Evidence-based medicine databases


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Showing EBM databases Cochrane, Clinical Evidence and EBM Guidelines.

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Evidence-based medicine databases

  1. 1. Evidence-based medicine databases 15-16.30 14 March 2006 Medical Library, Umeå UB Lars Iselid
  2. 2. How does a clinician choose the best intervention? <ul><li>The clinic’s less or more accepted, standard procedure of methods </li></ul><ul><li>The opinions of an authority, for example a professor </li></ul><ul><li>The method that is the most reliable based on scientific research - that’s EBM </li></ul>
  3. 3. Definition of Evidence-based medicine <ul><ul><li>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. </li></ul></ul><ul><ul><li>The term &quot;evidence based medicine&quot; was coined at McMaster Medical School in Canada in the 1980's </li></ul></ul>
  4. 4. The four steps in EBM <ul><ul><li>formulate a clear clinical question from a patient's problem; </li></ul></ul><ul><ul><li>search the literature for relevant clinical articles; </li></ul></ul><ul><ul><li>evaluate (critically appraise) the evidence for its validity and usefulness; </li></ul></ul><ul><ul><li>implement useful findings in clinical practice. </li></ul></ul>
  5. 5. Scientifically verified - Evidence-Based Medicine (EBM) <ul><li>Help clinicians to make well-founded decisions on interventions </li></ul><ul><li>Time-consuming finding all relevant clinical studies and compare them all by oneself </li></ul><ul><li>Systematic reviews saves you time by doing the comparisions for you </li></ul>
  6. 6. How to compile a systematic review? <ul><li>The authors identify an intervention for a specific disease or other problem in health care </li></ul><ul><li>Locate, appraise and synthesize evidence from as many relevant scientific studies as possible </li></ul><ul><li>Summarise conclusions about effectiveness </li></ul><ul><li>Differs from other types of reviews </li></ul><ul><ul><li>Strict design </li></ul></ul><ul><ul><li>Highly structured and systematic </li></ul></ul>
  7. 7. EBM resources <ul><li>Cochrane Library database </li></ul><ul><li>Clinical Evidence database </li></ul><ul><li>EBM guidelines database </li></ul>
  8. 8. Archibald Cochrane (1909-1988) www.cochrane.org/docs/archieco.htm <ul><li>” 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.” </li></ul><ul><li>As a prisoner of war he discovered the lack of knowledge in the medical education </li></ul><ul><li>Medical interventions should be based on scientific knowledge, not on presumption </li></ul>
  9. 9. Effectiveness and Efficiency. Random Reflections on Health Services, 1972 <ul><li>Clinical decisions should be based on knowledge, not on supposition or chances. </li></ul><ul><li>In 1979 he wrote, &quot; 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.&quot; </li></ul>
  10. 10. Cochrane Collaboration international network, 1993, Oxford <ul><li>The aim : to help people make well informed decisions about health care by: </li></ul><ul><ul><ul><li>preparing </li></ul></ul></ul><ul><ul><ul><li>maintaining </li></ul></ul></ul><ul><ul><ul><li>ensuring the accessibility of systematic reviews of the effects of health care interventions </li></ul></ul></ul><ul><li>Principles </li></ul><ul><ul><ul><li>Building on the enthusiasm of individuals </li></ul></ul></ul><ul><ul><ul><li>Avoiding duplication </li></ul></ul></ul><ul><ul><ul><li>Minimising bias </li></ul></ul></ul><ul><ul><ul><li>Keeping up to date </li></ul></ul></ul><ul><li>Selects RCT ’s - Randomized Controlled Trials and produces systematic reviews where all selected RCT’s(within the subject) are compared </li></ul><ul><li>Updates the systematic reviews when new studies are available </li></ul>
  11. 11. RCT-Randomized -controlled clinical trials - what’s that?? <ul><li>A trial where people randomly gets one or two(or more) clinical interventions </li></ul><ul><li>Often treatment outcome, but also diagnostic methods, surgical procedures, screening programmes etc </li></ul><ul><li>Randomizing </li></ul><ul><ul><li>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) </li></ul></ul>
