The broad aim of the Centre for Evidence Based Medicine is to develop, teach and promote evidence-based health care and provide support and resources to doctors and health care professionals to help maintain the highest standards of medicine. Many of the talks are taken from the Oxford Evidence-Based Health Care Programme and delivered by members of the Nuffield Department of Primary Care Health Sciences, the Centre of Evidence Medicine and leaders in the field of Evidence-based Health Care internationally.
Evidence-based dentistry: The building of the Dental Fact Box repository – OHA!
An introduction to OHA!, a tool currently being developed which aims to assist dentists in accessing the most reliable evidence regarding the effectiveness of common dental treatments. The OHA! repository has been purposefully crafted to be exceptionally selective and compact, ensuring that users can easily find straightforward and valuable answers to their dental clinical questions. During the presentation, Professor Paulo Nadanovsky will show two sample dental fact boxes (in draft form) that have been developed. One pertains to the success rate of root canal treatment, while the other focuses on the impact of shorter versus longer intervals between dental check-ups on oral health. Patients expect doctors to take action to help them, and the more treatment or diagnostic tests, the better they feel. Doctors genuinely want to help and can often come up with various treatment or testing options to try. Consequently, this leads to a situation where everyone becomes perpetual patients, regardless of their actual health needs and potential benefits – essentially, an overuse of healthcare. Furthermore, there is a pervasive illusion of certainty among healthcare professionals, including physicians and dentists. This illusion entails the belief that treatments are always effective, diagnostic tests are infallible, and there exists only a single, optimal treatment or management approach. Consequently, there is often a lack of systematic comparisons between the pros and cons of different options. To dispel this illusion of certainty, reduce excessive healthcare practices, and promote clear thinking when considering interventions, the provision of clear information is essential. The practice of evidence-based healthcare involves two distinct roles: that of evidence consumers and evidence producers. Consumers, including clinicians and the general public, often lack the expertise needed to evaluate and choose the most reliable evidence. Hence, it falls upon those producing healthcare evidence to assume the role of experts and develop tools that simplify the integration of the best available evidence into the decision-making process for clinicians and patients alike.
Bio: Professor Nadanovsky graduated as a dentist in Rio de Janeiro, Brazil. He worked for a few years in the clinic (mainly periodontics), then migrated to public health and epidemiology and obtained a PhD from the University of London in 1993. He witnessed the birth of the evidence-based medicine movement and of the Cochrane Collaboration while working as a lecturer at the London Hospital Medical College and at University College London (afterwards it was renamed Queen Mary and Westfield College). Professor Nadanovsky taught evidence-based dentistry between 1993 and 1997 and since 1997 has been teaching epidemiology and evidence-based health care to physicians, dentists, nutritionists, and other health care professionals. He supervises PhD and MSc students, and his main interest is in overdiagnosis and overtreatment in health care in general, and more specifically, in dentistry.
10/12/2023 • 53 minutes, 8 seconds
Speedy or sloppy?: The opportunities and challenges of rapid qualitative research
Using a variety of examples of fast and slow qualitative research this talk explores the affordances of rapid methods, and help researchers decide if and where to use them in their own work. Methodologies of rapid qualitative research have been around for decades, gaining particular prominence during the Covid-19 pandemic. They spark intense debate about the place of rapid qualitative methods in healthcare research. What questions are they best suited to answer? Is speed a trade-off for quality? Which parts of the qualitative process can and can't be done at pace? If can do research quicker, should we?
Dr Anna Dowrick (https://www.phc.ox.ac.uk/team/anna-dowrick) is an interdisciplinary social scientist, spanning medical sociology, medical anthropology and science and technology studies. Her research explores how social injustice can be seen and acted upon through understanding experiences of health and illness, with a view to informing and improving the design of public services. She has used rapid and slow qualitative designs to explore issues including: improving access to support for domestic violence and abuse, food poverty interventions, cancer detection, Covid and Long Covid, and beauty 'injectables'.
6/30/2023 • 51 minutes, 40 seconds
Realist inquiry in global health practice: trials, tribulations (& triumphs?)
Dr Sara Van Belle, Institute of Tropical Medicine, Antwerp gives a talk on the practice of realist inquiry in global health. Dr Sara Van Belle, Researcher at the Institute of Tropical Medicine, Antwerp provides an overview of the practice of realist inquiry origins and points of attraction or interest for global health systems and policy research. Specific challenges are discussed with some examples of applications in complex health programmes in LMIC and suggestions offered for further methodological development.
6/8/2023 • 32 minutes, 29 seconds
Testing usability and impact of the OxRisk prediction models
Professor Seena Fazel, University of Oxford gives a talk on recent advances in prognostic modelling in psychiatry. Professor Seena Fazel, a Professor of Forensic Psychiatry at the University of Oxford gives a talk gives a talk on recent advances in prognostic modelling in psychiatry. A number that examine risk for adverse outcomes, such as self-harm suicide, and violent crime, have been developed in Oxford (OxRisk tools), and further research on their feasibility, useability and impact will be outlined. Methodological challenges in their development and validation will be discussed, and how impact can be tested.
5/22/2023 • 37 minutes, 9 seconds
Alcohol and cardiovascular disease: Is moderate drinking really beneficial for cardiovascular disease?
Dr Derrick Bennett, University of Oxford gives a talk on the epidemiological evidence of alcohol and cardiovascular disease. Dr Derrick Bennett, Associate Professor at the Nuffield Department of Population Health, University of Oxford, presents an overview of the epidemiological evidence of alcohol and cardiovascular disease (CVD), describes how bias may have impacted on this observational evidence, and finally presents evidence for the causal relevance of alcohol for CVD disease based on MR studies.
5/22/2023 • 39 minutes, 27 seconds
Evidence in Women's Health: Coil contraceptive - what is it and what are the potential harms for women?
In this episode EBHC DPhil Director, Jamie Hartmann-Boyce and Dr. Anne Marie Boylan discuss intrauterine contraception commonly known as the coil. Given the uncertainty around who feels pain, they speak with Dr Neda Taghinejadi, a sexual and reproductive health doctor and academic clinical fellow, who specialises in fitting coils for those who have had problems having them fitted by their GP or who have experienced trauma and require a highly trained specialist.
This podcast series on evidence in women's health is brought to you by the Centre for Evidence-Based Medicine and the postgraduate programme in evidence based health care. Dr. Anne-Marie Boylan, a senior researcher and lecturer in the programme, and Associate Professor Jamie Hartmann-Boyce, interview relevant experts discussing the strengths and limitations of different sources of evidence as they relate to women's health and considering their implications for future research. In this episode EBHC DPhil Director, Jamie Hartmann-Boyce and Dr Anne Marie Boylan discuss intrauterine contraception commonly known as the coil. Given the uncertainty around who feels pain, they speak with Dr Neda Taghinejadi, a sexual and reproductive health doctor and academic clinical fellow, who specialises in fitting coils for those who have had problems having them fitted by their GP or who have experienced trauma and require a highly trained specialist.
3/23/2023 • 20 minutes, 17 seconds
The medical occupational outcomes of military mental health patients. A closed-cohort study
Surgeon Commander Charlotte Evans is Royal Navy Hudson Visiting Fellow at St. Anthony's College and gave a talk about her dissertation work in relation to military mental health patients.
3/8/2023 • 50 minutes, 7 seconds
Evidence in Women's Health: Evaluating a community singing intervention for postnatal depression
Dr Alexandra Burton reports on the SHAPER-PND study exploring singing's effect on postnatal depression in new mothers Singing has shown positive effects on maternal mood and mother–child bonding. The Scaling-Up Health-Arts Programmes: Implementation and Effectiveness Research-Postnatal Depression (SHAPER-PND) study will analyse the clinical and implementation effectiveness of a 10-week programme of singing sessions for PND in new mothers. This talk will present findings from the evaluation of an adapted online programme during the COVID-19 pandemic and describe the methods used to evaluate the main in-person programme.
This free guest lecture is part of the Mixed Methods in Health Research module, part of the Oxford University Evidence-Based Health Care (EBHC) programme (https://www.conted.ox.ac.uk/courses/mixed-methods-in-health-research?code=O22C212B9Y).
