This document discusses evidence-based practice in obstetrics and gynecology. It notes that while there are many systematic reviews, randomized controlled trials, and guidelines available, barriers still exist that prevent clinicians from fully incorporating research evidence into practice. These barriers include a lack of time and interest in research among some clinicians. The document also discusses challenges in determining which study findings are both statistically and clinically significant. It emphasizes that evidence-based practice requires integrating the best available research with clinical expertise and patient preferences. Successful implementation of evidence-based practices requires commitment from leadership, resources, and changes to existing practices.

1. So Much Evidence What is Next

2. Hesham Al-Inany, M.D, PhDProf., Cairo UniversityEditor, RBMonline (since 2010)Editor, BJOG (since 2004)Editor, GOI (since 2006)Editor, Cochrane MDSG (since 2004)

3. VALIDITYQUESTION:DESIGN:ParticipantsSelection?Representative?Allocation? Randomised?comparable groups?Allocation?Intervention Group (IG) & Comparison Group (CG)IGCGMaintenance of allocation?+-Maintenance?treated equally? compliant?Measurementsblind subjective? ORobjective?BAOutcome+How Evidence Is CreatedDC-Measurement of outcomes?

4. 5,000?per day1,500 per day55 per dayToo much information

5. The best evidence for different types of question

6. systematic reviews - 20% done for therapyAlderson, 2005

7. OBGYN in Pubmed563 meta-analysis 7184 RCT258 guidelines

8. Ready Made EBOG RCOGSOGCCochrane LibraryUpTodate

9. Still There is a Problem“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-GynResident

10. Beyond the Linear ModelClinical Trial(Efficacy)Basic ResearchTreatmentDevelopmentEffectivenessTrialTreatmentDeployment

11. Aware Accept Target Able Recall Agree Done ValidResearchMany “Leaks” from research & practiceIf 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21

12. Another Problem : Which are (i) statistically significant * and (ii) Clinically significant +?(a*+)(b+)(c*)(d)Minimum clinicalImportant differenceNo difference

14. Individual

15. Practitioner’s IndividualExpertiseBestEvidenceEBPClient Values and ExpectationsThe EBMModelSackett et al., 1997

16. EBPModelClinical state and circumstancesClinical ExpertiseClient Preferences and actionsResearchEvidence

17. But stillKnowledge 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” CommunityEvidence mappingMining the ResearchMissing Pieces: Identifying the Gaps in Evidence

20. “Evidence Base” Communityengaging patients in researchworking with guideline developersReporting and discussing practice guidelinesPodcasting as a Dissemination Strategyfunding for Knowledge Translation and Dissemination

21. Moving Methodology Forwardprognostic evidence in systematic reviews of interventions

22. There’s Nothing Constant but Change

23. Steps For Evidence Base Community Implementation Information sharing with decision Makers Organization preparation & Fund raisingEngagementStrategic planClinical Care ImprovementTraining on EBP’s, supervision, consultation and support Focus on outcomes that clients value.Clinicians, consumers, Stakeholers and SupervisorsFeedback :Efficiency & Effectiveness Improved Women Health