EvidenceBased Medicine

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Evidence-Based Medicine

• Chris Cairns
• June 2007

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EBM

• EBM is
• Integration of
• Best research evidence
• Clinical skills and experience
• Patient values
• EBM is not
• Just reading papers
• The removal of common sense
• Meant to be inflexible

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EBM

• Only the clinician can decide whether any
  evidence is relevant to their patient
• There are plenty of alternatives for the
  practising physician in the absence of evidence.
  This is what makes medicine an art as well as a
  science. (David Isaacs)

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Reading

• To keep up to date
• I need to read 17 articles a day, 365 days a
  year.
• I need to read.
• I dont (well not that much!).
• Nor does anyone else.
• So.I need to read effectively

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Information Sources for Use at the Point of Care

• Everything is based on the usefulness equation
• Usefulness Relevance x Validity
• Work

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What you really want to know

• In .. Patients managed with, rather than..,
  one additional life will be saved for
  every..patients treated.
• Some indication of risk of bias
• Further information if you want to read on.

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A possible solution

• www.sicsebm.org.uk

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The Solution

• One of these

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Bottom line read in seconds
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Trial details read in minutes
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Read trial details (minutes)
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Particularised for your own practice, integrate
with your expertise
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Caution!!

• Levels of evidence
• Grades of recommendation

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Levels of Evidence
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Levels of Evidence

• 1,2,3,4..purely descriptive
• - , , .. risk of bias
• Gives you little idea of clinical impact on the
  patient (remember back to NNT).

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Grade of recommendation
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Grade of recommendation

• Recommendation graded according to the risk of
  bias.
• Again the clinical impact needs to be weighed up
  when considering which recommendations are the
  most important.

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www.sicsebm.org.uk
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2003

• Website launched
• 4 Reviews
• ARDS I
• Gastric Prophylaxis
• Insulin
• Sepsis
• JICS editorial

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2004

• 5 Reviews
• Therapeutic Hypothermia I
• Making Changes to Practice
• Prevention of VAP
• Guillian-Barre Syndrome
• NO Proning in ARDS
• 11 CATs of published papers
• Equates to 47 new CATs
• Research/EBMG meeting

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2005

• Reviews
• CVCrBSI
• New projects started
• METs
• Outreach
• 20 free CATS, 1 review
• 56 in 2005 in total
• 136 now on website

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2006

• JICS partnership
• One review
• Early tracheostomy
• 20 CATS (11 in JICS)
• 163 CATS on the website

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JICS / ICS

• JICS now using SICS format
• JICS CATS published on SICS web site
• SICS EBM editing input with JICS
• SICS EBM publications listed in JICS
• EBM updates in ICS e-letter

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Website

• Increased world rankings
• Altavista 4th
• Google 1st
• BT.yahoo 2nd
• Yahoo 5th
• Several new features
• Feedback
• Downloads
• Updates to all SICS members
• Discussion Forum
• Costs
• 70.50 per annum

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Website Visitors
20,152
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Website Visitors
47,988
20,152
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Website Visitors
2005 79,541
2004 47,988
2003 20,152
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Monthly Website Visitors
2006 114,00
2005 61,326
2004 47,988
2003 20,152
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Cumulative Sessions
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The Future

• Keep the CATs coming
• 8 reviews ongoing
• SDD (JS)
• NIV (MMcM)
• Hypothermia II (CC)
• Nutrition (MMcD)
• VAP diagnosis (GB)
• Outreach (RP)
• Cultivate links with ICS / JICS
• SIGN methodology
• ANZICS???

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www.sicsebm.org.uk
icu_ebm-subscribe_at_yahoogroups.co.uk
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