About the speaker:
Dr Alexandra Burton is a Senior Research Fellow in Behavioural Science/Behaviour Change at University College London. She currently leads the qualitative component of the Shaper-PND implementation trial exploring the experiences of new mothers with postnatal depression who take part in group singing sessions, and the INSPYRE study evaluating social prescribing for young people who are on waiting lists for child and adolescent mental health services.
Questions?
Please contact the Evidence-Based Health Care (EBHC) team by emailing:
cpdhealthadmin@conted.ox.ac.uk
To stay informed of programme news, including lectures and research news, sign up to the EBHC mailing list:
https://conted.us6.list-manage.com/subscribe?u=b349338a9a&id=9769482733
Links:
Dr Alexandra Burton:
https://iris.ucl.ac.uk/iris/browse/profile?upi=ABURT01?
Evidence-Based Health Care Programme Overview:
https://www.conted.ox.ac.uk/evidence-based-healthcare
Mixed Methods in Health Research:
https://www.conted.ox.ac.uk/mixed-methods-in-health-research
2/10/2023 • 37 minutes, 49 seconds
Evidence in Women's Health: Why is endometriosis difficult to diagnose?
We discuss evidence around delays in diagnosis of endometriosis and speak with Dr Annalise Weckesser and Dr Sharon Dixon, who have both researched endometriosis from the perspective of women as patients and from that of GPs. This podcast series on evidence in women's health is brought to you by the Centre for Evidence-Based Medicine and the postgraduate programme in evidence based health care. Dr. Anne-Marie Boylan, a senior researcher and lecturer in the programme, and Associate Professor Jamie Hartmann-Boyce, interview relevant experts discussing the strengths and limitations of different sources of evidence as they relate to women's health and considering their implications for future research.
In this episode EBHC DPhil Director, Jamie Hartmann-Boyce and Dr. Anne Marie Boylan discuss research evidence around delays in diagnosis of endometriosis and speak with Dr Annalise Weckesser and Dr Sharon Dixon on this, who have both researched endometriosis from the perspective of women as patients and from that of GPs.
Contributors: Dr Jamie Hartmann-Boyce, Dr Anne-Marie Boylan, Dr Annalise Weckesser and Dr Sharon Dixon
Production: Megan Carter
1/30/2023 • 28 minutes, 50 seconds
Evidence in Women's Health: Menopause and Hormone Replacement Therapy (HRT) - What are the risks, benefits and experiences for women?
EBHC DPhil Director, Jamie Hartmann-Boyce and Dr. Anne Marie Boylan discuss menopause and hormone replacement therapy (HRT) In this episode EBHC DPhil Director, Jamie Hartmann-Boyce and Dr. Anne Marie Boylan discuss menopause and hormone replacement therapy (HRT). We hear from Dr. Elizabeth Spencer and Professor Carol Coupland, both of whom have conducted research on the risks of HRT using large databases, including the landmark million women's study.
This podcast series on evidence in women's health is brought to you by the Centre for Evidence-Based Medicine and the postgraduate programme in evidence based health care. Dr. Anne-Marie Boylan, a senior researcher and lecturer in the programme, and Associate Professor Jamie Hartmann-Boyce, interview relevant experts discussing the strengths and limitations of different sources of evidence as they relate to women's health and considering their implications for future research. In this episode EBHC DPhil Director, Jamie Hartmann-Boyce and Dr. Anne Marie Boylan discuss menopause and hormone replacement therapy (HRT) with interviews from Dr. Elizabeth Spencer and Professor Carol Coupland, both of whom have conducted research on the risks of HRT using large databases, including the landmark million women's study.
1/12/2023 • 25 minutes, 43 seconds
Heart Failure in Primary Care: Lessons from Big Data
Dr Clare J Taylor, Academic GP, explores how we can use large, anonymised GP datasets to improve our understanding of heart failure management in primary care. Nearly all UK residents are registered with a general practice and data collected during routine consultations can be used by researchers to understand more about common diseases. Heart failure occurs when the heart has been damaged and is struggling to pump enough blood to meet the needs of the body. Patients can feel breathless, exhausted and have swollen legs but treatments to improve quality of life and outlook are available.
In this lecture, Dr Taylor explores how we can use large, anonymised GP datasets to improve our understanding of heart failure management in primary care. With a focus on the patient throughout, she presents her recent work on heart failure diagnosis and survival to illustrate the power, and limitations, of using big GP data for research and to ultimately improve patient care.
Part of the Evidence-Based Health Care programme.
About the speaker:
Dr Clare J Taylor is a Clinical Lecturer in the Nuffield Department of Primary Care Health Sciences. Her research explores heart failure in primary care using big data epidemiology, prospective studies, and qualitative work. The findings have been published in high-impact journals and informed national and European heart failure policy. Clare is also experienced in postgraduate teaching and doctoral supervision and was a member of the National Institute for Health and Care Excellence Chronic Heart Failure guideline committee. She also works as an NHS general practitioner.
11/24/2022 • 45 minutes, 27 seconds
Evidence in Women's Health: Are there higher mortality rates in women who have been operated on by male surgeons?
In 2022 a Canadian population based retrospective cohort study hit the headlines in the U.K. by claiming that women were 32% more likely to die if operated on by a male surgeon. The study was led by Christopher Wallace who sought to examine the link between surgeon patient sex discordance and postoperative outcomes. Data was collected for over 1.3 million patients and nearly 3000 surgeons were included. It found that 14.9% of patients had one or more adverse postoperative outcome. But that worse outcomes were seen for female patients operated on by male surgeons, but not for males operated on by female surgeons.
Together with Director of the Centre for Evidence-Based Medicine, Professor Carl Heneghan, and EBHC DPhil Director, Dr. Jamie Hartmann-Boyce, Dr. Anne Marie Boylan discusses what this means for women, the accuracy of the study and whether it has any relevance here in the U.K. They also speak to Emily McFadden, a Senior Statistical Epidemiologist here at Oxford, Sunil Patel, a Canadian surgeon completing his DPhil in evidence based healthcare and Sharon Dixon, a GP and academic who's researching women's health in the department.Together with Director of the Centre for Evidence-Based Medicine, Professor Carl Heneghan, and EBHC DPhil Director, Jamie Hartmann-Boyce, Dr. Anne Marie Boylan discusses what this means for women, the accuracy of the study and whether it has any relevance here in the U.K.
10/31/2022 • 30 minutes, 31 seconds
Sporadic, late-onset, and multi-stage diseases
Dr Anthony Webster, University of Oxford gives a talk on combining mathematical modelling with big data statistics to distinguish between sporadic, late-onset, and multi-stage diseases. Dr Anthony Webster, a statistician at the University of Oxford gives a talk gives a talk on combining mathematical modelling with big data statistics to distinguish between diseases strongly linked to ageing and those that could potentially be avoided by making good choices throughout life.
10/20/2022 • 29 minutes, 9 seconds
How should we teach evidence-based medicine in the 21st century?
Dr Gordon Guyatt provides a guest talk on how we should teach evidence-based medicine in the 21st century This free guest lecture is part of the Teaching Evidence-Based Practice module, part of the Oxford University Evidence-Based Health Care (EBHC) programme.
About the speaker: Dr Gordon Guyatt is a Distinguished Professor in the Department of Clinical Epidemiology and Biostatistics, McMaster University and one of the founders of Evidence-Based Medicine. He has played a key role in over 30 major clinical studies (including both large-scale observational and randomized trials) and has extensive expertise in study methodology. As co-founder and co-chair of the GRADE working group, he has been intimately involved in the development and evolution of the GRADE approach.
Questions?
Please contact the Evidence-Based Health Care (EBHC) team by emailing: cpdhealth@conted.ox.ac.uk
To stay informed of programme news, including lectures and research news, sign up to the EBHC mailing list:
https://conted.us6.list-manage.com/subscribe?u=b349338a9a&id=9769482733
10/3/2022 • 21 minutes, 13 seconds
How do you carry out a realist synthesis of an intervention when there's 'no evidence'?
