1. Guide to a successful PowerPoint design – simple is best
Use the template wisely, make design amends that help your communication, do not alter the core design of the slide.
Use only one key message per slide. If you have more than one message, use more slides.
Some argue the target number of words on a slide should be 6. Limit the amount of text on each slide, and include copy in your notes.
Maintain a consistent design throughout - colours, fonts, graphics and images.

2. We'll supply the evidence, you make
the decisions.
clinicalevidence.bmj.com 2

3. Why get Evidence into Practice?
It took 200 years before the Royal Navy routinely used lemon juice to prevent scurvy. First study
The first RCT that showed the benefit of thrombolytic therapy was in acute MI late 1950s – not in routine use until 1990s 2
International guidelines first recommended antenatal corticosteroid use in preterm labour 22 years after first evidence 3
On average it takes 17 years for 14% of clinical research to become routine practice 4
Mosteller, F. Innovation and evaluation. Science 1981,211,881–86.
Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts: treatments for myocardial infarction. JAMA 1992;268(2):
Crowley, P. Prophylactic corticosteroids for preterm labour. The Cochrane Library 2000, Issue 1 (CDSR) Update software..
Westfall, J. M., Mold, J., & Fagnan, L. (2007). Practice based research - "Blue Highways" on the NIH roadmap. JAMA, 297(4), p. 403.
Historically we have not been good at applying clinical knowledge into practice...although we are getting better at it.
In 1601, it was discovered that lemon juice reduced the risk of scurvy (Vitamin C deficiency). But it took 200 years before this was routinely use on Naval ships where scurvy was a major problem
Thrombolytic therapy, one of the most important treatments in cardiology, took 35 years to become routine practice from the first study in the 1950’s.
Using steroids to help pre-term babies, took 22 years from the first study, to become recommended routinely. (RCOG – Royal College of Obstetricians and Gynaecologists UK)
It has been estimated that only 14% of evidence becomes routine practice and it takes on average 17 years to do so.

4. The burden of evidence is significant
…although figures vary
35,000 biomedical journal articles published annually
150,000 articles / month
120,000 RCT/year
500,000 articles are indexed in PubMed every year
So why is this? Well there are many reasons – but certainly in today's day and age – the burden of evidence is significant.
We know that the volume of clinical evidence is significant and growing every year.
We estimate that at least 35,000 journal articles are published every year in medicine and allied fields, 150,000 articles per month, 120,000 RCT’s in a year and amazingly there are approximately 500,000 articles indexed in PubMed every year!

5. National Library of Medicine
The information paradox:
“Doctors are overwhelmed with information yet cannot find the information they need”
Dr Muir Gray
Director of the UK’s
National Library of Medicine
This ‘information paradox’ was commented on by Sir Muir Gray, who is one of the doctors who has driven the adoption of Evidence Based Medicine in the UK. And its true - the wealth of knowledge that is available today is so great – that it can be very difficult to filter it down and use at exactly the time when perhaps a doctor might need to use it.
But if we did increase the ability to use the knowledge available out there more quickly and efficiently – we would see measureable results.

6. Evidence Centre – EBM Process1.
Clarify the Question 2.
Develop the search 3.
Find the evidence 4.
Synthesise the evidence 5.
Contextualise the evidence
Who needs the answer?
Diagnosis or treatment?
What stage of the patient journey?
How will the results be used?
Study Characteristics
Population
Intervention
Comparison
Outcome
Time to follow-up
Search Methodology
Where to search
Study type
Quality criteria
Studies identified from over medical journals
Key international guidelines
Drug databases and safety alerts
What is the evidence?
Studies meeting inclusion criteria
Studies of adequate quality
What does it mean?
Summarised evidence
GRADE quality evaluation
Putting the evidence into practice
Expert opinion
Guidance where there is no evidence
Peer review
The EBM Process – We start with a clinical question, we then run a search of public literature, appraise the search hits, summarise and synthesise the results and then eventually give it to our users. This process is under review but the main steps will remain the same.

7. Clinical Evidence provides:
Systematic reviews that summarise the current state of knowledge - and uncertainty - about the prevention and treatment of clinical conditions
Coverage of over 3300 interventions and answers to more than 570 clinical questions
EBM on the most common and/or important clinical conditions seen in primary and hospital care
Links to drug safety alerts, full text access to relevant major guidelines, and updates via the BMJ Updates service
Clinical Evidence is currently available in three formats
Cochrane Definition: “A systematic review attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question. Researchers conducting systematic reviews use explicit methods aimed at minimizing bias, in order to produce more reliable findings that can be used to inform decision making.“ 7

8. Quality of the Information
The quality of the evidence within Clinical Evidence is gold standard
Contributors, advisors and editors are all specialist expert clinicians
Findings based on evidence collected from detailed research using Cochrane Library, Medline, Embase and evidence based journals
A completely transparent, reliable source of information
Reaches more than a million clinicians worldwide in seven languages 8

9. CE is now an education tool CE used to regarded as a source of EBM9

10. First Icon – Learning EBM – help with what is EBM, what are systematic reviews, meta analysis
Second Icon – how to put evidence into clinical content, how to translate evidence to improve patient outcomes.
Third Icon – EBM toolbox with interactive appraisal tools. 10

14. Grading of Treatments 14

15. Evaluation system for grading evidence
Grading the Evidence
Clinical Evidence uses the GRADE method of scoring Evidence
Grading of
Recommendations
Assessment,
Development and
Evaluation system for grading evidence 15

16. GRADE categories: Quality of Evidence16

17. GRADE Evaluation of Anorexia Evidence
Link to study references
Number of patients
Number of studies 17

18. Thank You Web: group.bmj.com/training
Dju-Lyn Chng, Regional Training Manager
BMJ Publishing Group Limited All rights reserved.