Argomento Nome Descrizione
2. Critical Perspectives on EBM URL Video: What is Evidence-based Medicine?

Watch the video on BioMed Central and listen to two leading researchers talk about EBM and its strengths and weaknesses (you can activate subtitles in English!). Trish Greenhalgh is Professor of Primary Health Care and Dean for Research Impact at Bart's and the London School of Medicine and Dentistry, UK, while Neal Maskrey is Professor of Evidence-informed Decision Making at Keele University, UK. 

Both share a background in General Practice and are advocates of the campaign for real evidence-based medicine. Here Greenhalgh and Maskrey discuss the origins of evidence-based medicine, how it has gone astray, and what is needed to address some of the problems facing evidence-based practice today.
File Read about pros & cons of Evidence-Based Medicine

In the oral exam you will be asked general questions about Evidence-Based Medicine:

For example: What is EBM?  Can you give a definition? What are its strengthen and weaknesses?

What types of study designs do you know? How are they different? What different clinical questions do they answer? The link to the paper Pros and Cons gives a detailed overview of the strengths and weakness to help you answer these questions. The resources links are also very recommended.
URL Video on TED: Battling bad Science

This is a stimulating 14 minute talk on 'bad science 'by Ben Goldacre. It explains how important 'transparency' in clinical evidence is but also how easily evidence can be manipulated. You can listen to this talk with Italian subtitles. It provides a philosophical background to your EBM project and the idea of 'critical analysis'. 
Pagina Read about 'Validity and bias' in research
These notes on EBM are by Theodore J Gaeta, DO, MPH, FACEP. 
File Read about different types of 'bias'

This is a short paper on types of bias in clinical research. Use it to help you analyse potential bias in your presentation
3. EBM Exam Presentation Guide File EBM Presentation Project Guide 2019

 This guide describes what information  to include in your presentation, the titles you need to put on every slide, how many slides to use, and how to present the material. Your EBM presentation in the exam is worth 15/30.

 The table below has 15 sections. Each section explains criteria for 1 mark in the exam. Follow it carefully while you prepare your slides.

EBM Assessment Criteria

 

Yes

No

Structure of EBM Presentation: Use this guide to structure your slide presentation

 

 

 

1. Opening slide contains engaging patient centred title, presenter name and institutional affiliation:

   

 

 

 

2. Presents detailed  patient case clearly with background & clinical and social detail. (It is an advantage for 'lode' for students to use patient cases based on ones from their hospital ward experience)

 Title:  Patient Presentation  (1-2 slides

 

 

 

3. Provides appropriate clinical background to patient’s pathology 

Title: Clinical Background (1-2 slides)

 

 

4. Identifies a clinical problem and  writes a clear well structured clinical query as a starting point for searching for evidence  (e.g. using PICO)

Title:  Clinical Query or Clinical Question)  (1 slide)

 

 

 

5. Identifies key words, concepts and relevant terminology in English  to create a semantic map

Title: Key Search Terms or Key Terminology (1 slide)

 

 

 

6. Describes a systematic search strategy demonstrating knowledge of different medical databases with  some examples

Title: Search Strategies (1-2 slides)

 

 

 

7. Describes filters and inclusion/exclusion criteria for usng evidence, and indicates number of studies included and study designs.  

Title: Selection Criteria (1 slide)

 

 

 

8. Evaluates evidence explaining factors which influence the accuracy or validity of information

(e.g. how up to date it is; possible bias, compare and contrast, methodological factors (e.g. study designs and the strength or weakness of the evidence you present)  

Consider using a table like this below to present your evidence schematically, writing author names for the outcomes they described.

 Title: Evaluation of Evidence (1-2 Slides)

 

Clinical Outcomes

Intervention A

Intervention B

Quality of Life

Smith et al (2016)

Beal et al (2016)

Survival ?mortality

Rossi (2015), Beffe (2012)

Johnson (2015)

 

 

 

9. Balances primary and high quality secondary evidence. Evidence must include most recent up to date papers

In your oral synthesis consider grouping studies together under study design. You can do this in Italian or English. The important thing is to have structure in your synthesis. Here is a model guide to help you:

e.g. I identified 2 systematic reviews, 5 RCTs and 3 Cohort studies relevant to my patient and query. First I shall examine my primary studies.  I identified 5 RCTs for a total of  1,200  patients. These were comparable studies ….. (or not comparable) ..  because….. .  Possible sources of bias include….. . From these results we can generalize/cannot generalize that…. Possible sources of bias are ……..

Moving on, I also included 3 cohort studies which together included 4000 patients….These studies posed the same/different questions, including …….

To conclude I identified a Cochrane systematic review by Smith et al. published in 2018. It examined  38 RCTs…………. for a total patient population of 10,600. The results of this review suggest ………. One limitation of this study is that... however on balance....

So overall the message of my synthesis is ….. and the implications for future research are firstly.... secondly.. and finally ....