Joanne Greenhalgh, Professor of Applied Social Research Methodology (University of Leeds) on the experiences of conducting a realist synthesis of the feedback of aggregated patient reported outcome measure (PROMs) data to improve patient care. Her talk addresses two methodological questions (1) how do you carry out a realist synthesis of an intervention when there's 'no evidence'? and (2) how can you deal with the complexity of ‘context’?
5/25/2022 • 42 minutes, 34 seconds
The messy realities of qualitative health research
Dr Anne-Marie Boylan and Dr Laura Griffith, explore the value of qualitative health research and discuss what it's really like to undertake qualitative research. Qualitative research is a naturalistic mode of inquiry. It is used to answer a variety of research questions that have relevance to health policy and practice. In this podcast, Dr Anne-Marie Boylan, Director of the Postgraduate Certificate in Qualitative Health Research Methods at the University of Oxford, and Dr Laura Griffith, a former academic who now works in public health, explore the value of qualitative health research and discuss what it's really like to undertake qualitative research.
Speaker biography
Dr Laura Griffith completed her PhD in Anthropology about Motherhood in the East End in 2006 completing research in London and Bangladesh. During this time she also worked as a consultant and was the Chair of the Management Board for Sure Start and actively involved in other public health projects. From there she started as a Research Fellow in Warwick as the PI for a project investigating the experiences of minority ethnic populations of acute psychiatric services. Next was leading a project at Aston University about multi-professional team working in Mental Health teams, and from there she moved to the Health Experiences Research Group, University of Oxford, where she completed modules on psychosis, giving up smoking and experiences of ECT for the renowned healthtalk.org. She went on to lecture at the University of Birmingham in the sociology of health, and led the Health and Well-being stream in the Institute for Research into Superdiversity. At Birmingham she left the academic side of health research and moved into health consultancy - normally working with partners from the third sector. She now works in public health. Date: 18 May 2021
5/21/2021 • 54 minutes, 41 seconds
Leading and teaching Evidence-Based Health Care
Professor Kamal Mahtani and David Nunan interview Professor Paul Glasziou, Director of the Institute for Evidence-Based Healthcare at Bond University, about his experience of leadership and his work in capacity building through teaching and supervision. Professor Kamal Mahtani is Director of the Evidence-Based Health Care Leadership programme and David Nunan is Director of the PGCert in Teaching EBHC
3/18/2021 • 44 minutes, 2 seconds
Exploring the fundamentals of leadership with Professor Carl Heneghan - Part Two
Professor Kamal Mahtani continues his interview with Professor Carl Heneghan, discussing where your motivation as a leader comes from, succession planning, seeking mentoring, how leaders can engage with the wider world. Plus strategies for managing your work life balance.
11/25/2020 • 41 minutes, 34 seconds
Exploring the fundamentals of leadership with Professor Carl Heneghan - Part One
Professor Kamal Mahtani interviews Professor Carl Heneghan, exploring his leadership; how it all started, the challenges he has faced, emotional intelligence, the importance of clear communication and being a tortoise rather than a hare as a leader.
11/4/2020 • 39 minutes, 35 seconds
How do species postpone or even escape from senescence?
Dr Rob Salguero-Gomez, Associate Professor in Ecology, Department of Zoology, gives a talk on lessons for a longer, better human life for the EBHC podcast series.
11/2/2020 • 55 minutes, 19 seconds
Overdiagnosis and Lung Cancer Screening
Recent results of the NELSON Lung Cancer Screening Trial reports reductions in lung-cancer survival but not overall survival - The desire to detect disease even earlier means Overdiagnosis is on the rise. However, the interpretation of screening trial results is problematic and often gives rise to significant uncertainties that go unanswered.
Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience.
This talk was held as part of the Evidence-Based Diagnosis and Screening module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Medical Statistics.
2/14/2020 • 23 minutes, 11 seconds
When meta-analyses of the same question find different things
Dr Jamie Hartmann-Boyce discusses a case study of systematic reviews of electronic cigarettes for smoking cessation, looking across meta-analyses in this area. Dr Jamie Hartmann-Boyce is Senior Researcher, Health Behaviours team at the Nuffield Dept of Primary Care Health Sciences.
2/3/2020 • 42 minutes, 1 second
Conflicts of Interest in Medicine: Why it’s time for a UK Sunshine Act
Should doctors with commercial interests lead research on their products? Should we forget ‘conflicts’ and discuss ‘declarations of interest’ instead? Who should hold and maintain conflicts of interest registers for doctors? Should practicing doctors work with the pharma industry as well as serve on guideline committees? Should researchers with extensive financial interests be disqualified from studies of their own products?
The Physician Payments Sunshine Act requires US manufacturers to collect, track and report all financial relationships with clinicians and teaching hospitals. Professor Heneghan will discuss the failings with the current system of reporting of conflicts in medicine, what’s been tried so far, and why it is time for a UK Sunshine Act.
Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience.
This talk was held as part of the Practice of Evidence-Based Health Care module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Systematic Reviews. Members of the public are welcome to attend.
1/21/2020 • 30 minutes, 43 seconds
Health Policy Evaluation
Professor Karla Hemming discusses using evidence-based policy in the evaluation of policy interventions and answers the question 'how useful is the stepped-wedge study as an evaluation design? Professor Karla Hemming is the Professor of Biostatistics at the Institute of Applied Health Research, University of Birmingham.
12/12/2019 • 1 hour, 3 minutes, 52 seconds
Realist research in practice - informing a new TB policy in Georgia
Professor Bruno Marchal gives a talk illustrating the principles of realist evaluation using the case of the development of a new Tuberculosis control policy in Georgia. The talk focuses specifically on the central role of the programme theory, how this theory was developed and how it informed not only the policy, but also the study design.
Professor Bruno Marchal is Associate Professor at the Health Systems and Equity unit, Department of Public Health, Institute of Tropical Medicine, Antwerp.
11/29/2019 • 40 minutes, 51 seconds
Evidence isn't enough: The politics and practicalities of communicating health research
The logic and principles behind the drive for evidence-based health care are so compelling that often the limitations of evidence go unacknowledged. Despite a strong evidence base demonstrating the health risks associated with higher body weights, and health professionals routinely instructing patients to lose weight to improve their health, the incidence of obesity is predicted to continue to rise. Calling on his research into the relationships between obesity, inequality and health, Oli Williams - a fellow of The Healthcare Improvement Studies Institute - will argue that when it comes to reducing the burden on, and improving, health care a more critical approach to the way we generate, select, apply and communicate evidence is needed.
Oli Williams completed his PhD in the Department of Sociology at the University of Leicester. He was subsequently awarded the NIHR CLAHRC West Dan Hill Fellowship in Health Equity which he held at the University of Bath. He later re-joined the University of Leicester in the Department of Health Sciences working in the SAPPHIRE Group and is now based at King's College London after being awarded a THIS Institute Postdoctoral Fellowship. His research focuses on health inequalities, the promotion of healthy lifestyles, obesity, weight stigma, equitable intervention and co-production. He co-founded the art collective Act With Love (AWL) to promote social change. The Weight of Expectation comic is one example of their work, view others at: www.actwithlove.co.uk In recognition of his work on weight stigma the British Science Association invited Oli to deliver the Margaret Mead Award Lecture for Social Sciences at the British Science Festival 2018.
This talk was held as part of the Qualitative Research Methods course which is part of the Evidence-Based Health Care Programme.
11/27/2019 • 1 hour, 2 minutes, 29 seconds
Operationalising the potential of Applied Digital Health research
The increased reliance of health systems on the digital record as the primary mechanism for storing data on consultations and other health interactions has opened new opportunities for research, healthcare innovation, and health policy. The electronic health record (eHR) is now ubiquitous in many countries, in hospital and primary care settings, and in some countries their health systems in terms of reporting patient care activity are essentially 'paperless'.
Health systems globally are also facing accelerating challenges as they seek to deliver better value healthcare against the background of increasing levels of chronic disease, ageing populations, financial pressures and demands on public spending. Digital health tools and services are held up to be part of the solution to these challenges, potentially offering low-cost and patient-centred solutions.
