?
    • The clinic’s less or more accepted, standard procedure of methods
    • The opinions of an authority, for example a professor
    • The method that is the most reliable based on scientific research - that’s EBM
  • Definition of Evidence-based medicine
      • The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice.
      • The term "evidence based medicine" was coined at McMaster Medical School in Canada in the 1980's
  • The four steps in EBM
      • formulate a clear clinical question from a patient's problem;
      • search the literature for relevant clinical articles;
      • evaluate (critically appraise) the evidence for its validity and usefulness;
      • implement useful findings in clinical practice.
  • Scientifically verified - Evidence-Based Medicine (EBM)
    • Help clinicians to make well-founded decisions on interventions
    • Time-consuming finding all relevant clinical studies and compare them all by oneself
    • Systematic reviews saves you time by doing the comparisions for you
  • How to compile a systematic review?
    • The authors identify an intervention for a specific disease or other problem in health care
    • Locate, appraise and synthesize evidence from as many relevant scientific studies as possible
    • Summarise conclusions about effectiveness
    • Differs from other types of reviews
      • Strict design
      • Highly structured and systematic
  • EBM resources
    • Cochrane Library database
    • Clinical Evidence database
    • EBM guidelines database
  • Archibald Cochrane (1909-1988) www.cochrane.org/docs/archieco.htm
    • ” I had considerable freedom of clinical choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge. I had never heard then of 'randomised controlled trials', but I knew there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention.”
    • As a prisoner of war he discovered the lack of knowledge in the medical education
    • Medical interventions should be based on scientific knowledge, not on presumption
  • Effectiveness and Efficiency. Random Reflections on Health Services, 1972
    • Clinical decisions should be based on knowledge, not on supposition or chances.
    • In 1979 he wrote, " It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials."
  • Cochrane Collaboration international network, 1993, Oxford
    • The aim : to help people make well informed decisions about health care by:
        • preparing
        • maintaining
        • ensuring the accessibility of systematic reviews of the effects of health care interventions
    • Principles
        • Building on the enthusiasm of individuals
        • Avoiding duplication
        • Minimising bias
        • Keeping up to date
    • Selects RCT ’s - Randomized Controlled Trials and produces systematic reviews where all selected RCT’s(within the subject) are compared
    • Updates the systematic reviews when new studies are available
  • RCT-Randomized -controlled clinical trials - what’s that??
    • A trial where people randomly gets one or two(or more) clinical interventions
    • Often treatment outcome, but also diagnostic methods, surgical procedures, screening programmes etc
    • Randomizing
      • patients randomly gets for example a new drug or the standard treatment (instead of the standard treatment sometimes placebo, for example sugar pills or no treatment at all)
  • RCT-Randomized -controlled clinical trials - what’s that??
    • Controlled
      • means comparative. A control group is necessary, they get the the standard treatment (or placebo)
    • Clinical trials
      • the trial is made on humans (not animal trials)
  • Structure
    • 51 Collaborative review groups Airways grpup, Anaesthesia group, Back group, Breast Cancer group…)
      • Reliable, up-to-date information relevant to prevention, treatment and rehabilitation of particular health problem
      • Each group composed of people around the world who share an interest in developing and maintaining systematic reviews
    • 10 Method groups
    • 13 Cochrane Center
      • Nordic Cochrane Center in Copenhagen
  • Cochrane Library
    • unique source of reliable and up-to-date information on the effects of interventions in health care
    • Started 1995
    • Updating quarterly
    • Contains 7 databases
    • Published by Wiley Interscience
    • Free for all internet users in Sweden
      • www.sbu.se/filer/content0/dokument/presscochrane.html
  • The Cochrane Database of Systematic Reviews
    • Cochrane Reviews
    • Full-text systematic reviews which provide an overview of the effects of interventions in health care
      • Each review covers a specific and well-defined area
      • May include graphs with the data from each individual study
    • Cochrane Protocols
      • Provide information about reviews which are currently being written
  • Other databases in the Cochrane Library
    • Database of Abstracts of Reviews of Effectivness (DARE)
      • Structured abstracts of systematic reviews published in the scientific literature which are critically appraised and commented.
  • Other databases in the Cochrane Library
    • The Cochrane Controlled Trials Register (CENTRAL)
      • Bibliography of publications which report on controlled trials.
      • About 50% of all RCT from PubMed.
  • Other databases in the Cochrane Library
    • Health Technology Assessment Database
      • Bibliographic information to reports from International Network of Agencies for Health Technology Assessment (INAHTA), non-profit organizations like SBU ( The Swedish Council on Technology Assessment in Health Care) that evaluates healthcare technology.
        • www.inahta.org
  • Other databases in the Cochrane Library
    • NHS economic evaluation of health care interventions
      • … reliable information about the costs as well as the effects of drugs, treatments and procedures, to inform their decisions.
  • Clinical Evidence The international source of the best available evidence of effective healthcare ( BMJ Publishing Group)
    • Identify important clinical questions
    • Search and summerise the best available evidence to answer them
        • Systematic reviews (Cochrane Library, journals)
        • Randomized controlled trials
        • Concise format
    • Show the gaps in the evidence
    • The evidence must be individually interpreted
        • Differences in individual patient’s risks and preferences
        • Local availability of interventions
  • EBM guidelines
    • ”… a unique collection of concise and easy-to-use clinical guidelines for primary care combined with the best available evidence”.
    • Produced in Finland.