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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
Question + Resident +MERIT Faculty +
Content Expert + Librarian
Search Articles(s)Appraise
1 2
3
Presentation ofQuestion / Search
3 Sites
Appraisal Summaryand Discussion
3 Sites
Individual Sites
Publish (Intranet)For Government
Access
Formulate CATClinical Bottom
Lines