There has been huge investment in Big Data research in health, particularly in relation to digitised imaging and automated reporting and predictive modelling using phenotypic and increasingly genetic data. There have also been similar gains in more applied research that explores the potential of accessing the huge quantum of data held in the eHR, and linkage of these data to other national or regional databases, such as mortality records or cancer data. This session will explore some of the applications for routine data research, illustrated by projects that have resulted in research success and better healthcare.
This will include the exemplars of using large eHR platforms and prescribing data platforms to create infrastructure for i) common disease surveillance, such as the UK RCGP RSC; ii) generation and validation of disease risk assessment tools, such as QRisk scores; iii) pragmatic electronic follow up trials; iv) within practice systems dashboard feedback reports, eg data normalised to regional and national rates on prescribing and investigation physician activity; v) traditional epidemiological linkage studies; and vi) linkage to long term phenotypic follow up of established disease cohorts.
Richard Hobbs is Nuffield Professor of Primary Care at the University of Oxford, and Head of the Nuffield Department of Primary Care Health Sciences. He has served a decade as National Director of the National Institute for Health Research’s School for Primary Care Research and was Director of the NHS Quality and Outcomes Framework (QOF) Review panel from 2005-09. He has served many national and international scientific and research funding boards in UK, Ireland, Canada, and WHO, including the BHF Council, British Primary Care Cardiovascular Society, and the ESC Council for Cardiovascular Primary Care. He currently chairs the European Primary Care Cardiovascular Society, a WONCA Special Interest Group.
He is one of the world's leading academics in primary care, and has developed at Oxford one of the largest and most highly ranked centres for academic primary care globally. He has also made major contributions to growing primary care academic capacity, in terms of people development and research networks. A highly cited primary care clinical scientist, he has authored over 450 peer reviewed publications, has an h-index of 90, with over 63000 citations (36000 since 2013) and 81 papers cited over 100 times, 14 papers cited over 1000 times and 7 papers with over 2000 citations. He has an outstanding track record in cardiovascular research, delivering trials that changed international guidelines and practice, especially in the areas of stroke prevention in atrial fibrillation (BAFTA, SAFE, and SMART trials), heart failure burden and diagnosis (ECHOES and REFER trials), and hypertension self-management (TASMINH series). He is only the fifth ever recipient of the RCGP Discovery Prize in 2018 (an occasional award made since 1953) and received an inaugural Distinguished Researcher Shine Prize plus Best Presentation Prize at the WONCA World Congress in 2018. He was awarded a CBE for services to medical research in the 2018 New Year's Honours.
This talk was held as part of the Big Data Epidemiology course which is part of the Evidence-Based Health Care Programme.
11/27/2019 • 40 minutes, 51 seconds
Everything is a poison
Professor Jeffrey Aronson, Consultant Physician and Clinical Pharmacologist, Department of Primary Care Health Sciences, gives a talk on dose-response curves for the EBHC podcast series.
10/29/2019 • 54 minutes, 50 seconds
Safe and effective drugs: The need to use all the available evidence to inform the effectiveness of commonly used medicines
Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience. Professor Carl Heneghan will talk about his involvement in Tamiflu research that led to the discovery of 170,000 pages of clinical study reports, the subsequent development of Alltrials he was involved in and the current epidemic of publication and reporting bias that plagues much of the current research evidence.
This talk was held as part of the Practice of Evidence-Based Health Care module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Systematic Reviews.
10/21/2019 • 33 minutes, 49 seconds
Diabetes, blood sugar, and red wine: a personal study
This talk was delivered by Martin Bland. Martin Bland joined the University of York as Professor of Health Statistics in 2003, retiring and becoming Emeritus Professor in 2015. Earlier posts were at St. George's and St. Thomas's Hospital Medical Schools and in industry with ICI, working on agricultural experiments. He is the author of An Introduction to Medical Statistics, now in its fourth edition, and co-author of Statistical Questions in Evidence-based Medicine, both Oxford University Press, 303 refereed journal articles, and, with the late Prof. Doug Altman, the Statistics Notes series in the British Medical Journal. He and Doug Altman also invented the limits of agreement method for comparing methods of measurement, which led to the most highly cited papers in six different journals and one of the top 30 most highly cited papers over all fields.
This is an account of a little research study which I carried out, using myself as the only research subject. I shall describe how I came to do it and some of the practical statistical problems which I encountered. These include serial P-values, the effect of other factors, and generalisability from a single subject.
7/17/2019 • 32 minutes, 47 seconds
The secret diary of a health ethnographer - what's it *really* like doing qualitative observation in operating rooms, ambulances, triage call centres and other health care settings?
This guest lecture draws on nearly thirty years' experience of doing qualitative research in a variety of health settings that contain people, blood, injury, disease, emotions, and technologies. Prof Catherine Pope will describe some of the practical difficulties and everyday challenges of doing ethnography in these environments, and reflect on what it feels like to be an embodied researcher.
Catherine Pope is Professor of Medical Sociology, and, from July 2019, will be based at the Nuffield Department of Primary Care Health Sciences, University of Oxford. She has championed the use of qualitative methods in health research, and played a leading role in developing qualitative evidence synthesis. Her research includes studies of NHS urgent and emergency care, evaluations of health service organisation and reconfiguration, and projects about everyday health care work.
This talk was held as part of the Qualitative Research Methods course which is part of the Evidence-Based Health Care Programme.
7/3/2019 • 54 minutes, 35 seconds
Big data in heart failure - opportunities and realities
The global health burden of heart failure is high, both as the common end-point for many cardiovascular diseases (e.g. hypertension and heart attacks) and a common point on the trajectory of non-cardiovascular diseases (e.g. chronic respiratory disease). Despite advances in treatment, our ability to tailor strategies for prevention or management to individuals with heart failure is currently limited. Large-scale electronic health records and novel data analysis techniques have great potential to improve the status quo in both research and practice. In this talk, Amitava Banerjee examines the real progress and the limitations of recent big data research in heart failure, from epidemiology to machine learning.
Amitava Banerjee is Associate Professor in Clinical Data Science at University College London, and Honorary Consultant Cardiologist at University College London Hospitals and Barts Health NHS Trusts. He is a pragmatic researcher, a passionate educator and a practising clinician, with interests spanning data science, cardiovascular disease, global health, training and evidence-based healthcare.
After qualifying from Oxford Medical School, he trained as a junior doctor in Oxford, Newcastle, Hull and London. His interest in preventive cardiology and evidence-based medicine led to a Masters in Public Health at Harvard (2004/05), an internship at the World Health Organisation(2005) and DPhil in epidemiology from Oxford (2010). He was Clinical Lecturer in Cardiovascular Medicine at the University of Birmingham, before moving to UCL in 2015.
He works across two busy tertiary care settings: University College London Hospitals and Barts Health NHS Trusts with both inpatient and outpatient commitments. Although he is subspecialised in heart failure, he has ongoing practice in acute general cardiology and a keen interest in the diagnosis and management of atrial fibrillation. His clinical work very much informs his research and vice versa, whether in the evaluation of medical technology or the ethics of large-scale use of patient data.
This talk was held as part of the Big Data Epidemiology module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Medical Statistics.
7/3/2019 • 37 minutes, 51 seconds
Behavioural Interventions to Improve the Quality of the Grocery Shopping
This evening lecture is given in conjunction with the Introduction to Study Design and Research Methods accredited short course, part of the Evidence-Based Healthcare programme at the University of Oxford's Department for Continuing Education. Carmen is a Public Health Nutrition scientist at the Department of Primary Care Health Sciences (University of Oxford). Her principal research interests lie in the prevention and management of non-communicable chronic disease through dietary improvements, in particular, obesity and cardiovascular disease.
Diet is an important determinant of health, and food purchasing is a key antecedent to consumption hence improving the nutritional quality of food purchases presents a clear opportunity to intervene. She has been involved in a recent systematic review of interventions implemented in grocery stores which suggested that price manipulations, healthier swap suggestions, and perhaps manipulations to item availability change food purchasing and could play a role in public health strategies to improve health. However, the evidence base for interventions in grocery stores or at the individual level is still very limited.
