Why controversies are of continuous relevance

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  • Sackett, D.L., Rosenberg, W.M.C., Muir Gray, J.A., Haynes, R.B., Richardson, W.S. (1996). Evidence-Based Medicine: what it is and what it isn't . British Medical Journal , 312:71-72) http:// cebm .jr2.ox.ac. uk / ebmisisnt .html
  • Focusing the question Focusing the question is an important prerequisite of the search for evidence. A number of sites describe how this should be done: http://www.shef.ac.uk/~scharr/ir/focusing.html CASP Appraisal Tools http://www.phru.org.uk/~casp/appraisa.htm
  • http://www.indigojazz.co.uk/cebm/levels_of_evidence.asp
  • Why controversies are of continuous relevance

    1. 1. WHY CONTROVERSIES ARE OF CONTINUOUS RELEVANCEPROF.A.V.SRINIVASAN, MD, DM, PhD, F.A.A.N, F.I.A.N, I Emeritus Professor, The Tamilnadu Dr.M.G.R. Medical University,
    2. 2. NOTHING NEW UNDER THE SUN• COCHRANE COLLOBORATION• MAVENS OF MCMASTER• JAMES LIND LIBRARY• www.jameslindlibrary .org
    3. 3. Evidence Based Medicine > Health Care > Practice Sackett et al (1996) defined Evidence Based Medicine as "the conscientious, explicit andjudicious use of current best evidence in making decisions about the care of the individual patient. It meansintegrating individual clinical expertise with the best available external; clinical evidence from systematic research".
    4. 4. EBP at the micro levelThe Processes of Evidence Based Practice – ASK (question formulation) – FIND (information seeking) – APPRAISE (critical awareness) – ACT (applicability) – EVALUATE (could I do it better?)
    5. 5. Finding & Appraising Evidence Evidence hierarchy – RCTs & Systematic Reviews – Case, cohort, pre-test/post test studies with controls – Expert opinion (extended anecdote) Cochrane Collaboration & its Library www.cochrane.org Campbell Collaboration www.campbellcollaboration.org – Social, Psychological, Educational, and Criminological Trials Register (C2-SPECTR) – Register of C2 Systematic Reviews of Interventions and Policy Evaluation (C2-RIPE)
    6. 6. HISTORY- EVIDENCE BASED MEDICINE• FIRST CONTROLLED TRIAL• BOOK OF DANIEL• (OLD TESTAMENT)• JAIN CHALMERS• 2000BCE TO THE PRESENT TIME
    7. 7. HISTORY CONTD OLIVER WENDELL HOMES 1861• DANGERS OF CHANCE• BIAS AND• OF COURSE -LISTENING TO EXPERTS
    8. 8. INVETERATE LOGICAL ERRORS1. COUNTING ONLY FAVOURABLE CASES2. TABULATION OF FACTS –3. ILL OBSERVED OR IMPROPERLY CLASSIFIED4. FALSE INDUCTION FROM GENUINE FACTS (SCHOOL FO BROUSSAIS)3. REASON OF THE GOLDEN TOOTH (SIR THOMAS BROWNE)
    9. 9. EVIDENCE BASED MEDICINE EXPERT MEDICINE- EXPERIENCE BASED• Why is Evidence-Based Medicine Important in the Clinical Neurosciences• Can Busy, Neurologists Practice Evidence-Based Medicine?
    10. 10. IDENTIFYING THE RESOURCES• What EBCP Resources Are Available for the clinical Neurosciences?• How Can EBCP Be introduced into Neurologic Training Programs?• What Are Some Other Evidence –Based Neuroscience Initiatives• Establishment of the Merit Center
    11. 11. Question + Resident + MERIT Faculty + Content Expert + Librarian Publish (Intranet) Formulate CAT Search For Government Clinical BottomArticles(s) Access Lines Appraise Presentation of 1 2 Appraisal Summary Question / Search and Discussion 3 Sites 3 3 Sites Individual Sites

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