Evidence-based medicine databases

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.

The Cochrane Controlled Trials Register (CENTRAL)
Bibliography of publications which report on controlled trials.
About 50% of all RCT from PubMed.

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

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.

http://ebm97.blogspot.com	33
http://www.slideshare.net	19
http://davidrothman.net	17
http://e-medicalnotes.com	2
http://www.cochrane.org	1
http://learn.valenciacollege.edu	1

Evidence-based medicine databases

by nabot

Accessibility

Categories

Upload Details

Usage Rights

6 Embeds 73

Statistics

Evidence-based medicine databases Presentation Transcript