She is currently working on a range of studies aiming to examine the effectiveness of interventions based around healthier swaps on the quality of the food purchased and eaten as well as the short term effects on relevant health outcomes. She has recently conducted a complex behavioural intervention based in primary care to improve diet quality among patients with high cholesterol (PC-SHOP study). The intervention consisted of health professional (HP) advice alone, or in combination with personalised feedback based on the nutritional analysis of grocery store loyalty card data from one of the largest UK supermarkets. Overall her research aims to develop and test simpler and inexpensive ways to help people improve diet and prevent cardiovascular disease and obesity.
This evening lecture is given in conjunction with the Introduction to Study Design and Research Methods accredited short course, part of the Evidence-Based Healthcare programme at the University of Oxford's Department for Continuing Education.
Find out more.
6/11/2019 • 41 minutes, 4 seconds
The BMJ's open data campaign
Fiona Godlee, Editor in Chief of The BMJ, gives a talk for the EBHC podcast series Fiona Godlee is the Editor in Chief of The BMJ. She qualified as a doctor in 1985, trained as a general physician in Cambridge and London, and is a Fellow of the Royal College of Physicians. She has written and lectured on a broad range of issues, including health and the environment, the ethics of academic publishing, evidence based medicine, access to clinical trial data, research integrity, open access publishing, patient partnership, conflict of interest, and overdiagnosis and overtreatment. After joining The BMJ as an assistant editor in 1990, she moved in 2000 to help establish the open access publisher BioMedCentral as its founding Editorial Director for Medicine. In 2003 she returned to BMJ to lead its Knowledge division and was appointed Editor in Chief of The BMJ in March 2005. Fiona is honorary professor at the Netherlands School for Primary Care Research (CaRe), honorary fellow of the Royal College of General Practitioners, a senior visiting fellow at the Institute of Public Health at the University of Cambridge, honorary fellow of the Faculty of Public Health and a by-fellow of King’s College Cambridge. She is on the advisory or executive boards of the Health Improvement Studies (THIS) Institute (thisinstitute.cam.ac.uk), Alltrials (alltrials.net), the Peer Review Congress (peerreviewcongress.org), the International Forum for Quality and Safety and Healthcare (internationalforum.bmj.com), Evidence Live (evidencelive.org), Preventing Overdiagnosis (preventingoverdiagnosis.net), the UK Health Alliance on Climate Change (ukhealthalliance.org) and the Climate and Health Council. She was a Harkness Fellow (1994-5), President of the World Association of Medical Editors (WAME) (1998-2000), Chair of the Committee on Publication Ethics (COPE) (2003-5), and PPA Editor of the Year (2014). Fiona is co-editor of Peer Review in Health Sciences. She lives in Cambridge with her husband and two children.
5/13/2019 • 40 minutes, 16 seconds
Using evidence to overcome fake news about healthcare
Professor Carl Heneghan has extensive experience of working with the media. In this talk he will discuss some recent case examples, working with the BBC amongst others. This talk will discuss how using an evidence-based approach can help overcome the growing problem of fake news, and provide insights on how to work with the media to ensure your message is not distorted, and will discuss why academics should engage more with the media and the wider public.
Professor Carl Heneghan is Director of CEBM, and an NHS Urgent Care GP, and has been interested for over twenty years in how we can use evidence in real world practice.
4/9/2019 • 37 minutes, 3 seconds
Are we really advancing qualitative methods in health research?
For many good reasons, semi-structured interviews, focus groups, thematic analysis, and realist tales have become key tools within the qualitative researcher's methodological toolkit. In this presentation, Dr Cassandra Phoenix invites the audience to consider the extent to which they may have (inadvertently) become the only tools within their toolkit. Drawing on examples from across the social sciences, she considers how else we might collect, analyse and represent qualitative data within health research, asking what it means and involves to truly advance qualitative research methods in this field.
The short video played for the audience can be seen at: https://vimeo.com/43182928.
Dr Cassandra Phoenix is a Reader in the Department for Health at the University of Bath. Her research examines ageing, health and wellbeing from a critical-socio-cultural perspective. She has authored numerous publications on topics including the social and cultural dimensions of: physical activity in mid and later life; the lived experiences of chronic conditions (e.g. late onset visual impairment, vestibular disorders); and engagement with nature. Cassandra's work is supported by a range of funders including ESRC, Wellcome Trust, Leverhulme Trust, WHO and the NIHR.
This talk was held as part of the Advanced Qualitative Research Methods course which is part of the Evidence-Based Health Care Programme.
4/8/2019 • 33 minutes, 9 seconds
Size matters a tous les temps, a tous les peuples
Dr. Martyn Sene is Deputy CEO of the National Physical Laboratory (NPL), here, he gives an introduction to the importance of measurement and metrology (the science of measurement). NPL is the UK's National Metrology Institute and is a world-leading centre of excellence in developing and applying the most accurate measurement standards, science and technology available. He is a member of the NPL Management Ltd. Board and also a member of the CIPM (Comite International des Poids et Mesures), established under the Metre Convention to promote world-wide uniformity in units of measurement and oversee the headquarters of the International Measurement System (BIPM) in Paris.
This talk will provide an introduction to the importance of measurement and metrology (the science of measurement), how we ensure confidence in measurement and how measurement today requires and relies on leading edge (including Nobel prize winning) science and technology. It will also highlight why 2019 is such an important year for the International Measurement System - the year in which the SI units are redefined in a way that locks them to unchanging properties of the universe. The culmination of a project that traces its origins to the French Revolution - a measurement system 'a tous les temps, a tous les peuples'.
4/3/2019 • 48 minutes, 42 seconds
The role of network meta-analysis in the evaluation of antidepressants for depression
Andrea Cipriani is NIHR Research Professor at the Department of Psychiatry, University of Oxford and Honorary Consultant Psychiatrist at the NHS Foundation Trust in Oxford. His main interest in psychiatry is evidence-based mental health and his research focuses on the evaluation of treatments in psychiatry, mainly major depression, bipolar disorder and schizophrenia. Dr Cipriani is author of 267 peer reviewed scientific publications (Scopus), mainly systematic reviews, meta-analyses and randomised controlled trials in psychopharmacology, however in the past few years he has also been investigating relevant issues in epidemiological psychiatry and public health, like patterns of drug consumption, risk of serious adverse events (most of all suicide and deliberate self harm) and implementation of treatment guidelines.
Being interested in the methodology of evidence synthesis, Dr Cipriani has now a specific focus on network meta-analysis and individual patient data meta-analysis, trying to assess the validity, breadth, structure and interpretation of these statistical approaches to better inform the mental healthcare decision-making process. He is currently Editor in Chief of Evidence-Based Mental Health (ebmh.bmj.com) and also on the Editorial Board of the Lancet Psychiatry, the Australian and New Zealand Journal of Psychiatry and the Cochrane Collaboration for Depression, Anxiety and Neurosis
3/26/2019 • 46 minutes, 52 seconds
Why poor diagnostic reasoning is failing patients, the public and health systems
Carl Heneghan asks the question, "What is driving the increase in diagnostic testing in healthcare?" and discusses why expectations, technology and the media are contributing to the problems of too much medicine and overdiagnosis. Carl Heneghan, Professor of Evidence-Based Medicine, employs evidence-based methods to research diagnostic reasoning, test accuracy and communicating diagnostic results to a wider audience.
This talk was held as part of the Evidence-Based Diagnosis and Screening module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Medical Statistics.
2/6/2019 • 33 minutes, 23 seconds
Selection bias in cluster randomised controlled trials
Professor David Torgerson, Director of the York Trials Unit, gives a talk for the Evidence Based Healthcare podcast series. He has published widely with over 250 peer reviewed papers many of them on the design of randomised trials including a student text book 'Designing Randomised Trials in Health Education and the Social Sciences' (2008, Palgrave MacMillan). He has a particular interest in the design and conduct of cluster randomised trials.
Randomisation, if conducted properly, will abolish selection bias. Poor randomisation practice for individually randomised trials allows the allocation schedule to be predicted and can lead to subversion of the randomisation, which introduces selection bias. In cluster randomised controlled trials there is a particular problem with some trials in that cluster randomisation occurs before individual recruitment. When this occurs the allocation can become known to the potential participant and the recruiting clinician and research. This, then, allows selective recruitment to occur which means that selection bias is introduced at the level of the individual participant. In this talk the problem is illustrated in case studies and I discuss approaches to dealing with this potential source of selection bias.
