Introduction to UWO
Evidence-Based
Neurology
Miguel Bussière
With a little help from
Dr. Jenkins and Dr. Burneo
July 12, 2005
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
How do we practice EBN?
Steps:
1. Develop a clinical question
2. Search for the best available evidence
3. Critical appraisal of the evidence for its
validity, impact and applicability
4. Integrate the results of the critical
appraisal with our clinical expertise and
patient’s values
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.
2.
Develop a focused clinical question based on a “real” clinical scenario
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.ca
Jorge.Burneo@lhsc.on.ca
4.
Distribute articles to residents
- AT LEAST 1 week ahead!
5.
Critical appraisal of article(s)
- Worksheets
6.
7.
Facilitation of discussion at EBN rounds
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
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
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
Define the clinical bottom lines and comments
5-10 min