Ebm talk-general-mar99-ppt95

Problemas ,[object Object],[object Object]

Minutos por semana de lectura sobre los pacientes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Deterioro de la performance también ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicina Basada en la Evidencia es: ,[object Object],[object Object],[object Object],[object Object]

I. Experiencia Clínica Individual ,[object Object],[object Object]

II. Mejor Evidencia Externa : ,[object Object],[object Object],[object Object]

III. Valores y Expectativas de los Pacientes ,[object Object],[object Object]

Que no es la MBE : ,[object Object],[object Object],[object Object],[object Object]

Medicina Basada en la Evidencia: la práctica. ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicina Basada en la Evidencia: la práctica ,[object Object],[object Object],[object Object]

We needn’t always carry out all 5 steps to provide E-B Care ,[object Object],[object Object],[object Object],[object Object],[object Object]

We’ve identified 3 different modes of practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Even fully EB-trained clinicians work in all 3 modes ,[object Object],[object Object],[object Object]

Patients can benefit ,[object Object],[object Object],[object Object]

Three solutions ,[object Object],[object Object],[object Object],[object Object]

Information required within seconds ,[object Object]

Cochrane Systematic Reviews (522; another 500 in preparation) Database of Abstracts of Reviews of Effectiveness (1895) Registry of Randomised Controlled Trials (218,355)

Information required within seconds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

2. Seeking and Applying EBM generated by others ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

2. Seeking and Applying EBM generated by others ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Can you really practice EBM? ,[object Object]

Conventional Wisdom ,[object Object]

Even on the U.S. Talk-Shows: (“Health Outrage of the Week”) ,[object Object]

Problems with Conventional Wisdom ,[object Object],[object Object],[object Object],[object Object]

Performed an empirical study on a busy in-patient service ,[object Object],[object Object]

The Protocol ,[object Object],[object Object],[object Object]

The Protocol (cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Interventions were Classified by Level: ,[object Object],[object Object],[object Object]

Conclusions from E-B oriented General Medicine: ,[object Object],[object Object],[object Object],[object Object]

Evidence from RCTs (53%) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evidence from RCTs (53%) ,[object Object],[object Object],[object Object],[object Object]

Convincing non-experimental evidence (29%) ,[object Object],[object Object],[object Object]

Interventions without substantial evidence (18%) ,[object Object]

Better Outcomes for Patients When EBM Is Practised ,[object Object],[object Object],[object Object]

Centres for Evidence-Based Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Worse Outcomes for Patients When EBM Is Not Practised: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Worse Outcomes for Patients When EBM Is Not Practised ,[object Object],[object Object],[object Object],[object Object]

Evidence-Based Ambulatory Paediatrics ,[object Object],[object Object],[object Object],[object Object]

Centres for Evidence-Based Psychiatry ,[object Object],[object Object],[object Object],[object Object]

Evidence-Based General Practice ,[object Object],[object Object],[object Object],[object Object],[object Object]

Can we get evidence to the bedside? ,[object Object],[object Object]

Searching for Evidence in the Month Before the Cart : ,[object Object],[object Object],[object Object]

Contents of the Cart : ,[object Object],[object Object],[object Object],[object Object]

Contents of the Cart (cont) : Library Round-Trip = 7 min ,[object Object],[object Object]

Contents of the Cart (cont) : Library Round-Trip = 7 min ,[object Object],[object Object],[object Object],[object Object],[object Object]

Usefulness of the Cart : ,[object Object],[object Object],[object Object]

Of the successful searches (from the perspective of the most junior responsible team member): ,[object Object],[object Object],[object Object]

Searching for Evidence in a 3-day period after the Cart : ,[object Object],[object Object],[object Object]

EBM and Purchasing ,[object Object],[object Object],[object Object]

What we could save in Oxford by switching from: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

EBM and Purchasing ,[object Object],[object Object]

EBM and Purchasing ,[object Object],[object Object],[object Object],[object Object]

EBM and E-B Guidelines ,[object Object],[object Object]

EBM and E-B Guidelines ,[object Object],[object Object],[object Object],[object Object]

EBM and E-B Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

1. Burden - Peso ,[object Object],[object Object]

2. Barriers - Barreras ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

3. Behaviours - Comportamientos ,[object Object],[object Object],[object Object]

Killer B’s ,[object Object],[object Object],[object Object],[object Object]

Two monumental wastes of time and energy ,[object Object],[object Object],[object Object]

Applying a study result to my patient ,[object Object],[object Object]

Extrapolating (particularising) to my individual patient: ,[object Object],[object Object],[object Object]

To add Clinical Expertise and Patient’s Biology & Values : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

To add Clinical Expertise and Patient’s Biology & Values : ,[object Object],[object Object],[object Object]

For example, Warfarin in nonvalvular atrial fibrillation: ,[object Object],[object Object],[object Object],[object Object]

How can I adjust that ARR for my pt’s Risk and Responsiveness? ,[object Object],[object Object],[object Object],[object Object],[object Object]

How can I adjust that ARR for my pt’s Risk and Responsiveness? ,[object Object],[object Object],[object Object],[object Object]

Must also consider the probability that I will do harm: ,[object Object],[object Object]

… and adjust the probability of harm for my patient ,[object Object],[object Object],[object Object]

Can now begin to estimate the Likelihood of Help vs. Harm ,[object Object],[object Object],[object Object],[object Object]

The LHH has to include my patient’s values ,[object Object],[object Object],[object Object],[object Object],[object Object]

On in-patient services in Oxford and Toronto: ,[object Object],[object Object],[object Object]

So the LHH becomes: ,[object Object],[object Object],[object Object],[object Object]

We can work out the LHH for most patients <6 minutes ,[object Object]

Reactions from our patients ,[object Object],[object Object],[object Object],[object Object]

Ebm talk-general-mar99-ppt95

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Ebm talk-general-mar99-ppt95

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