1. Buidling an evidence base1 Developing an SLT evidence base in the current climate: mission impossible? Professor Paul Carding Dept of Voice, Speech and Swallowing Freeman Hospital and University Medical School, Newcastle upon Tyne, UK

2. Buidling an evidence base2 Clinical services

3. Buidling an evidence base3 Clinical researchClinical services

4. Buidling an evidence base4 How can we realistically balance these two demands ? Clinical researchClinical services

5. Buidling an evidence base5 Why do we need to be concerned about our evidence base? Evidence base

6. Buidling an evidence base6 Why do we need to be concerned about our evidence base? Evidence base

7. Buidling an evidence base7 Why do we need to be concerned about our evidence base? Evidence base

8. Buidling an evidence base8 Why do we need to be concerned about our evidence base? Evidence base

9. Buidling an evidence base9 Why do we need to be concerned about our evidence base? Evidence base

10. Buidling an evidence base10 Professional responsibility  Professional clinicians  Patient expectations  Financial reasons

11. Buidling an evidence base11

12. Buidling an evidence base12 A simplified evidence hierarchy (http://cebm.jr2.ox.ac.uk) Level I Systematic review and meta- analysis of all relevant randomised controlled trials (RCTs) Level II At least one high quality RCT Level III 1. Prospective controlled trials 2. Prospective cohort studies or case series 3. Prospective single case studies Level IV Expert opinions, expert guidelines, descriptive studies

13. Buidling an evidence base13 Summary of levels of evidence for selected disorders (from RCSLT guidelines)

14. Buidling an evidence base14

15. Buidling an evidence base15 “Study the past if you would define the future.” Confucius

16. Buidling an evidence base16 The barriers to developing our clinical evidence base

17. Buidling an evidence base17 Barriers to clinical research (1)  Clinician barriers  “I’m a practitioner”.  “The job of academics”.  “Waste of precious clinical time”

18. Buidling an evidence base18 Barriers to clinical research (2)  Manager barriers  “ You’re a practitioner”.  Productivity is God.  “value for money”  “Don’t think, work”

19. Buidling an evidence base19 Barriers to clinical research (3)  Institution-based barriers  No links between academic and clinical  No mutual aims  Limited mutual output

20. Buidling an evidence base20 Barriers to clinical research (4)

21. Buidling an evidence base21 Barriers to clinical research (4)

22. Buidling an evidence base22 Barriers to clinical research (4)

23. Buidling an evidence base23 In summary- it is not mission impossible!!  Clinician and manager attitude  Use the career structure (A4C)  National research strategy initiatives  External funding opportunities  Clinical and academic links

24. Buidling an evidence base24 In summary- it is not mission impossible!!  Clinician and manager attitude  Use the career structure (A4C)  National research strategy initiatives  External funding opportunities  Clinical and academic links

25. Buidling an evidence base25 Summary- consequences  Cut services more  De-skill ourselves  Failing the people we serve  Save services  Develop ourselves  Understand more If we don’t respond If we do respond

26. Buidling an evidence base26 Developing an SLT evidence base in the current climate: mission impossible? Professor Paul Carding Dept of Voice, Speech and Swallowing Freeman Hospital and University Medical School, Newcastle upon Tyne, UK