1. Foundations of Evidence-based Healthcare:  Roadmap to scientifically informed medical practice
Peter Wyer MD
Associate Professor of Medicine
Columbia University Medical Center
Co-chair, Section on Evidence Based Health Care
New York Academy of Medicine

2. Scientifically Informed Medical Practice and Learning - SIMPLE Model
“Knowledge does not extend from those who consider they know to those who consider they do not know. Knowledge is built in the relationship between human beings and perfects it self in the critical problematization of these relations.”
Paulo Freire
Critical Problematization
Clinical Action
Scientific Evidence
Suzana Silva, Sicily Conference, Italy 2009 | JECP 2010

3. WHAT WE KNOW YOU WON’T DO
Carefully define questions arising in the course of patient care using a structured format such as “P-I-C-O”
Interrupt your busy practices in the midst of patient care to perform lit searches
Spend hours pouring over primary literature to appraise the quality of included evidence
Work through book length presentations of clinical guidelines for the purpose of evaluating the trustworthiness of the recommendations
Use ornate diagrams of smily vs frowning faces or complex decision analyses to explain the probabilistic implications of research findings to your patients
Gabbay and LeMay Practice Based Evidence for Healthcare 2011

4. WHAT WE BELIEVE YOU MUST DO (To Achieve Evidence Literacy)
Learn the organization of design related information
Learn to utilize information resources, including librarians, efficiently
Learn the principles underlying evaluation of evidence quality
Learn the principles underlying evaluation of the quality of clinical guidelines

5. Alternatives to Evidence Literacy
Regulators
Payers
Industry
Consultants
The evidence
illiterate
practitioner

6. Evidence Literacy Primer
Defining information needs
The hierarchy of evidence-based resources
The quality of evidence

7. The Hierarchy of Information

8. Hierarchical Escalation of Information from Research
SUMMARIES
Tertiary data
Collection
Enrollment of stakeholder groups and systematic reviews
SYNTHESES
Secondary data
collection
Enrollment of individual studies
STUDIES
Primary data collection
Direct enrollment of human subjects

9. Multiple questions
within a clinical area
Clinical Guidelines
Multiple studies on
a single question
Systematic Review
Direct observations involving
human subjects
Trials, Cohort studies

10. Databases

14. Garbage In Garbage Out

15. Systematic Reviews: The Primary Unit of Evidence
What defines the quality of evidence?

16. Determinants of Evidence Quality (GRADE system categories)
Incomplete evidence
Risk of bias
Indirectness
Inconsistency
Imprecision

17. Completeness of Evidence

18. Risk of Bias
Capitals vs Maple Leafs

19. Indirectness Wrong population Wrong comparisons Wrong dosages
Wrong outcomes

20. Inconsistency and Imprecision

21. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: A meta-analysis*
Alan E. Jones, MD; Michael D. Brown, MD, MSc; Stephen Trzeciak, MD, MPH.
Critical Care Medicine 2008

22. Drunk Using Lamp Post