1/7/2019 • 48 minutes, 42 seconds
The application of realist approaches at the research/policy/practice interface: NICE work if you can do it
Professor Mike Kelly, Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, gives a talk for the Evidence Based Healthcare seminar series. Professor Mike Kelly is Senior Visiting Fellow in the Department of Public Health and Primary Care at the Institute of Public Health and a member of St John's College at the University of Cambridge. Between 2005 and 2014, when he retired, he was the Director of the Centre for Public Health at the National Institute of Health and Care Excellence (NICE). From 2005 to 2007, he directed the methodology work stream for the World Health Organisation's (WHO) Commission on the Social Determinants of Health. His research interests include the prevention of non-communicable disease, living with chronic illness, health inequalities, health related behaviour change, end of life care, dental public health, the relationship between evidence and policy and the methods and philosophy of evidence based medicine.
This talk will describe the approach to development of public health guidelines adopted by NICE (the National institute for Health and Care Excellence) between 2005 and 2014 when Mike Kelly was leading the public health team there. It will consider the influences that realist theories and methods had on the process which NICE engineered as it applied the conventional model of evidence based medicine to public health matters. Some of the academic opposition to this endeavour will be noted and the broader political environment described. Using the development of the guideline on the prevention of alcohol misuse as a case study, the paper will examine the political consequences of taking a realist approach to the evidence. The controversy, which ensued after NICE, published the guideline, which among other things recommended minimum unit pricing, will be analysed. Some of the lessons of working at the policy/practice/politics/academy interface will be discussed.
12/12/2018 • 1 hour, 27 seconds
How imperfect can a study be?
Professor Alan Silman is an epidemiologist and a rheumatologist and is the co-author of 'Epidemiological Studies: A Practical Guide', which is the recommended textbook for the module 'Introduction to Study Design and Research Methods'. Alan Silman is currently Professor of Musculoskeletal Health at the University of Oxford. He was Director of the UK's Arthritis Research Epidemiology Unit in Manchester from 1988-2006, and then Medical Director of Arthritis Research UK, before moving to Oxford to take up his current position.
He has published over 500 articles in the broad field of arthritis and musculoskeletal disease epidemiology.
This talk was held as part of the Introduction to Study Design and Research Methods module, which is part of the MSc in Evidence-Based Health Care.
12/5/2018 • 49 minutes, 26 seconds
Adults' experiences of trying to lose weight on their own: findings from three qualitative syntheses
Jamie Hartmann-Boyce is a Senior Researcher in Health Behaviours, based at the Nuffield Department of Primary Care Health Sciences, University of Oxford. Her work focusses on obesity and tobacco control and her particular interests lie in evidence synthes Though the vast majority of people trying to lose weight do so on their own, without support from healthcare professionals or formal weight loss programmes, most research into weight loss focuses on more intensive programmes. We therefore set out to find out more about what people do when trying to lose weight on their own. As part of this work, we conducted three qualitative systematic reviews to explore people's experiences with self-directed weight loss. The first review provides an overview of the cognitive and behavioural strategies used during self-directed weight loss attempts, and the second two reviews delve further into particular weight loss strategies that emerged as part of the overview, namely self-monitoring and reframing. In this talk, I'll cover key findings from each of the three reviews, and also use these reviews to illustrate how qualitative syntheses can be conducted and used to shed light on people's experiences.
This talk was held as part of the Qualitative Research Methods module which is part of the MSc in Evidence-Based Health Care.
11/6/2018 • 47 minutes, 20 seconds
Can antibiotics make you pregnant?
Dr Jeffrey Aronson gives a talk for the Evidence Based Healthcare series.
10/29/2018 • 45 minutes, 52 seconds
History of evidence synthesis
Professor Mike Clarke gives a talk for the Evidence Based Healthcare series.
10/29/2018 • 44 minutes, 39 seconds
Evidence-Based Manifesto for better healthcare
Professor Carl Heneghan gives a talk for the Evidence Based Healthcare series. Patients are being let down by serious flaws in the creation, dissemination, and implementation of medical research. Too much of the resulting research evidence is withheld or disseminated only piecemeal. As the volume of clinical research activity has grown, the quality of evidence has often worsened, which has compromised medicine's ability to provide affordable, effective, high-value care for patients.
Professor Carl Heneghan will discuss the CEBM initiatives that have grown out of EBM Live, a yearly conference designed to "develop, disseminate, and implement better evidence for better healthcare. He is Director of CEBM, and an NHS Urgent Care GP, and has been interested for over twenty years in how we can use evidence in real world practice. In preparation for this talk you are invited to read the following: https://doi.org/10.1136/bmj.j2973
10/10/2018 • 36 minutes, 14 seconds
The jugglers and the black cat
There has never been such a high demand for our personal data, such that it is often said that individuals are the product, not just the client. Using the donation of general personal data and health data in example scenarios, areas such as: the unknown element in data content; trust and trustworthiness in data custodians; and meaningful public engagement, will be explored. The alternative is that data are not used, with the corresponding harms this may bring. Ironically, this is not an unusual situation in settings where having adequate data on which to base decisions is paramount for individual well-being. By drawing upon an international case study of health data non-use, it will be shown that this is a complex, global problem with multiple explanations resulting in untold harms to individuals and society. But there are many scenarios where our personal data are in demand, not just for public good. As individuals we need to consider the bioethical balance between individual autonomy, personal exploitation and social responsibility in making our donation decisions. Ultimately, the question is whether we, as individuals and society, want to 'gift' our data in some circumstances and grant its use under licence in others; and whether we can really make informed choices with the panoply of issues that may influence our decisions.
Kerina Jones is an Associate Professor of Health Informatics at Swansea University, where she is the academic lead for Information Governance and Public Engagement to ensure data protection and maximise socially-acceptable data utility across the various Swansea University-based data intensive/linkage initiatives, including: the SAIL Databank, Administrative Data Research Centre Wales, Farr@CIPHER and the recently awarded HDRUK collaboration between Swansea University and Queen's University Belfast. Kerina leads the active Innovative Governance working group of the Farr Institute, which works collaboratively to advise and influence the developing data governance landscape to promote the safe reuse of data. She leads an IG research programme including work to inform cross-centre research and how emerging data types, such as genetic data, can be used in conjunction with health record data. This includes a programme of public engagement and Kerina enjoys working with the public on the use of anonymised data for research.
This talk was held as part of the Big Data Epidemiology module which is part of the MSc in Evidence-based Health Care.
7/31/2018 • 57 minutes, 43 seconds
Fake surgeries and dummy pills – control for bias and study design in trials on treatment efficacy in chronic pain
In this talk Karolina presented various types of study design she has used in trials of treatments for chronic pain. Karolina also discussed why blinding is important and why a placebo control may be necessary, even in surgical trials. This talk was held as part of the Introduction to Study Design and Research Methods module, which is part of the MSc in Evidence-Based Health Care.
7/2/2018 • 40 minutes, 28 seconds
The shifting evidence paradigm – from literature to data
Carol Lefebvre gives a talk for the Evidence based healthcare seminar series. Carol Lefebvre will address the shift in focus over the last 20 years away from purely ‘literature searching’, i.e. only searching databases such as MEDLINE/PubMed for published literature, such as journal articles and books for identifying studies for evidence synthesis. She will consider the ever-increasing role of unpublished data sources such as trials registers and regulatory agency sources.
Carol Lefebvre is an Independent Information Consultant and was previously the Senior Information Specialist at the UK Cochrane Centre in Oxford from 1992 to 2012. She is a founder member of the Cochrane Collaboration. She is Co-Convenor of the Cochrane Information Retrieval Methods Group, serves on the Cochrane Methods Executive and is lead author on the searching chapter of The Cochrane Handbook. She also co-led the development of the Cochrane standards for searching (MECIR).
She was awarded an M.Sc. in Library and Information Science from the University of Loughborough (UK) in 1985 and an Honorary Fellowship of the Chartered Institute of Library and Information Professionals in 2007.