  12. 12. RCT-Randomized -controlled clinical trials - what’s that?? <ul><li>Controlled </li></ul><ul><ul><li>means comparative. A control group is necessary, they get the the standard treatment (or placebo) </li></ul></ul><ul><li>Clinical trials </li></ul><ul><ul><li>the trial is made on humans (not animal trials) </li></ul></ul>
  13. 13. Structure <ul><li>51 Collaborative review groups Airways grpup, Anaesthesia group, Back group, Breast Cancer group…) </li></ul><ul><ul><li>Reliable, up-to-date information relevant to prevention, treatment and rehabilitation of particular health problem </li></ul></ul><ul><ul><li>Each group composed of people around the world who share an interest in developing and maintaining systematic reviews </li></ul></ul><ul><li>10 Method groups </li></ul><ul><li>13 Cochrane Center </li></ul><ul><ul><li>Nordic Cochrane Center in Copenhagen </li></ul></ul>
  14. 14. Cochrane Library <ul><li>unique source of reliable and up-to-date information on the effects of interventions in health care </li></ul><ul><li>Started 1995 </li></ul><ul><li>Updating quarterly </li></ul><ul><li>Contains 7 databases </li></ul><ul><li>Published by Wiley Interscience </li></ul><ul><li>Free for all internet users in Sweden </li></ul><ul><ul><li>www.sbu.se/filer/content0/dokument/presscochrane.html </li></ul></ul>
  15. 15. The Cochrane Database of Systematic Reviews <ul><li>Cochrane Reviews </li></ul><ul><li>Full-text systematic reviews which provide an overview of the effects of interventions in health care </li></ul><ul><ul><li>Each review covers a specific and well-defined area </li></ul></ul><ul><ul><li>May include graphs with the data from each individual study </li></ul></ul><ul><li>Cochrane Protocols </li></ul><ul><ul><li>Provide information about reviews which are currently being written </li></ul></ul>
  16. 16. Other databases in the Cochrane Library <ul><li>Database of Abstracts of Reviews of Effectivness (DARE) </li></ul><ul><ul><li>Structured abstracts of systematic reviews published in the scientific literature which are critically appraised and commented. </li></ul></ul>
  17. 17. Other databases in the Cochrane Library <ul><li>The Cochrane Controlled Trials Register (CENTRAL) </li></ul><ul><ul><li>Bibliography of publications which report on controlled trials. </li></ul></ul><ul><ul><li>About 50% of all RCT from PubMed. </li></ul></ul>
  18. 18. Other databases in the Cochrane Library <ul><li>Health Technology Assessment Database </li></ul><ul><ul><li>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. </li></ul></ul><ul><ul><ul><li>www.inahta.org </li></ul></ul></ul>
  19. 19. Other databases in the Cochrane Library <ul><li>NHS economic evaluation of health care interventions </li></ul><ul><ul><li>… reliable information about the costs as well as the effects of drugs, treatments and procedures, to inform their decisions. </li></ul></ul>
  20. 20. Clinical Evidence The international source of the best available evidence of effective healthcare ( BMJ Publishing Group) <ul><li>Identify important clinical questions </li></ul><ul><li>Search and summerise the best available evidence to answer them </li></ul><ul><ul><ul><li>Systematic reviews (Cochrane Library, journals) </li></ul></ul></ul><ul><ul><ul><li>Randomized controlled trials </li></ul></ul></ul><ul><ul><ul><li>Concise format </li></ul></ul></ul><ul><li>Show the gaps in the evidence </li></ul><ul><li>The evidence must be individually interpreted </li></ul><ul><ul><ul><li>Differences in individual patient’s risks and preferences </li></ul></ul></ul><ul><ul><ul><li>Local availability of interventions </li></ul></ul></ul>
  21. 21. EBM guidelines <ul><li>”… a unique collection of concise and easy-to-use clinical guidelines for primary care combined with the best available evidence”. </li></ul><ul><li>Produced in Finland. </li></ul>