So much evidence : initiating EBWH society

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Evidence based women's health society is a new emerging society in the field of women's health. Why there is a need for such society? this talk highlights this issue

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So much evidence : initiating EBWH society

  1. 1. So Much Evidence What is Next
  2. 2. Process of Randomisation Participants RandomlyAssigned Intervention Group Control Group Follow-up Follow-up Intervention Group Control Group OutcomeCompared
  3. 3. Assessed for eligibility (n= 245) Excluded (n= 15) Not meeting inclusion criteria (n=7) Refused to participate (n=5) Social reasons (n=3) Received IUI (110) Analyzed (n=110) Cycles cancelled (n=5) Inadequate response (n=4) Hyper-response (n=1) Group I (n=115) received Merional + CC Cycles cancelled (n=8) Inadequate response (n=6) Hyper-response (n=2) Group II (n=115) received Merional alone Received IUI (107) Analyzed (n=107) Allocation Analysis Follow-Up Enrollment Randomized (n=230)
  4. 4. The best evidence for different types of question Level Treatment Prognosis Diagnosis I Systematic Review of … Systematic Review of … Systematic Review of … II Randomised trial Cohort Cross sectional III
  5. 5. systematic reviews 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200 3400 3600 3800 4000 1995/1 1995/2 1996/1 1996/2 1996/3 1997/1 1997/2 1997/3 1997/4 1998/1 1998/2 1998/3 1998/4 1999/1 1999/2 1999/3 1999/4 2000/1 2000/2 2000/3 2000/4 2001/1 2001/2 2001/3 2001/4 2002/1 2002/2 2002/3 2002/4 2003/1 2003/2 2003/3 2003/4 2004/1 2004/2 2004/3 New protocols Existing protocols New reviews Updated reviews Existing reviews, not incl updates Reviews and protocols for reviews on The Cochrane Database of Systematic Reviews Issue 1/2005 Alderson, 2005
  6. 6. Too much information 0 500000 1000000 1500000 2000000 2500000 Biomedical MEDLINE Trials Diagnostic? MedicalArticlesperYear 5,000? per day 1,500 per day 55 per day
  7. 7. OBGYN in Pubmed • 563 meta-analysis • 7184 RCT
  8. 8. Ready Made EBOG • RCOG • SOGC • Cochrane Library • UpTodate
  9. 9. “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-Gyn Resident Still There is a Problem
  10. 10. Many “Leaks” from research to practice Aware Accept Target Able Recall Agree Done Valid Research If 80% achieved at each stage then 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
  11. 11. (a*+) (b+) (c*) (d) Minimum clinical Important difference No difference Another Problem : Which are (i) statistically significant * and (ii) Clinically significant +?
  12. 12. So • Too many information • Little applied
  13. 13. Read EBM sources Start Journal club Engage colleagues Record ur practice Write a Letter to BMJ Individual
  14. 14. EBP The EBM Model Best Evidence Client Values and Expectations Practitioner’s Individual Expertise Sackett et al., 1997
  15. 15. EBP Model Institution state and circumstances Clinical Expertise Client Preferences and actions Research Evidence
  16. 16. But still Knowledge needs to be managed much more effectively than it has been in the past
  17. 17. “Evidence Base” Community • “The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)
  18. 18. “Evidence Base” Community • Evidence mapping • Mining the Research • Missing Pieces: Identifying the Gaps in Evidence
  19. 19. Unexplained Infertility IUI alone IUI + O.I Timed intercourse O.I alone Spontaneous intercourse??
  20. 20. Ines Trial IUI + O.I IVF + sET NC IVF
  21. 21. “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
  22. 22. Steps For Evidence Base Community Implementation Information sharing with decision Makers Organization & Fund raising Clinical Care Improvement Training on EBP’s, supervision, consultation and support Engagement Strategic plan Focus on outcomes that clients value. Improved Women Health Clinicians, consumers, Stakeholers Feedback :Efficiency & Effectiveness
  23. 23. 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.
  24. 24. So • There is a need for an authorised body to handle these tasks • To communicate with decision makers • To cooperate with existing societies • To gather interested people: doctors and consumers
  25. 25. Hence
  26. 26. • International society • Open to every one • Starting activity from September 2010 • Cooperate with different societies involved in women health

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