1. Miguel Bussière With a little help from Dr. Jenkins and Dr. Burneo July 12, 2005 Introduction to UWO Evidence-Based Neurology

2. What is EBN? “The conscientious, explicit, and judicious use of current best external evidence in making decisions about the care of individual patients. Practicing EBN requires the integration of individual clinical expertise, proficiency, judgment, and compassion with the best available evidence from systematic and relevant basic science and clinical research.” Demaerschalk BM and Wiebe S EBN: An Innovative Curriculum for Post-Graduate Training in the Neurological Sciences http://www.uwo.ca/cns/ebn

3. Goals of the EBN Course Primary –To learn how to find the best available evidence –To learn how to critically appraise an article –To learn about the different types of studies and methodologies Therapy, diagnosis, prognosis, harm, economic analysis, guidelines, decision analysis... Meta-analysis, RCTs, cross-over, case-control, cohort… Secondary –Stay up-to-date with current neurological literature

4. Steps: 1. Develop a clinical question 2. Search for the best available evidence 3. Critical appraisal of the evidence for its validity, impact and applicability 4. Integrate the results of the critical appraisal with our clinical expertise and patient’s values How do we practice EBN?

5. EBN topic selection At the end of each academic year, residents get together and create a list of potential topics for the upcoming year Final topics are decided upon by Dr. Jenkins and Dr. Burneo Each resident is responsible for 1-2 topics per year –Pgy 1 & 5 will review 1 topic –Pgy 2-4 will review 2 topics Total 18-20 topics per year

6. When it’s your turn... 1. Develop a focused clinical question based on a “real” clinical scenario 2.Literature search a. Develop a search strategy e.g. MeSH, keywords, limits... b. Search databases e.g. PubMed, SUMSearch, Cochrane... 3.Final article selection - Discuss with Dr. Jenkins / Dr. Burneo Mary.Jenkins@lhsc.on.ca Jorge.Burneo@lhsc.on.ca 4.Distribute articles to residents - AT LEAST 1 week ahead! 5.Critical appraisal of article(s) - Worksheets 6.Facilitation of discussion at EBN rounds 7.Final CAT preparation and “prompt” submission

7. EBN Resources 1.Sackett et al. EBM. How to practice and teach EBM. (2005), 3rd ed. 2.EBN Binder –Collection of articles e.g. JAMA series 3.EBN web site –http://www.uwo.ca/cns/ebn/ –Schedule, worksheets, links to databases and other useful sites, CAT collection 4.UWO library

8. EBN Rounds 5-10 min 5 min 5-10 min Review of various aspects and methodologies of EBN (Dr. Burneo / Dr. Jenkins) Brief introduction of topic (optional) Presentation and discussion of clinical scenario and focused clinical question 5-10 minPresentation and analysis of literature search strategy and results 20-30 minCritical appraisal of the evidence 15 minInterpretation of results and application to the case at hand 5-10 minDefine the clinical bottom lines and comments