This document discusses the history and importance of evidence-based medicine. It notes that evidence-based practice involves asking questions, finding evidence, appraising evidence, applying it to individual patients, and evaluating outcomes. The document outlines the hierarchy of evidence sources, with randomized controlled trials and systematic reviews being the strongest forms of evidence. It provides examples of organizations like the Cochrane Collaboration that evaluate evidence. Finally, it discusses how evidence-based practice can be introduced into neurology training programs through resources, initiatives, and establishing centers to support the process.

1. WHY CONTROVERSIES ARE OF
CONTINUOUS RELEVANCE
PROF.A.V.SRINIVASAN, MD, DM, PhD, F.A.A.N, F.I.A.N,
I
Emeritus Professor, The
Tamilnadu Dr.M.G.R.
Medical University,

2. NOTHING NEW UNDER THE SUN
• COCHRANE COLLOBORATION
• MAVENS OF MCMASTER
• JAMES LIND LIBRARY
• www.jameslindlibrary .org

3. Evidence Based
Medicine > Health Care > Practice
Sackett 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".

4. EBP at the micro level
The Processes of Evidence Based Practice
– ASK (question formulation)
– FIND (information seeking)
– APPRAISE (critical awareness)
– ACT (applicability)
– EVALUATE (could I do it better?)

5. Finding & Appraising Evidence
Evidence hierarchy
– RCTs & Systematic Reviews
– Case, cohort, pre-test/post test studies with controls
– Expert opinion (extended anecdote)
Cochrane Collaboration & its Library
www.cochrane.org
Campbell Collaboration
www.campbellcollaboration.org
– Social, Psychological, Educational, and Criminological
Trials Register (C2-SPECTR)
– Register of C2 Systematic Reviews of Interventions and
Policy Evaluation (C2-RIPE)

6. HISTORY-
EVIDENCE BASED MEDICINE
• FIRST CONTROLLED TRIAL
• BOOK OF DANIEL
• (OLD TESTAMENT)
• JAIN CHALMERS
• 2000BCE TO THE PRESENT TIME

7. HISTORY CONTD
OLIVER WENDELL HOMES
1861
• DANGERS OF CHANCE
• BIAS AND
• OF COURSE -LISTENING TO EXPERTS

8. INVETERATE 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)

9. EVIDENCE BASED MEDICINE EXPERT MEDICINE-
EXPERIENCE BASED
• Why is Evidence-Based Medicine
Important in the Clinical Neurosciences
• Can Busy, Neurologists Practice
Evidence-Based Medicine?

10. IDENTIFYING 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

11. Question + Resident +
MERIT Faculty +
Content Expert + Librarian
Publish (Intranet) Formulate CAT
Search
For Government Clinical Bottom
Articles(s)
Access Lines
Appraise
Presentation of
1 2 Appraisal Summary
Question / Search and Discussion
3 Sites
3 3 Sites
Individual Sites