(you can take notes to help you remember the details of each study)

 

 

10. Relates synthesis of evidence to own patient and explains unresolved issues and/or future directions for research 

 Title: ‘Clinical Message, and or ‘Conclusion’ (1-2 slides)

 

 

11. Bibliography is  formatted using a bibliographic software (e.g. Mendeley, Zotero, Papers,) and is of a professional standard for medical publication 

Title: References  (1-2 slides)

 

 

 

Quality of Presentation

 

 

12. All medical definitions/descriptions and images are referenced professionally on slides using bibliographic software (e.g. Mendeley, Zotero, Papers, Endnote).  Each student must present a minimum of 10 full text papers. Bring these on a pen drive during to the exam. You can include a maximum of 3 secondary reviews. (15+ papers for groups of 2 students)  Evidence must be up to date 

 

 

 

13. Patient confidentiality is maintained and data anonymised. The best presentations will be based on patients you have met and worked with in the hospital during your studies. Permission to use case must be requested form the clinicians responsible (see point 14)

 

 

 

14. Appropriate acknowledgement is made of all public Hospital  data reported (patient records, imaging, laboratory tests etc) and clinicians who have aided you in your work: e.g. Courtesy of Dr. Rossi Azienda Policlinico Umberto I, Rome Italy

 

 

 

15. Communicates effectively (engages audience, uses multimedia support, clear structure & signposting and keeps to timing

 

 

 

TOTAL MARKS

 

15/30

 

 

 
4. Clinical Study Designs Pagina Types of Studies by content
Pagina Types of studies by type of design

These notes on EBM are by Theodore J Gaeta, DO, MPH, FACEP Assoc Prof Emergency Medicine. The link http://www.cebm.net/study-designs/  also provides a summary of pros and cons of different designs
URL Types of Studies

Here is a powerpoint presentation which explains different types of clinical studies (i.e. it describes different 'study designs)
URL Critical Appraisal Tools

Here are some useful tools and checklists to help you evaluate different study designs for your EBM project
5. ASKING CLINICAL QUESTIONS & PICO URL Video: Framing your search question

Here is  a short presentation describing PICOT (in case you have forgotten!) It explains the process of research preparation. This is a good guide for the exam! There are many other YouTube films and presentations on the internet you can consult for more help.
URL EBM Tool Box - formulating questions

This is a resource to help you refine your clinical questions.
URL Writing clinical questions.

How do you write a focussed clinical question? This link will give you a head start using PICO  to commence your EBM project. In the exam you must demonstrate you can do this (4/30)
URL GIMBE Borsa di Studio

Ecco un'opportunità di approfindire le vostre conoscenze dell'Evidence based Medicine
6. ONLINE STUDY RESOURCES URL Gruppo Italiano Medicina basate sulle Evidenza (GIMBE)
I recommend you explore the GIMBE web site. It is a pioneer site in Italian  to spread knowledge about the basics of EBM.
URL Evidence-Based Practice Resources

This University of Washington link offers many links to extend your knowledge of different aspects of EBM. It is designed for students and doctors. You will find useful links to find evidence and evaluate evidence.
URL TRIP database: Searching for Evidence

The TRIP Plus database is a meta-search engine that searches across multiple sites of high-quality medical information, including PubMed's Clinical Inquiries. TRIP Plus is an electronic resource.
URL Podcast:Randomised Trials: podcast (7min)
Listen to a short Podcast on RCTs and their strengths and weaknesses

Randomized Trials Stopped Early for Benefit: Interview With Dr Victor Montori

Released23 May 2011

Victor Montori, MD, discusses randomized trials that are stopped early for benefit.
URL SUMSearch - a Meta-Search Engine
SUMSearch is a unique method of searching for medical evidence by using the Internet. SUMSearch combines meta-searching and contingency searching in order to automate searching for medical evidence. Meta-searching means simultaneously searching multiple Internet sites (including MEDLINE) and collating the results into one page.
7. Key Readings on EBM File How to read a paper - key papers



File How to read a paper which summaises other papers
This third paper examines summaries of medical evidence and how to judge their quality.
File How to read a paper on drug trials
This is a second paper by Trisha Greenhalgh examining papers on drug trials.
File Example of critical appraisal: Screening for lung cancer

This papers gives a worked example of how to critically appraise a clinical study.  It gives you a clear tool to analyses the papers in your own presentation. Spring07.pdf


Pagina Essential EBM biblioraphy
Here are some references. Make sure you consult at least one of these.
8. BIbliographic Software URL MENDELEY - Bibliographic software

Bibliographic Software

All students need to choose one referencing software. This is a professional tool for all research, and is also essential for your thesis. The free software applications will make your bibliographies accurate and professional. Click on the link to download Mendele. http://www.mendeley.com    
URL Mendeley - Plug in

Using Bibliographic Software

 

INSTRUCTIONS FOR INSERTING CITATIONS into your documents USING MENDELEY:

 

Some students have had problems inserting citations from their Mendeley library using Microsoft Word. You need to do this to complete the short summary exercises  for each module online.So here is some help to solve the problem. After you download the free software 'Mendeley Desktop,' follow these instructions.

 

1.     Download the Microsoft Word plug in for your browser from the link below

http://support.mendeley.com/customer/en/portal/articles/170054-installing-and-using-the-word-plugin-in-os-x

2.     The plug-in gives you a link to Mendeley from your Microsoft Word  toolbar.

3.     From the menu choose the citation style (e.g. ‘Nature) for a Word document, or Harvard for a Power point presentation.

4.     Put the cursor where you want to insert the references in your document

5.     From the menu  slect ‘Insert citation >Go to Mendeley and select the paper (or papers) you want to cite. Select the  ‘Cite’ icon from the menu in your library. Mendeley will insert in-text numbers1

6.     At the end of your work write the word ‘References,’  then select ‘Insert bibliography from the plug in menu in Word


 References        (example using citation style ‘Nature’)

1.        Alon, U. How to choose a good scientific problem. Mol. Cell 35, 726–728 (2009).

 
URL ZOTERO - referencing software


The link below is to ZOTERO. This is an alternative to Mendeley: http://www.zotero.org
Pagina How to cite evidence.
You must present a professional reference list, of publications, texts, images and web sites that you have used for your presentation.  Refer to the link here from the US National library of Medicine for how to cite different kinds of texts.