1. So Much Evidence What is Next

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

3. VALIDITY QUESTION: DESIGN: Participants Selection? Representative? Allocation? Randomised?comparable groups? Allocation? Intervention Group (IG) & Comparison Group (CG) IG CG Maintenance of allocation? + - Maintenance?treated equally? compliant?Measurementsblind subjective? ORobjective? B A Outcome + How Evidence Is Created D C - Measurement of outcomes?

4. 5,000? per day 1,500 per day 55 per day Too much information

5. The best evidence for different types of question

6. systematic reviews - 20% done for therapy Alderson, 2005

7. OBGYN in Pubmed 563 meta-analysis 7184 RCT 258 guidelines

8. Ready Made EBOG RCOG SOGC Cochrane Library UpTodate

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 Model Clinical Trial (Efficacy) Basic Research Treatment Development Effectiveness Trial Treatment Deployment

11. Aware Accept Target Able Recall Agree Done Valid Research Many “Leaks” from research & practice If 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 clinical Important difference No difference

14. Individual

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

16. EBPModel Clinical 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. “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

21. Moving Methodology Forward prognostic 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 raising Engagement Strategic plan Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support Focus on outcomes that clients value. Clinicians, consumers, Stakeholers and Supervisors Feedback :Efficiency & Effectiveness Improved Women Health

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.