Evidence Based Medicine in International Health

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Evidence Based Medicine in International Health

• Some guidelines for residents

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Evidence Based Medicine in Global Health how is
it different?
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What is our question?

• Therapy/Prevention
• How effective is zinc therapy in reducing the
  duration of childhood diarrheal disease?
• Does ATLS training in a developing country impact
  trauma outcomes?
• Diagnosis
• How reliable are the results of rapid malaria
  testing in X regional/population setting?
• Harm
• What is the impact of civil conflict on mortality
  and/or overall health status of affected
  populations?

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What is our question?

• Screening
• When should we screen immigrants for exposure to
  political violence in their country of origin?
• Clinical prediction/decision rules
• Is it possible to apply WHO pneumonia case
  management rules to X population?
• Economic analysis
• Is treating multidrug resistant TB cost-effective
  in resource challenged settings?

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What is our question?

• Qualitative research/feasibility studies
• How do social/cultural constructions of STDs
  affect health seeking behaviors?
• Systematic review/meta-analysis
• What is the strength of the evidence for male
  circumcision in reducing rates of HIV
  transmisison?

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Consider the clinical context

• Local and/or cultural
• Historical, as applicable
• Economic points of reference, including health
  care access
• Societal boundaries and changing geographies
• Geopolitical influences

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Undertaking a search

• Some databases
• The ubiquitous PubMed
• Global Health (Ovid database)
• Library of Congress Overseas Network
• http//www.loc.gov/acq/ovop/
• Quarterly Index of African Periodical Literature
• http//lcweb2.loc.gov/misc/qsihtml/

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Some journals you might not usually refer to

• BMJ
• The Lancet
• Bulletin of the WHO
• MMWR (CDC)
• PLoS (Public Library of Science) Medicine
• Humanitarian Practice Network publications
• www.odihpn.org
• Field Exchange
• www.ennonline.net
• Disasters Journal of Disaster Studies, Policy
  and Management
• Disaster Management and Response

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Country profiles/situation reports

• ReliefWeb (OCHA)
• www.reliefweb.int
• FEWS Net (Famine Early Warning System, USAID)
• www.fews.net
• GIEWS (Global Information and Early Warning
  System, FAO)
• http//www.fao.org/giews/english/index.htm

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Performing a critical analysis some available
online resources

• Evidence Based Medicine Toolkit (Alberta)
• http//www.med.ualberta.ca/ebm/ebm.htm
• Users Guide to Evidence Based Practice
  full-text links to complete JAMA series
• Centre for Health Evidence (Alberta)
• http//www.cche.net/usersguides/main.asp
• MSSM Library website (under databases, EBM)
• http//ugi.userguides.org/UGI/default.asp
• Centre for Evidence-Based Medicine (Oxford)
• Web-based tools (e.g., pre-test probability/LR
  calculators), glossary
• http//www.cebm.net/