1. February 2008 Providing evidence based resources

2. February 2008 What is not an evidence based resource? Evidence based medicine does not tell healthcare professionals what to do. Evidence based medicine identifies management options, and how well they are supported by evidence in defined populations.

3. February 2008 Traditional Steps of Evidence Based Medicine Assess Ask clinical question Acquire the evidence Appraise the evidence Apply the evidence

4. February 2008 Planning – Ask clinical questions... PICOT –Patient –Intervention/Risk factor –Comparison –Outcome –Type of Study (Systematic reviews? RCTs?) Quality parameters –Size of study –Length of follow up –Loss to follow up

5. February 2008 Sources for finding evidence [systems ] evidence summary resources databases of systematic reviews databases of primary studies (e.g. RCTs) [intranet, integrated computerised decision support – future?] e.g. BMJ Clinical Evidence; UpToDate; NLH Clinical Knowledge Summaries (2009?) e.g. Cochrane Database of Systematic Reviews; DARE e.g. Medline; Embase; CINAHL, Cochrane CENTRAL Time needed to search increases [Some overlap e.g Clinical Evidence] Step 1: Search for evidence summaries first Step 2: If question not addressed by an evidence summary, search for individual systematic reviews next Step 3: Search for primary research: if your question is not addressed by the above secondary resources or you feel the search date indicates an update search is necessary

6. February 2008 Planning SearchingAppraisal Publish How BMJ Clinical Evidence relates to the steps of EBM? Ask Review planning Acquire Search primary sources Appraise Results appraised following recognised criteria Combined into structured summaries

7. February 2008 The aim of Clinical Evidence is to summarise evidence on medical interventions from high quality systematic reviews and large well- designed randomised controlled trials.

8. February 2008 Clinical Evidence facts A compendium of the best available research & evidence findings on common and important clinical questions (systematic reviews) Covers over 3000 interventions and answers more than 570 clinical questions Describes the questions, summary and background of a condition then benefits & harms of preventative and therapeutic interventions Emphasis on the outcome for patients Findings based on expert knowledge & evidence collected from detailed research using Cochrane Library, Medline, Embase and evidence based journals Contributors, advisors and editors are all specialist expert clinicians

9. February 2008 Who uses Clinical Evidence? GPs Researchers Students Hospital Doctors

10. February 2008 Time saved per day using BMJ Clinical Evidence Survey based on 566 CE subscribers, from across the world, mix of academic/primary care/secondary, 20 in-depth phone interviews and two mini focus-groups http://clinicalevidence.bmj.com/downloads/BMJCEMRP0508.pdf

11. February 2008 Reasons for using BMJ Clinical Evidence Survey based on 566 CE subscribers, from across the world, mix of academic/primary care/secondary, 20 in-depth phone interviews and two mini focus-groups http://clinicalevidence.bmj.com/downloads/BMJCEMRP0508.pdf

12. February 2008 Clinical Evidence – Home page

13. February 2008 CE front page continued

14. February 2008 Case Scenario: You are an inexperienced junior hospital doctor. A 55 year old asthmatic man who has heart failure attends the out- patient clinic. Despite taking an ACE inhibitor his heart failure is inadequately controlled. You discuss the case with your senior who advises that you add an Angiotensin II reception blocker to his treatment. You are worried, having never combined these two types of drugs before, and would like reassurance that this is a reasonable course of action…

15. February 2008 Access via sections

16. February 2008 Access via sections

17. February 2008

18. Systematic review – Heart failure

19. February 2008 Systematic review – Heart failure

20. February 2008