Why controversies are of continuous relevance

WHY CONTROVERSIES ARE OF WHY CONTROVERSIES ARE OF CONTINUOUS RELEVANCECONTINUOUS RELEVANCE

II

Emeritus Professor, The Emeritus Professor, The Tamilnadu Dr.M.G.R. Tamilnadu Dr.M.G.R. Medical University,Medical University,

PROF.A.V.SRINIVASAN, MD, DM, PhD, F.A.A.N, F.I.A.N,

NOTHING NEW UNDER THE SUNNOTHING NEW UNDER THE SUN

• COCHRANE COLLOBORATION

• MAVENS OF MCMASTER

• JAMES LIND LIBRARY

• www.jameslindlibrary .org

Evidence Based Evidence Based Medicine > Health Care > PracticeMedicine > Health Care > PracticeSackett et al (1996) defined Evidence Based Medicine as

"the conscientious, explicit and judicious use of current best evidence in making decisions about the care of

the individual patient. It means integrating individual clinical expertise

with the best available external; clinical evidence from systematic

research".

EBP at the micro levelEBP at the micro level

The Processes of Evidence Based PracticeThe Processes of Evidence Based Practice– ASK (question formulation)– FIND (information seeking)– APPRAISE (critical awareness)– ACT (applicability)– EVALUATE (could I do it better?)

Finding & Appraising EvidenceFinding & Appraising Evidence

Evidence hierarchy– RCTs & Systematic Reviews– Case, cohort, pre-test/post test studies with controls– Expert opinion (extended anecdote)

Cochrane Collaboration & its Librarywww.cochrane.org

Campbell Collaborationwww.campbellcollaboration.org– Social, Psychological, Educational, and Criminological

Trials Register (C2-SPECTR) – Register of C2 Systematic Reviews of Interventions and

Policy Evaluation (C2-RIPE)

HISTORY-HISTORY-EVIDENCE BASED MEDICINEEVIDENCE BASED MEDICINE

• FIRST CONTROLLED TRIAL • BOOK OF DANIEL• (OLD TESTAMENT)• JAIN CHALMERS• 2000BCE TO THE PRESENT TIME

HISTORY CONTDHISTORY CONTD

OLIVER WENDELL HOMES

1861

• DANGERS OF CHANCE

• BIAS AND

• OF COURSE -LISTENING TO EXPERTS

INVETERATE LOGICAL ERRORSINVETERATE LOGICAL ERRORS

1. COUNTING ONLY FAVOURABLE CASES

2. TABULATION OF FACTS –

3. ILL OBSERVED OR IMPROPERLY CLASSIFIED

4. FALSE INDUCTION FROM GENUINE FACTS

(SCHOOL FO BROUSSAIS)

3. REASON OF THE GOLDEN TOOTH (SIR THOMAS BROWNE)

EVIDENCE BASED MEDICINE EXPERT MEDICINE-EVIDENCE BASED MEDICINE EXPERT MEDICINE-

EXPERIENCE BASEDEXPERIENCE BASED

• Why is Evidence-Based Medicine Important in the Clinical Neurosciences

• Can Busy, Neurologists Practice Evidence-Based Medicine?

IDENTIFYING THE RESOURCESIDENTIFYING THE RESOURCES

• What EBCP Resources Are Available for the clinical Neurosciences?

• How Can EBCP Be introduced into Neurologic Training Programs?

• What Are Some Other Evidence –Based Neuroscience Initiatives

• Establishment of the Merit Center

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