Belgian Centre for EvidenceBased Medicine Belgian branch of the Cochrane Collaboration

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Belgian Centre for Evidence-Based
MedicineBelgian branch of the Cochrane
Collaboration

• Karin Hannes

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Evidence-based medicine

• The conscientious, explicit and judicious use of
  current best evidence in making decisions about
  the care of individual patients
• The integration of individual clinical expertise
  with the best available external evidence and
  patients values and expectations
• Sackett DL et al. BMJ 199631271-72

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Evidence part of decision making
Evidence
Expertise
Patient
The environment
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Evidence-Based Medicine new???

• We all want the best for our patient, no?
• Our education guarantees sufficient knowledge and
  quality of practice
• Medical literature is full of contradictions
• There is a lack of evidence for many therapies or
  treatments

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4 reasons to continue

• Evidence is not used or is used too
• New evidence can change policy
• updates of knowledge are necessary
• The traditional forms of education fail in
  delivering new scientific insights quick and
  efficient enough.

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Did you know

• Only about 15 of medical interventions are
  supported by solid scientific evidence,
• BMJ editorial 1995

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Did you know

• this would put 80 to 90 of accepted
  medical procedures in this country under the
  heading of quackery!
• Lets raise our hand for Harry Potter?

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EBM was born

• It is surely a great criticism of our profession
  that we have not organised a critical summary,,
  adapted periodically, of all relevant randomised
  controlled trials
• Archie Cochrane

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The Cochrane Collaboration
International organisation that produces, updates
and disseminates systematic reviews in the
broader field of health care
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Evidence-Based Medicine?5 steps

• Step1 Defining the problem
• Generate a searchable question out of a clinical
  case

But for certain questions we do not already have
the answers
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Evidence-Based Medicine?5 steps

• Step 2 Search for evidence in medical resources
  of high quality
• My experience
• I heard it from a colleague
• The professor said...
• I read an RCT
• Systematic Reviews

If you find a systematic review on your topic
that provides sufficient evidence, you do not
have to re-invent the fire.
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Evidence-Based Medicine?5 steps

• Step 3Critical appraisal of scientific studies
• Is the methodology of high quality?
• Where does the information come from?

Be aware of conflicts of interest !
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Evidence-Based Medicine?5 steps

• Step 4 Implement the evidence in practice
• Be carefull with generalising results from
  scientific studies.

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Each individual is unique !!!
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Evidence-Based Medicine?5 steps

• Step 5 Evaluate!
• Did I take the right decision?
• Dit I take the best decision?
• Being right does not mean adapting completely to
  what scientific studies tell you do to!
• You are responsible for the choices you make!

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Alternatives have to be possible... Always, but
with the right motivation.
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Your experience will guide you through the
implementation of scientific insights!
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Because adapting completely to the rules of
science with your eyes closed...

• aw... That hurts!

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PICOFrom a clinical case to a searchable
question...
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A searchable question 4 ingredients
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Domains

• Wats the problem? Diagnostics
• Whats the cause ? Etiology
• Whats the perspective ? Prognostic
• Wat can I do ? Therapeutic
• Does it harm? Adverse effects

PICO domain search strategy
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Step 1 the problem

• I have always brushed my teeth with a manual
  toothbrusher. My brother, however, is keen on
  using an electric one. Last week there was a
  sale-out on electric toothbrushes in the
  supermarket. I wanted to buy one... But I wanted
  to be sure that the result of the brushing was
  better than the result of my manual toothbrush.
  I started my search...

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Test...

• What is the domain of this PICO?

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patiënt
• I Interventie
• C Comparison
• O Outcome

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patiënt Patiënt developing caries, female,
  33 years old
• I Interventie Brushing with an electric
  toothbrush
• C Comparison Brushing with a manual toothbrush
• O Outcome Reducing plaque and caries

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patiënt first grade students
• I Index test CUGE-test
• C reference test DSM IV-test
• O outcome alcohol depence

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patiënt patient with high blood pressure
• I Intervention family history of hart
  failure
• C Comparison without family history of hart
  failure
• O Outcome development of hart problems in the
  future

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patient patient with neck pain
• I Intervention manipulation by a
  chiropractitioner
• C Comparison (placebo)
• O Outcome long term adverse effects

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Step 2 Formulate a clinical question

• Formulate a searchable question PICO
• P Patient patient with high blood
  pressure
• I blootstelling lives in the city (polluted
  air
• C zonder blootstelling lives at the country
  site (clean air)
• O Outcome development of asthma

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Lets move to our search

• PUBMED

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