Providing evidence based resources

1. Providing evidence based resources

2. What is not an evidence based resource? Evidence based medicine does not tell healthcare professionals what to do. Evidence based medicine identifies management options, and how well they are supported by evidence in defined populations.

3. Traditional Steps of Evidence Based Medicine • Assess • Ask clinical question • Acquire the evidence • Appraise the evidence • Apply the evidence

4. Planning – Ask clinical questions... • PICOT • Patient • Intervention/Risk factor • Comparison • Outcome • Type of Study (Systematic reviews? RCTs?) • Quality parameters • Size of study • Length of follow up • Loss to follow up

5. Sources for finding evidence [systems] [intranet, integrated computerised decision support – future?] evidence summary resources e.g. BMJ Clinical Evidence; UpToDate; NLH Clinical Knowledge Summaries (2009?) Time needed to search increases [Some overlap e.g Clinical Evidence] databases of systematic reviews Step 1: Search for evidence summaries first e.g. Cochrane Database of Systematic Reviews; DARE databases of primary studies (e.g. RCTs) Step 2: If question not addressed by an evidence summary, search for individual systematic reviews next e.g. Medline; Embase; CINAHL, Cochrane CENTRAL • Step 3: Search for primary research: • if your question is not addressed by the above secondary resources • or you feel the search date indicates an update search is necessary

6. How BMJ Clinical Evidence relates to the steps of EBM? • “Ask” • Review planning • Combined into structured summaries • “Acquire” • Search primary sources • “Appraise” • Results appraised following recognised criteria

7. The aim of Clinical Evidence is to summarise evidence on medical interventions from high quality systematic reviews and large well-designed randomised controlled trials.

8. Clinical Evidence facts • A compendium of the best available research & evidence findings on common and important clinical questions (systematic reviews) • Covers over 3000 interventions and answers more than 570 clinical questions • Describes the questions, summary and background of a condition then benefits & harms of preventative and therapeutic interventions • Emphasis on the outcome for patients • Findings based on expert knowledge & evidence collected from detailed research using Cochrane Library, Medline, Embase and evidence based journals • Contributors, advisors and editors are all specialist expert clinicians

9. Who uses Clinical Evidence? • GP’s • Researchers • Students • Hospital Doctors

10. Time saved per day using BMJ Clinical Evidence Survey based on 566 CE subscribers, from across the world, mix of academic/primary care/secondary, 20 in-depth phone interviews and two mini focus-groups http://clinicalevidence.bmj.com/downloads/BMJCEMRP0508.pdf

11. Reasons for using BMJ Clinical Evidence Survey based on 566 CE subscribers, from across the world, mix of academic/primary care/secondary, 20 in-depth phone interviews and two mini focus-groups http://clinicalevidence.bmj.com/downloads/BMJCEMRP0508.pdf

12. Clinical Evidence – Home page

13. CE front page continued

14. Case Scenario: You are an inexperienced junior hospital doctor. A 55 year old asthmatic man who has heart failure attends the out-patient clinic. Despite taking an ACE inhibitor his heart failure is inadequately controlled. You discuss the case with your senior who advises that you add an Angiotensin II reception blocker to his treatment. You are worried, having never combined these two types of drugs before, and would like reassurance that this is a reasonable course of action…

15. Access via sections

16. Access via sections

18. Systematic review – Heart failure

19. Systematic review – Heart failure