Clinical Evidence

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Clinical Evidence clinicalevidence.bmj.com
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• Challenges facing health systems internationally
• Ensuring appropriate use of resources
• Ensuring consistent, optimal clinical
  performance
• Improving patient outcomes
• Delivering patient centred care

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• Vehicles to overcome the challenges
• Evidence Based Medicine
• Technology
• System based approach

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• Knowledge is the enemy of disease. The
  application of what we know will have greater
  impact than any new drug or technology likely to
  be developed in the next decade
• Professor Sir J. Muir Gray
• Director of the National Library for Health UK

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So. Whats so difficult about that?

• 8000 articles published per day
• 30 kg of guidelines per family doctor
• 25,000 biomedical journals in print
• 1500 medical articles onto Medline per day

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5S evolution of Information Resources
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Systems
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Summaries
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Synopses
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Syntheses
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Studies
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Clinical Evidence

• A database of the best available research
  evidence findings on common and important
  clinical questions (systematic reviews)
• Covers over 570 topics and over 3000 treatments
• These topics are the most important common
  conditions seen in primary and hospital care
• Describes the questions, summary and background
  of a condition
• Includes evidence on 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

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How is Clinical Evidence put together ?

• Select Topics common conditions
• Review data on consultation rates, morbidity,
  mortality
• Advice and suggestions from clinicians and
  patient groups
• Topic Planning select the questions
• Relevance to actual practice
• Detailed and systematic appraisal of material
• Quality check of EBM material and guidelines
• Search appraise literature systematic reviews
  and RCTs
• Where no evidence observational studies
• Done by in-house specialists contributions from
  external clinical specialists
• Summarize the evidence peer review and edit
• Peer reviewed by at least 2 expert clinicians
• Edited and compared with original papers
• Consistency and quality measures also monitored
• Feedback, error corrections and user responses

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Survey participants

• 75 males, 25 females

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Scientific validity and understandability ()
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CE has a broad range of specific and general uses

• CE enjoys high levels of usage across a wide
  range of activities ( ever use)
• Information on specific patient cases (83)
• Training and learning (77)
• Informing conversations with colleagues (71)
• In discussion with patients (63)
• In presentations and talks/ developing protocols
  (51-52)

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CE is used across a wide range of conditions
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CEs impact on changing clinical practice

• Three quarters of all GPs agreed that CE had
  influenced aspects of their clinical practice
  two thirds of these stated that they had changed
  their practice within the last 6 months

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Integrating knowledge sources means better
decision-making at the point of care.
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Thanks???Arthur SunProduct SpecialistTaiwan
Online Plus, Inc.arthur_at_onlineplus.com.tw