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EBM

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How to apply evidence-based medicine to anaesthesia ... The Cochrane Anaesthesia Review Group ... Evidence-based anaesthesia-related systematic reviews ... – PowerPoint PPT presentation

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Title: EBM


1
EBM
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2
What is systematic review
  • A review that include an explicit and detailed
    description of how it was conducted
  • Minimize bias, maximize precision
  • Include a clear research question, criteria for
    inclusion or exclusion primary studies, the
    process to identify primary studies, and the
    method used to access the methodological quality
    of the selected studies, the methods used to
    extract and summarise the results of primary
    trials on which the conclusion are based

3
Categorising evidence
  • Summarised evidence can be categorized according
    to study design, and reflects susceptibility to
    bias.
  • A comprehensive plan for estimating the strength
    of clinical recommendations can be found on the
    Centre of Evidence-Based Medicines (Oxford)
    homepage evidence-basedmedicine.jr2.ox.ac.uk/,
    and an adaptation of the North of England
    Evidence Based Guidelines Development Project )
    (Table 1) describes the categories in descending
    order of importance.

4
How to apply evidence-based medicine to
anaesthesia
  • Surrogate or intermediate outcomes such as
    laboratory findings, blood pressure or other
    physiological parameters predominate, and may
    reflect the emphasis given to basic sciences
    during anaesthetic training.
  • The disadvantages of using surrogate outcome
    measures have been described in a systematic
    review by Gøtzsche and colleagues in 1996 (30)
    surrogate outcomes impede the search for evidence
    to support clinical decisions.

5
The Cochrane Anaesthesia Review Group
  • The Cochrane Collaboration is an international
    organisation that aims to help people make
    well-informed decisions about health care by
    preparing, maintaining and promoting the
    accessibility of systematic reviews of the
    effects of health care interventions.
  • The group promotes evidence-based anaesthesia
    through the production and maintenance of
    systematic reviews of the effects of
    interventions in anaesthesia, intensive care,
    acute pain treatment, prehospital medicine,
    resuscitation and emergency.

6
Evidence-based anaesthesia-related systematic
reviews
  • A title of a review that is initially registered
    within the group becomes a protocol, which
    prospectively sets out what is being tested, why,
    and how it will be done.
  • The complete systematic review adheres to the
    protocol in order to maintain uniformity and
    minimise bias.
  • Systematic reviews performed by the CARG are
    reviews of studies in which evidence has been
    systematically searched for, studied, assessed,
    and summarised according to predetermined
    criteria.

7
  • Preparation and maintenance of Cochrane reviews
    is the responsibility of international
    collaborative review groups, such as the CARG.
  • The members of these groups researchers, health
    care professionals, consumers, and others share
    an interest in generating reliable, up-to-date
    evidence relevant to the prevention, treatment
    and rehabilitation of particular health problems
    or groups of problems.

8
The future of evidence-based anaesthesiology
  • Anaesthetists are co-operation and teamwork
  • Even good evidence can be misapplied in an
    atypical clinical situation
  • Evidence-based practice should be incorporated
    into our education, and reinforced in daily
    clinical problem solving

9
  • Evidence-based medicine provides the best basis
    on which to evaluate those interventions that
    should be abandoned, and those that are
    beneficial and cost-effective.
  • It should be a national strategy that the health
    care system be evidence-based, also in
    anaesthesiology

10
Conclusions
  • There is emerging evidence that, when evidence
    based medicine is practiced, the patient
    benefits.
  • Evidence- based medicine requires you not only to
    read articles but to read the right articles and
    then to alter your behaviour.
  • Systematic reviews allow some assessment of the
    generalisability of findings, and consistency of
    treatment effect to be explored.

11
  • An often-cited advantage is increased power.
  • The precision of the estimate increases because
    the confidence limits become progressively
    narrower.
  • The evidence found through systematic reviews of
    randomised controlled trials should be in
    concordance with the clinicians experience and
    the patients wishes.

12
  • Clinical experience is invaluable, especially
    when a clinical picture is atypical, or when a
    patient is dissimilar from the population in a
    randomised controlled trial.
  • Good knowledge of pathophysiology is also
    advantageous.
  • However, experience or pathophysiological
    explanations may be misleading if they are the
    sole reason for arriving at a specific clinical
    decision
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