So much evidence : initiating EBWH society

So Much Evidence

What is Next

Process of Randomisation ParticipantsParticipants

R a

n d

o m

l y

A

s s

i g

n e

dR

a n

d o

m l

y

A s

s i

g n

e d

Intervention GroupIntervention Group

Control GroupControl Group

Follow-upFollow-up

Follow-upFollow-up

Intervention Intervention GroupGroup

Control Control GroupGroup

O u

t c

o m

e

C

o m

p a

r e

O u

t c

o m

e

C

o m

p a

r e

dd

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)

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

systematic reviews

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

2600

2800

3000

3200

3400

3600

3800

4000

1995

/1

1995

/2

1996

/1

1996

/2

1996

/3

1997

/1

1997

/2

1997

/3

1997

/4

1998

/1

1998

/2

1998

/3

1998

/4

1999

/1

1999

/2

1999

/3

1999

/4

2000

/1

2000

/2

2000

/3

2000

/4

2001

/1

2001

/2

2001

/3

2001

/4

2002

/1

2002

/2

2002

/3

2002

/4

2003

/1

2003

/2

2003

/3

2003

/4

2004

/1

2004

/2

2004

/3

2004

/4

2005

/1

New protocolsExisting protocolsNew reviewsUpdated reviewsExisting reviews, not incl updates

Reviews and protocols for reviews on The Cochrane Database of Systematic Reviews

Issue 1/2005Alderson, 2005

Too much information

0

500000

1000000

1500000

2000000

2500000

Biomedical MEDLINE Trials Diagnostic?

Med

ical

Art

icle

s pe

r Yea

r

5,000?per day

1,500 per day

55 per day

OBGYN in Pubmed

• 563 meta-analysis • 7184 RCT

Ready Made EBOG

• RCOG• SOGC• Cochrane Library• UpTodate

“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

Many “Leaks” from research to practice

Aware Accept Target Able Recall Agree Done

ValidResearch

If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21

(a*+) (b+)

(c*) (d)

Minimum clinicalImportant difference

No difference

Another Problem : Which are (i) statistically significant * and (ii) Clinically significant +?

So

• Too many information• Little applied

Individual

EBP

The EBM Model

BestEvidence

Client Values and Expectations

Practitioner’s IndividualExpertise

Sackett et al., 1997

EBP Model

Institution state and

circumstances

Clinical Expertise

Client Preferences and actions

ResearchEvidence

But still

Knowledge needs to be managed

much more effectively than it

has been in the past

“Evidence Base” Community

• “The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)

“Evidence Base” Community

• Evidence mapping• Mining the Research• Missing Pieces: Identifying the Gaps in

Evidence

Unexplained InfertilityIUI alone IUI + O.I

Timed intercourse O.I alone

Spontaneous intercourse??

Ines TrialIUI + O.I

IVF + sET

NC IVF

“Evidence Base” Community

• engaging patients in research• working with guideline developers• Reporting and discussing practice guidelines• Podcasting as a Dissemination Strategy• funding for Knowledge Translation and

Dissemination

Steps For Evidence Base Community Implementation

Information sharing with decision Makers

Organization & Fund raising

Clinical Care ImprovementTraining on EBP’s, supervision, consultation and support

Engagement Strategic planFocus on outcomes that clients value.

Improved Women Health

Clinicians, consumers, Stakeholers

Feedback :Efficiency & Effectiveness

Elements Important (Fixsen et al, 2005)

• Commitment of leadership to the implementation process.

• “unfreezing” current organizational practices.• Resources for extra costs, effort, materials, recruiting,

access to expertise, retraining.

So

• There is a need for an authorised body to handle these tasks

• To communicate with decision makers• To cooperate with existing societies • To gather interested people: doctors and

consumers

Hence

• International society• Open to every one• Starting activity from September 2010• Cooperate with different societies involved in

women health