Miguel BussièreWith a little help from

Dr. Jenkins and Dr. Burneo

July 12, 2005

Introduction to UWO Evidence-Based

Neurology

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

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

Steps:1. Develop a clinical question2. Search for the best available evidence3. Critical appraisal of the evidence for its validity, impact and applicability4. Integrate the results of the critical appraisal with our clinical expertise and patient’s values

How do we practice EBN?

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

When it’s your turn...

1. Develop a focused clinical question based on a “real” clinical scenario2. 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.caJorge.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 rounds7. Final CAT preparation and “prompt” submission

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

                

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 min Presentation and analysis of literature search strategy and results

20-30 min Critical appraisal of the evidence

15 min Interpretation of results and application to the case at hand

5-10 min Define the clinical bottom lines and comments