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

1. So Much Evidence
What is Next

2. Process of Randomisation
Participants
RandomlyAssigned
Intervention Group
Control Group
Follow-up
Follow-up
Intervention Group
Control Group
OutcomeCompared

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. 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. 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. 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. OBGYN in Pubmed
• 563 meta-analysis
• 7184 RCT

8. Ready Made EBOG
• RCOG
• SOGC
• Cochrane Library
• UpTodate

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. 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. (a*+) (b+)
(c*) (d)
Minimum clinical
Important difference
No difference
Another Problem : Which are
(i) statistically significant * and
(ii) Clinically significant +?

13. So
• Too many information
• Little applied

14. Read EBM
sources
Start
Journal
club
Engage
colleagues
Record ur
practice
Write a
Letter to
BMJ
Individual

15. EBP
The EBM Model
Best
Evidence
Client Values and
Expectations
Practitioner’s
Individual
Expertise
Sackett et al., 1997

16. EBP Model
Institution state
and
circumstances
Clinical
Expertise
Client
Preferences
and actions
Research
Evidence

17. But still
Knowledge needs to
be managed much
more effectively
than it has been in
the past

18. “Evidence Base” Community
• “The purchase of treatments and services that
have been scientifically confirmed to improve
outcomes.” (Lehman et al, 2004)

19. “Evidence Base” Community
• Evidence mapping
• Mining the Research
• Missing Pieces: Identifying the Gaps in
Evidence

20. Unexplained Infertility
IUI alone IUI + O.I
Timed intercourse O.I alone
Spontaneous intercourse??

21. Ines Trial
IUI + O.I
IVF + sET
NC IVF

22. “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

23. 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

24. 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.

25. 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

26. Hence

27. • International society
• Open to every one
• Starting activity from September 2010
• Cooperate with different societies involved in
women health