She now focusses on teaching and consultancy in information retrieval for evidence synthesis, such as systematic reviews, health technology assessment and guideline development.
6/26/2018 • 30 minutes, 25 seconds
Vagina Dialogues: Challenging Stigmas around Menstruation, Menopause and Female Sexuality
Communication taboos surround many aspects of women’s health and wellbeing, from menstruation to menopause to sexual pleasure. This presentation will briefly discuss the historical and socio-cultural roots of such stigmas before outlining the latest research on how these taboos come to negatively impact girls’ and women’s health. Dr Weckesser will focus on her qualitative research on endometriosis as a case study for how cultural codes of silence around menstruation play a part in the delayed diagnosis of the condition. She will also discuss her STEAM-funded project, ‘The VQ: A Women’s Health, Sex and Pleasure Pop Up,’ which is an impact initiative that creates spaces and events for women to learn about, and purchase products related to, their (sexual) health.
Dr Annalise Weckesser is a Senior Research Fellow at the Centre for Social Care and Health Related Research at Birmingham City University. She trained as a medical anthropologist at the University of Warwick and specialises in qualitative research on women’s sexual and reproductive health.
This talk was held as part of the Qualitative Research Methods module which is part of the MSc in Evidence-based Health Care.
6/22/2018 • 42 minutes, 29 seconds
The Replication Crisis in Biomedicine. What (kind of) crisis?
Professor Alexander Bird, Professor of Philosophy and Medicine, King's College London, gives a talk for the Centre for Evidenced Based Medicine. The replication (replicability, reproducibility) crisis in clinical medicine and in other fields arises from the fact that many apparently well-confirmed experimental results are subsequently overturned by studies that aim to replicate the original study. The culprit is widely held to be poor science: questionable research practices, failure to publish negative results, bad incentives, and even fraud. In this paper I argue that the high rate of failed replications is consistent with high quality science. We would expect this outcome if the field of science in question produces a high proportion of false hypotheses prior to testing. If most of the hypotheses under test are false, then there will be many false hypotheses that are apparently supported by the outcomes of well conducted experiments and null-hypothesis significance tests with a type-I error rate (alpha) of 5\%. Failure to recognize this is to commit the fallacy of ignoring the base rate. I argue that this is a plausible diagnosis of the replication crisis and examine what lessons we thereby learn for the future conduct of medical science.
4/11/2018 • 46 minutes, 58 seconds
Real versus rubbish EBM: do you know the difference?
A light hearted account of being treated by the 'wrong' guideline - with a serious conclusion about making sure this doesn’t happen. Professor Trish Greenhalgh is a Professor of Primary Care Health Sciences and the Nuffield Department of Primary Care Health Sciences. Trish Greenhalgh is an internationally recognised academic in primary health care and trained as a GP. She joined the Nuffield Department of Primary Care Health Sciences in January 2015 after previously holding professorships at University College London and Queen Mary University of London.
3/2/2018 • 31 minutes, 51 seconds
Launch of new website to catalogue biases affecting health and medical research
Professor Carl Heneghan and Dr David Nunan from the Oxford Centre for Evidence-Based Medicine presented the launch of a new website that catalogues the important biases affecting health and medical research. The website is in response to a call-to-arms raised nearly 40 years ago by the late David Sackett, where he called for 'The continued development of an annotated catalog of bias. Each citation should include a useful definition, a referenced example illustrating the magnitude and direction of its effects, and a description of the appropriate preventive measures, if any. I volunteer for this task, would welcome collaboration, and would appreciate receiving nominations and examples of additional biases.'
In honour of David's memory and legacy, the CEBM have taken up where he left off. We are now ready to share the catalogue with the rest of the world for welcome feedback, discussion and further evolution. Additional input from Professor Sir Iain Chalmers.
This talk was held as part of the Practice of Evidence-Based Health Care course which is part of the Evidence-Based Health Care Programme.
2/5/2018 • 39 minutes, 59 seconds
Beyond accuracy: Evidence gaps and unintended consequences. Factors influencing utility of point-of-care diagnostic tests
Point-of-care or near-patient-tests, are as these descriptors suggest, medical diagnostic tests which can be performed by a clinician, patient, or carer of a patient, without the need for samples to be transported to laboratories. These tests usually yield results rapidly, with clear convenience benefits for patients but with the potential to variably impact on clinicians. Our research suggests that evaluations of point-of-care tests usually focus on the accuracy of these tests when compared to the ‘reference standard’ laboratory tests, with manufacturers aiming to achieve equivalence or non-inferiority. This is admirable and essential, however the broader impact of tests on the relevant clinical pathways and patient health are often neglected.
This talk will outline the areas of evidence which are frequently underrepresented in point-of-care test evaluations and will explore some of the more nuanced and unusual barriers and impacts of test introduction using some true and hypothetical examples to illustrate the inherent complexity of the test-pathway nexus.
Phil Turner is a diagnostics researcher and Manager of the Community Healthcare MIC. His role incorporates responsibility for liaising with members of the in vitro diagnostics industry and for facilitating interactions with the MIC research team. His research has focussed on the diagnostic needs of clinicians, barriers to implementation, and the identification of evidence gaps which commonly exist in the evidence base for point-of-care diagnostic tests. He has a personal interest in IVDs which could be deployed in resource-limited settings.
His background is in cell physiology, membrane transport processes and signalling and he has a particular interest in the control of ventilation and in particular how humans respond to changes in the partial pressure of inspired oxygen. He has an associated interest in the physiology and medicine of life in remote regions and at high altitude.
This talk was held as part of the Evidence-Based Diagnosis and Screening course which is part of the Evidence-Based Health Care Programme.
1/30/2018 • 39 minutes, 21 seconds
Mixed methods in the real world: a messy business?
Dr Katherine Pollard gives a talk for the Evidence Based Healthcare seminar series. This talk focuses on mixed methods research in health care education and practice, drawing on Kathy's experience of two large mixed methods projects to demonstrate salient issues: a longitudinal evaluation of an interprofessional undergraduate curriculum and a case study of quality measurement in community nursing. Kathy discusses research design and implementation, highlighting the challenges that arose, and the strategies employed to ensure successful project delivery.
Dr Pollard has been an active researcher since 1998 and is currently employed as a Senior Research Fellow at the University of the Wet of England, Bristol. She has a clinical background in midwifery.
1/24/2018 • 45 minutes, 56 seconds
The Future of Healthcare - Evidencer and Value Based
Muir Gray is now working with both NHS England and Public Health England to bring about a transformation of care with the aim of increasing value for both populations and individuals. Here he gives a talk on improving healthcare systems. Here are some questions we cannot answer after nearly 70 years of a purportedly National Health Service. The lecture will address these questions and how they can be answered.
1. Is the service for people with seizures and epilepsy in Manchester of higher value than the service in Liverpool?
2. How many liver disease services are there in England and how many should there be?
3. Which service for people at the end of life in London provides the best value?
4. Is the service for people with asthma of higher than the service in Somerset?
5. How many services are there for people with MusculoSkeletal Disease in the North East, and which gives best value?
We cannot answer them because we deliver care that is institutionally based not population based but to do so will need new knowledge and skills to answer questions such as:
1. What do you understand by the term complexity?
2. What is meant by the term system and how does it differ from a network?
3. What is meant by population based healthcare rather than bureaucracy based care?
4. What are the three meanings of the term value in 21st Century healthcare? Not ‘values’ as in 'we value diversity' but the economic meanings
5. What is the relationship between value and efficiency?
6. What is meant by the optimal use of resources?
7. What is meant by the term quality and how does it relate to value?
8. What is a system and a standard?
9. How would you assess the culture of an organisation?
10. How would you decide if an organisation had a strong culture of stewardship?
Muir Gray is now working with both NHS England and Public Health England to bring about a transformation of care with the aim of increasing value for both populations and individuals and published a series of How To Handbooks for example, How to Get Better Value Healthcare, How To Build Healthcare Systems and How To Create the Right Healthcare Culture.
