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We'll supply the evidence, you make the decisions. clinicalevidence.bmj.com Why get Evidence into Practice? •It took 200 years before the Royal Navy routinely used lemon juice to prevent scurvy. First study 1601 1 •The first RCT that showed the benefit of thrombolytic therapy was in acute MI late 1950s – not in routine use until 1990s 2 •International guidelines first recommended antenatal corticosteroid use in preterm labour 22 years after first evidence 3 •On average it takes 17 years for 14% of clinical research to become routine practice 4 1. Mosteller, F. Innovation and evaluation. Science 1981,211,881–86. 2. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts: treatments for myocardial infarction. JAMA 1992;268(2):240-248.. 3. Crowley, P. Prophylactic corticosteroids for preterm labour. The Cochrane Library 2000, Issue 1 (CDSR) Update software.. 4. Westfall, J. M., Mold, J., & Fagnan, L. (2007). Practice based research - "Blue Highways" on the NIH roadmap. JAMA, 297(4), p. 403. The burden of evidence is significant …although figures vary • 35,000 biomedical journal articles published annually • 150,000 articles / month • 120,000 RCT/year • 500,000 articles are indexed in PubMed every year The information paradox: “Doctors are overwhelmed with information yet cannot find the information they need” Dr Muir Gray Director of the UK’s National Library of Medicine Evidence Centre – EBM Process 1. 2. 3. Clarify the Question Develop the search Find the evidence • Who needs the answer? • Study Characteristics • Diagnosis or treatment? - Population Intervention Comparison Outcome Time to follow-up • Search Methodology • • What stage of the patient journey? How will the results be used? - Where to search Study type Quality criteria • Studies identified from over 8000 medical journals • Key international guidelines • Drug databases and safety alerts 4. 5. Synthesise the evidence Contextualis e the evidence • What is the evidence? - Studies meeting inclusion criteria Studies of adequate quality • - - What does it mean? Summarised evidence GRADE quality evaluation • Putting the evidence into practice • Expert opinion • Guidance where there is no evidence • Peer review Clinical Evidence provides: • Systematic reviews that summarise the current state of knowledge and uncertainty - about the prevention and treatment of clinical conditions • Coverage of over 3300 interventions and answers to more than 570 clinical questions • EBM on the most common and/or important clinical conditions seen in primary and hospital care • Links to drug safety alerts, full text access to relevant major guidelines, and updates via the BMJ Updates service • Clinical Evidence is currently available in three formats Quality of the Information •The quality of the evidence within Clinical Evidence is gold standard •Contributors, advisors and editors are all specialist expert clinicians •Findings based on evidence collected from detailed research using Cochrane Library, Medline, Embase and evidence based journals •A completely transparent, reliable source of information •Reaches more than a million clinicians worldwide in seven languages CE is now an education tool CE used to regarded as a source of EBM 9 Grading of Treatments Grading the Evidence Clinical Evidence uses the GRADE method of scoring Evidence Grading of Recommendations Assessment, Development and Evaluation system for grading evidence GRADE categories: Quality of Evidence GRADE Evaluation of Anorexia Evidence Link to study references Number of patients Number of studies Thank You Web: group.bmj.com/training Email: [email protected] Dju-Lyn Chng, Regional Training Manager BMJ Publishing Group Limited 2013. All rights reserved.