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So Much Evidence <br />What is Next<br />
Hesham Al-Inany, M.D, PhD<br />Prof., Cairo UniversityEditor, RBMonline (since 2010)Editor, BJOG (since 2004)Editor, GOI (...
VALIDITY<br />QUESTION:<br />DESIGN:<br />Participants<br />Selection?<br />Representative?<br />Allocation?  Randomised?c...
5,000?<br />per day<br />1,500 per day<br />55 per day<br />Too much information<br />
The best evidence for different types of question<br />
systematic reviews - 20% done for therapy<br />Alderson, 2005<br />
OBGYN in Pubmed<br />563 meta-analysis <br />7184 RCT<br />258 guidelines<br />
Ready Made EBOG	<br />RCOG<br />SOGC<br />Cochrane Library<br />UpTodate<br />
Still There is a Problem<br />“I don’t know…”<br />“I don’t really care about <br />all of this research stuff…”<br />“I j...
Beyond the Linear Model<br />Clinical <br />Trial<br />(Efficacy)<br />Basic <br />Research<br />Treatment<br />Developmen...
Aware   Accept    Target      Able   Recall  Agree    Done   <br />Valid<br />Research<br />Many “Leaks” from research & p...
Another Problem : Which are<br />   (i) statistically significant * and    (ii) Clinically significant +?<br />(a*+)<br />...
Individual <br />
Practitioner’s Individual<br />Expertise<br />Best<br />Evidence<br />EBP<br />Client Values and Expectations<br />The EBM...
EBPModel<br />Clinical state and circumstances<br />Clinical Expertise<br />Client Preferences and actions<br />Research<b...
But still<br />Knowledge needs to be managed much more effectively than it has been in the past<br />
“Evidence Base” Community<br />“The purchase of treatments and services that have been scientifically confirmed to improve...
“Evidence Base” Community<br />Evidence mapping<br />Mining the Research<br />Missing Pieces: Identifying the Gaps in Evid...
“Evidence Base” Community<br />engaging patients in research<br />working with guideline developers<br />Reporting and dis...
Moving Methodology Forward<br />prognostic evidence in systematic reviews of interventions<br />
There’s Nothing Constant but Change<br />
Steps For Evidence Base Community Implementation<br />      Information sharing with decision Makers<br />   Organization ...
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So much evidence Slide 1 So much evidence Slide 2 So much evidence Slide 3 So much evidence Slide 4 So much evidence Slide 5 So much evidence Slide 6 So much evidence Slide 7 So much evidence Slide 8 So much evidence Slide 9 So much evidence Slide 10 So much evidence Slide 11 So much evidence Slide 12 So much evidence Slide 13 So much evidence Slide 14 So much evidence Slide 15 So much evidence Slide 16 So much evidence Slide 17 So much evidence Slide 18 So much evidence Slide 19 So much evidence Slide 20 So much evidence Slide 21 So much evidence Slide 22 So much evidence Slide 23
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So much evidence

  1. 1. So Much Evidence <br />What is Next<br />
  2. 2. Hesham Al-Inany, M.D, PhD<br />Prof., Cairo UniversityEditor, RBMonline (since 2010)Editor, BJOG (since 2004)Editor, GOI (since 2006)Editor, Cochrane MDSG (since 2004)<br />
  3. 3. VALIDITY<br />QUESTION:<br />DESIGN:<br />Participants<br />Selection?<br />Representative?<br />Allocation? Randomised?comparable groups?<br />Allocation?<br />Intervention Group (IG) & Comparison Group (CG)<br />IG<br />CG<br />Maintenance of allocation?<br />+<br />-<br />Maintenance?treated equally? compliant?Measurementsblind subjective? ORobjective?<br />B<br />A<br />Outcome<br />+<br />How Evidence Is Created<br />D<br />C<br />-<br />Measurement of outcomes?<br />
  4. 4. 5,000?<br />per day<br />1,500 per day<br />55 per day<br />Too much information<br />
  5. 5. The best evidence for different types of question<br />
  6. 6. systematic reviews - 20% done for therapy<br />Alderson, 2005<br />
  7. 7. OBGYN in Pubmed<br />563 meta-analysis <br />7184 RCT<br />258 guidelines<br />
  8. 8. Ready Made EBOG <br />RCOG<br />SOGC<br />Cochrane Library<br />UpTodate<br />
  9. 9. Still There is a Problem<br />“I don’t know…”<br />“I don’t really care about <br />all of this research stuff…”<br />“I just want to take care of patients…”<br />Unnamed Ob-GynResident<br />
  10. 10. Beyond the Linear Model<br />Clinical <br />Trial<br />(Efficacy)<br />Basic <br />Research<br />Treatment<br />Development<br />Effectiveness<br />Trial<br />Treatment<br />Deployment<br />
  11. 11. Aware Accept Target Able Recall Agree Done <br />Valid<br />Research<br />Many “Leaks” from research & practice<br />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<br />
  12. 12. Another Problem : Which are<br /> (i) statistically significant * and (ii) Clinically significant +?<br />(a*+)<br />(b+)<br />(c*)<br />(d)<br />Minimum clinical<br />Important difference<br />No difference<br />
  13. 13.
  14. 14. Individual <br />
  15. 15. Practitioner’s Individual<br />Expertise<br />Best<br />Evidence<br />EBP<br />Client Values and Expectations<br />The EBMModel<br />Sackett et al., 1997<br />
  16. 16. EBPModel<br />Clinical state and circumstances<br />Clinical Expertise<br />Client Preferences and actions<br />Research<br />Evidence<br />
  17. 17. But still<br />Knowledge needs to be managed much more effectively than it has been in the past<br />
  18. 18. “Evidence Base” Community<br />“The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)<br />
  19. 19. “Evidence Base” Community<br />Evidence mapping<br />Mining the Research<br />Missing Pieces: Identifying the Gaps in Evidence<br />
  20. 20. “Evidence Base” Community<br />engaging patients in research<br />working with guideline developers<br />Reporting and discussing practice guidelines<br />Podcasting as a Dissemination Strategy<br />funding for Knowledge Translation and Dissemination<br />
  21. 21. Moving Methodology Forward<br />prognostic evidence in systematic reviews of interventions<br />
  22. 22. There’s Nothing Constant but Change<br />
  23. 23. Steps For Evidence Base Community Implementation<br /> Information sharing with decision Makers<br /> Organization preparation & Fund raising<br />Engagement<br />Strategic plan<br />Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support <br />Focus on outcomes that clients value.<br />Clinicians, consumers, Stakeholers and Supervisors<br />Feedback :Efficiency & Effectiveness<br /> Improved Women Health<br />
  24. 24. Elements Important (Fixsen et al, 2005)<br />Commitment of leadership to the implementation process.<br />“unfreezing” current organizational practices.<br />Resources for extra costs, effort, materials, recruiting, access to expertise, retraining.<br />
  • drfarraj

    Dec. 11, 2015

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