1. So Much Evidence What is Next

2. P articipants I ntervention Group (IG) & C omparison Group (CG) O utcome I G CG + - + - D C B A R epresentative? Allocation? Selection? Maintenance of allocation? VALIDITY M aintenance? treated equally? compliant? M easurements b lind subjective? OR o bjective? QUESTION: A llocation? Randomised? comparable groups? Measurement of outcomes? DESIGN:

3. Process of Randomisation Participants R a n d o m l y A s s i g n e d Intervention Group Control Group Follow-up Follow-up Intervention Group Control Group O u t c o m e C o m p a r e d

4. Assessed for eligibility (n= 245) Excluded (n= 15) Not meeting inclusion criteria (n=7) Refused to participate (n=5) Social reasons (n=3) Received IUI (110) Analyzed (n=110) Cycles cancelled (n=5) Inadequate response (n=4) Hyper-response (n=1) Group I (n=115) received Merional + CC Cycles cancelled (n=8) Inadequate response (n=6) Hyper-response (n=2) Group II (n=115) received Merional alone Received IUI (107) Analyzed (n=107) Allocation Analysis Follow-Up Enrollment Randomized (n=230 )

5. The best evidence for different types of question Level Treatment Prognosis Diagnosis I Systematic Review of … Systematic Review of … Systematic Review of … II Randomised trial Cohort Cross sectional III

6. systematic reviews Alderson, 2005

7. Too much information 5,000? per day 1,500 per day 55 per day

10. “ I don’t know…” “ I don’t really care about all of this research stuff…” “ I just want to take care of patients…” Unnamed Ob-Gyn Resident Still There is a Problem

11. Many “Leaks” from research to practice If 80% achieved at each stage then 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21 Aware Accept Target Able Recall Agree Done Valid Research

12. (a*+) (b+) (c*) (d) Minimum clinical Important difference No difference Another Problem : Which are (i) statistically significant * and (ii) Clinically significant +?

15. Individual

16. The EB M Model Sackett et al., 1997 EBP Best Evidence Client Values and Expectations Practitioner’s Individual Expertise

17. EB P Model Institution state and circumstances Clinical Expertise Client Preferences and actions Research Evidence

18. But still Knowledge needs to be managed much more effectively than it has been in the past

21. Unexplained Infertility Spontaneous intercourse?? IUI alone IUI + O.I Timed intercourse O.I alone

22. Ines Trial IUI + O.I IVF + sET NC IVF

26. Steps For Evidence Base Community Implementation Information sharing with decision Makers Organization & Fund raising Clinical Care Improvement Training on EBP’s, supervision, consultation and support Engagement Strategic plan Focus on outcomes that clients value. Improved Women Health Clinicians, consumers, Stakeholers Feedback :Efficiency & Effectiveness

29. Hence