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Policy, practice, and politics

21 Apr, 16 | by BMJ Clinical Evidence

Van photoBy Van Charles Lansingh

In the advent of the Zika scare, it is clear that the need for evidence and sensationalism are difficult to balance, and due to the pressure from the media, many governments and various entities, responded in haste and with probably very little time to analyze their recommendations. A similar case was seen in the wake of the Ebola outbreak. The global community has seen and experienced the consequences: fear and confusion of managing and controlling a disease that has limited evidence and knowledge base, and lack of historical antecedents to support the actions taken.

However, we often do have the evidence more or less readily available to respond to the health information needs and to the requests from policy makers. Unfortunately, more often than not, this information is too complex and difficult to determine what is correct and what is simply popular belief. The plethora of publications makes it difficult to sift through and summarize, so that there is an adequate process of translation from evidence generated by researchers, to policy and practice. more…

What does Evidence-based actually mean? or Where have all the sceptics gone?

25 Feb, 16 | by BMJ Clinical Evidence

Caroline Blaine

By Caroline Blaine

Commonly held opinions of Evidence-Based Medicine (EBM) include:

“Surely all medicine practised today is evidence-based.”

OR

“EBM just means blindly following guideline recommendations and trial results. It allows no place for professionalism, it is too rigid, and it does not “fit” the patient in front of me.”

Neither of these assumptions is true. The first one denies—against all evidence—that a problem exists, and the second is far from what the founders of EBM described.

Looking back to the publications on EBM from the early 1990’s onwards gives a perspective of the serious issues they were tackling, and the desire to make this fun, as well as easy to understand and adopt. Re-reading the original papers, it is disappointing to reflect on how little the paradigm has shifted. more…

Dabigatran Reversal

28 Jan, 16 | by BMJ Clinical Evidence

Ken MilneBy Ken Milne

Case: A 62-year-old woman presents to the emergency department with a history of atrial fibrillation and gastroesophageal reflux. She is on metoprolol 25mg twice daily, dabigatran 150mg twice daily, and omeprazole 20mg once daily. She noted some mild epigastric pain over the last week and had a coffee ground emesis that morning. She arrives via EMS with a blood pressure of 110/60, heart rate of 64bmp and O2 saturation of 97% on room air. You wonder if there is a specific agent that can safely and effectively reverse dabigatran? more…

PACK: Practical Approach to Care Kit – Bridging the EBM/local policy divide in Primary Care

14 Jan, 16 | by BMJ Clinical Evidence

Tracy Eastmanx150By Tracy Eastman

Primary health care is key to achieving the Millennium Development Goals and the broader goal of “health for all” by providing accessible, affordable and effective health care. Yet in many low and middle income countries (LMIC’s), primary health care is constrained by a lack of adequately skilled and supervised health workers.

The Knowledge Translation Unit (“KTU”) is a clinical research unit within the University of Cape Town Lung Institute (“UCTLI”) which has spent 15 years developing the Practical Approach to Care Kit (“PACK programme”) to support and empower nurses, doctors and other health workers working in primary healthcare. The programme has been scaled up countrywide in South Africa and is now used across more than 2000 clinics by more than 20,000 clinical staff. BMJ has partnered with the KTU to make the PACK programme available to assist in improving primary care services world-wide, and especially in underserved communities. more…

GATE – a Graphic Appraisal Tool for Epidemiological studies

12 Nov, 15 | by BMJ Clinical Evidence

Rod Jackson head shotBy Rod Jackson

The Graphic Appraisal Tool for Epidemiological studies (GATE) is a simple, easily remembered toolkit to help you critically appraise epidemiological studies that includes one picture, two equations and three acronyms. GATE uses a picture of a triangle, circle, square and two arrows to represent the generic structure of epidemiological studies. We call this picture ‘the GATE frame.’ All common epidemiological study designs, from randomised controlled trials to case-control studies, can be illustrated using a GATE frame. While the GATE approach to critical appraisal covers the same ground as other critical appraisal guides, its point of difference is its generic graphic framework that emphasises the similarities between all study designs. With GATE, your goal is to ‘hang’ a study on the GATE frame as follows: more…

The Skeptics’ Guide to Emergency Medicine (SGEM)

16 Jul, 15 | by BMJ Clinical Evidence

By Ken Milne

Ken Milne

“It takes 50 years to get a wrong idea out of medicine, and 100 years a right one into medicine”. (Dr. John Hughlings Jackson – British Neurologist)

Dr. Jackson’s quote points out how long it can take for knowledge translation (KT) in medicine. More recent data suggests it can take an average of 17 years for 14% of medical information to reach the patient’s bedside.

This is far too long in the age of social media. Don’t panic! The goal of the Skeptics’ Guide to Emergency Medicine (SGEM) is to shorten that KT window down from over ten years to less than one year. more…

BMJ Clinical Evidence – putting evidence in context

18 Jun, 15 | by BMJ Clinical Evidence

By Caroline Blaine

Caroline Blaine

 

BMJ Clinical Evidence is now 16 years old. Those in the UK and North America may remember the handbook – initially pocket size it grew over the years as new topics and new evidence were constantly added. Clinical Evidence is now very much an online resource offering a unique systematic overview of the current evidence base for common clinical conditions. This is combined with our tools to practise, learn and teach evidence-based medicine making it a go to place for clinicians, researchers and students. more…

Six proposals for EBM’s future

27 Mar, 15 | by BMJ Clinical Evidence

by Paul Glasziou

Paul Glasziou

 

Gordon Guyatt coined the term ‘Evidence-based Medicine’ (EBM) over 20 years ago, and it has had a remarkable global influence. But EBM is not a static set of concepts, set in stone tablets in the 1990’s; it is a young and evolving discipline. The fundamental concept of EBM – using the best available research evidence to aid clinical care – may have changed little, but what is best and how to apply the concepts in practice continue to develop. more…

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Clinical Evidence is a database of systematic overviews on the effectiveness of key interventions, together with tools and resources to learn and practise EBM. Visit site



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