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Identifying the evidence

Identifying the evidence. Phil Hannaford NHS Grampian Chair of Primary Care. Evidence based medicine.

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Identifying the evidence

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  1. Identifying the evidence Phil Hannaford NHS Grampian Chair of Primary Care

  2. Evidence based medicine “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient’s unique values and circumstances.” Centre for EBM

  3. Some reasons for EBM • Increasing demand for high quality, effective and efficient care • Continuous improvements in diagnosis, treatment and prevention of disease or unwanted health-related outcomes • Recognition that clinicians rarely spend more than 30 minutes a week keeping up-to-date

  4. Clinicians (and managers) frequently have information overload

  5. Textbooks Experts Narrative reviews Editorials Medical journals out of date wrong or selective wrong or selective wrong or selective overwhelming volume / irrelevant information Traditional information sources often have problems

  6. We need new ways of getting and handling information

  7. Approach depends on your information need • Identify and appraise original article(s) • Identify and appraise summary, review articles • Seek clinical guidance • Get regular relevant new information

  8. 1. Identify and appraise original article(s) • Ask a friend or colleague

  9. 1. Identify and appraise original article(s) • Ask a friend or colleague • Ask a librarian

  10. 1. Identify and appraise original article(s) • Ask a friend or colleague • Ask a librarian • Look up past copies of the journal

  11. 1. Identify and appraise original article(s) • Ask a friend or colleague • Ask a librarian • Look up past copies of the journal • Search a database of articles

  12. Some databases • MEDLINE • EMBASE (biomedical and pharmaceutical database) • CINAHL (Cumulative Index to Nursing & Allied Health) • CHID (Combined Health Information Database) • PsycINFO

  13. MEDLINE • Produced by the US National Library of Medicine • Focus on clinical medicine and biomedical literature • Includes information from Index Medicus, Index to Dental Literature, and International Nursing • More than 12 million records from mid 1960s, from more than 3,900 journals, plus selected monographs of congresses and symposia (1976-1981) • Abstracts included for about 67% of the records

  14. PubMed www.ncbi.nlm.nih.gov/PubMed • Free service of the National Library of Medicine • Provides access to MEDLINE citations and other additional life science references • Searches can be limited to particular subsets of data • Includes links to many sites providing full text articles and other related resources • Weekly alert service

  15. www.med.ualberta.ca/ebm

  16. "This is a collection of tools for identifying, assessing and applyingrelevant evidence for better health care decision-making. The appraisal tools are adapted from the Users' Guides seriesprepared by the Evidence Based Medicine Working Groupand originally published in JAMA" jeanette.buckingham@ualberta.cabruce.fisher@ualberta.caduncan.saunders@ualberta.ca

  17. www.cebm.utoronto.ca

  18. “The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practise and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of clinical disciplines. This site also serves as a support for the book entitled, Evidence-based Medicine: How to practice and teach EBM by David L. Sackett, Sharon E. Straus, W. Scott Richardson, William Rosenberg, and R. Brian Haynes”.

  19. 2. Identify and appraise summary, review articles • Traditional narrative review

  20. 2. Identify and appraise summary, review articles • Traditional narrative review • Systematic review /meta-analysis

  21. Systematic review A summary of the medical literature that uses explicit methods to perform a comprehensive literature search and critical appraisal of individual studies. If the results of the studies can be combined and summarized statistically, the systematic review is called a Meta-analysis.

  22. Cochrane Review Groups Nearly 50 topic based groups, including: • Breast cancer • Consumers and communication • Fertility regulation • Gynecological cancer • Incontinence • Menstrual disorders and subfertility • Sexually transmitted diseases

  23. Cochrane librarywww.cochrane.org • Cochrane Database of Systematic Reviews • Database of Abstracts of Reviews of Effectiveness • Cochrane Central Register of Controlled Trials • Cochrane Database of Methodology Reviews • Cochrane Methodology Register • Health Technology Assessment Database • NHS Economic Evaluation Database

  24. Campbell Collaborationwww.campbellcollaboration.org • Similar systematic approach for interventions in social, behavioural and educational fields

  25. 3. Seek clinical guidance • Ask a colleague

  26. 3. Seek clinical guidance • Ask a colleague • Ask an expert

  27. 3. Seek clinical guidance • Ask a colleague • Ask an expert • Consult a traditional (GOBSAAT) guideline

  28. 3. Seek clinical guidance • Ask a colleague • Ask an expert • Consult a traditional (GOBSAAT) guideline • Consult an evidence-based guideline

  29. National Guideline Clearinghouse www.guideline.gov • A public resource for evidence-based clinical practice guidelines • An initiative of the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services • Includes national and local guidelines • Includes information on how guideline was developed • Has links to full guideline (when available)

  30. Medical eligibility criteria for contraceptive use • Assesses who can safely use different contraceptives • www.who.int/reproductive-health/publications/mec/

  31. Selected practice recommendations for contraceptive methods • Provides guidance on the safe and effective use of contraceptives • www.who.int/reproductive-health/publications/spr

  32. 4. Get regular relevant new information • Read the journals

  33. 4. Get regular relevant new information • Read the journals • Read a journal of secondary publication (abstraction journal)

  34. Some journals of secondary publication • ACP Journal Club • Evidence Based Medicine • Evidence Based Mental Health • Evidence Based Nursing • Evidence Based Obstetrics and Gynaecology • Journal of Evidence-based Health Care

  35. 4. Get regular relevant new information • Read the journals • Read a journal of secondary publication (abstraction journal) • Consult other evidence-based resources

  36. www.rhlibrary.com • Includes: • Cochrane reviews from Fertility Regulation and other • reproductive health related groups • Commentaries and implementation aids • Educational material • Practical videos • Available in English, Spanish, • (Chinese, French,Vietnamese)

  37. 4. Get regular relevant new information • Read the journals • Read a journal of secondary publication (abstraction journal) • Consult other evidence-based resources • Organise an alert service

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