His hobby is ageing and how to cope with it and he has published a book for people aged seventy called Sod 70! and one for the younger decade called Sod 60! This with Dr Claire Parker, and his book for people aged 40-60, titled Midlife, appeared in January 2017. Other books in the series on Sod Ageing are Sod it, Eat Well, with Anita Bean and Sod Sitting, Get Moving with Diana Moran, the Green Goddess. For people of all ages Dr Gray’s Walking Cure summarises the evidence on this wonderful means of feeling well, reducing the risk of disease and minimising disability should disease strike.
This talk was held as part of the Practice of Evidence-Based Health Care course which is part of the Evidence-Based Health Care Programme.
1/19/2018 • 47 minutes, 13 seconds
Life as a trial statistician – the good, the bad and the ugly
Professor Jonathan Cook is a Senior Medical Statistician at the Oxford Clinical Trials Research Unit. His main research interest is in the design, conduct, analysis and reporting of randomised controlled trials (particularly surgical trials). Key areas of interest include specification of the target difference in the sample size calculation, addressing interventional expertise, and methods for improving recruitment.
In this light-hearted talk he discusses his experiences during his career as a trial statistician, picking out the good the bad and the ugly.
12/6/2017 • 49 minutes, 9 seconds
How we change behaviour and what to do to support it: lessons from randomised controlled trials and other research
Professor Paul Aveyard, Nuffield Department of Primary Care Health Sciences gives a talk on behavioural change in evidence based medicine. In our society, we tend to view motivation, the state of 'wanting it' as a prime mover of behaviour. However, research calls this into question both directly and by showing that, even among people with lukewarm motivation, we can enable behaviour change. Using randomised data mainly from randomised trials and other research, we will examine what these forces are and show how they can be harnessed to change behaviour, even when people have seemingly strong preferences.
11/28/2017 • 41 minutes, 51 seconds
And then the magic happens! Can realist synthesis really be systematic?
Dr Andrew Booth gives a talk for the Realist Reviews and Realist Evaluations short course. Realist synthesis has positioned itself as a potentially valuable tool within health services research and evaluation. Opportunistically, it now inhabits the shadowy borderland between the messy domain of real world evaluation and the perceived rigorous scientific method of systematic review and evidence synthesis. Occupying this methodological demilitarised zone is not without its challenges; offering ongoing friction, perceptible tensions but not, at least to date, incandescent light! In this presentation Dr Booth will explore the extent to which realist synthesis can be seen as a bona fide member of the review family or, alternatively, as a rogue claimant syphoning off time, expertise and resources from the systematic reviews movement. He will explore his own experience on over half-a-dozen funded and unfunded realist syntheses against a backdrop of developments and current controversies within synthesis methods. Underpinning mechanisms will include conflict, rapprochement and, ultimately, reconciliation.
11/24/2017 • 51 minutes, 34 seconds
Working 'up' and 'out': how qualitative researchers approach analysis
Dr John MacArtney gives a talk for the Evidence Based Healthcare seminar series. Qualitative researchers employ a range of different approaches to conducting qualitative analyses. In the process, they describe and interpret data, explaining the relationships between the patterns they find and interrogating their findings in various ways to provide thick descriptions of phenomena or explanatory theories. Drawing on his own qualitative analyses on experiences of cancer, Dr John MacArtney will explore some of the ways in which qualitative analysts approach these processes. This lecture will provide the opportunity to demystify an often intangible process and tackle some of the challenges facing qualitative health researchers today.
Dr MacArtney is a Senior Researcher with the Nuffield Department of Primary Care Health Sciences at the University of Oxford and is a sociologist of health and illness with specific interests in the diagnosis of cancer, end of life and palliative care, and bereavement. He specialises in qualitative research.
This talk was held as part of the Qualitative Research Methods module which is part of the MSc in Evidence-based Health Care.
11/15/2017 • 40 minutes, 52 seconds
A little known law of numbers
Professor Jeffrey Aronson, Consultant Physician and Clinical Pharmacologist, gives a talk for the Evidence Based Healthcare lecture series,
10/20/2017 • 36 minutes, 11 seconds
Critical Appraisal and EBM in the Real World
The overwhelming volume of evidence and its lack of relevance to patient care and decisions means health professionals require skills to sift evidence more efficiently: discarding what doesn't make a difference to focus on evidence that matters for health This talk will present a simple effective appraisal system based on two first steps to rapidly appraise and sift the evidence for its relevance and application to actual patient care, prior to assessing its validity.
Professor Carl Heneghan is Director of CEBM, and an NHS Urgent Care GP, and has been interested for over twenty years in how we can use evidence in real world practice.
This talk is being held as part of the Practice of Evidence-Based Health Care module which is part of the MSc in Evidence-Based Health Care and the MSc in EBHC Systematic Reviews.
10/13/2017 • 31 minutes, 47 seconds
Making trials more efficient: Trial Forge and how you can help
Trials are important; very often they are also inefficient. Trial Forge aims to improve trial efficacy by identifying and then filling gaps in trial methods research. Coordination and collaboration are key: letting a thousand flowers bloom is all very well but it does mean that evidence to support trial decisions is patchy and accumulates very slowly. In addition to introducing Trial Forge, the talk will suggest ways in which you can contribute to it.
7/10/2017 • 50 minutes, 16 seconds
Using mixed methods in health psychology: Reflections on research design, epistemology, and practicalities
In this talk, Dr Felicity Bishop will critically reflect on mixed methods research that she has conducted and discuss the philosophical and technical challenges of mixed methods.
7/10/2017 • 1 hour, 43 seconds
Better evidence for better healthcare manifesto
The integration of evidence with clinical expertise and patient values which underpins the delivery of high quality evidence-based medicine. Hard though this often is to achieve in practice, one fundamental principle is that evidence integrated into decision making should be the “current best evidence.” Whilst the amount of research, funded and published, has grown enormously, there is little to suggest concomitant increases in outputs that have led to real improvements in patient care. Equally worrying, the growth and volume of evidence has been accompanied by a corrosion in the quality of evidence, which has compromised medicine’s ability to provide affordable, effective, high value care.
4/12/2017 • 44 minutes, 10 seconds
Wye speling matturs (Slides)
Jeffrey Aronson presents a light-hearted talk on spelling in systematic reviewing. Jeff is a Consultant Physician and Clinical Pharmacologist at the Oxford University Department for Primary Health Care. His research expertise includes methods of classifying, detecting, and reporting adverse drug reactions, including systematic reviews and meta-analyses.
3/29/2017 • 0
Wye speling matturs
Jeffrey Aronson presents a light-hearted talk on spelling in systematic reviewing. Jeff is a Consultant Physician and Clinical Pharmacologist at the Oxford University Department for Primary Health Care. His research expertise includes methods of classifying, detecting, and reporting adverse drug reactions, including systematic reviews and meta-analyses.
3/29/2017 • 38 minutes, 45 seconds
Rethinking the epidemic of overdiagnosis
Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Newer, more accurate technologies, and the desire to detect disease even earlier means Overdiagnosis is on the rise. Understanding the impact of Overdiagnosis, how to detect it and what to do about it might stem its inexplicable rise and prevent the epidemic of unnecessary testing. Professor Carl Heneghan is a board member of the Preventing Overdiagnosis conference and has an active interest in diagnostic reasoning and how this can, or in some cases cannot, make a real difference to patient outcomes. He is also Professor of Evidence-Based Medicine at the Department of Primary Care Health Sciences at the University of Oxford, Director of the Centre for Evidence-Based Medicine, a fellow of Kellogg College and an NHS Honorary Clinical Consultant and GP.
1/27/2017 • 34 minutes, 18 seconds
Resuscitating poor quality research
Healthcare research is all too often plagued by biases that are rooted in poor methods, leading to the wrong result and conclusions and preventing uptake into practice. We need a better understanding of what constitutes rigorous research; what are the different types of research that underpin decision making that matters to patients and how we should go about fixing the problems of poor quality research.
There are major structural problems with the current production and use of evidence that needs resuscitating. If left unaddressed, these inherent problems may become entrenched and unsolvable.
1/17/2017 • 37 minutes, 18 seconds
Trials and Tribulations in Africa
Dr Merlin Willcox gives a talk for the Evidence Based Healthcare series. Merlin’s research focuses on global health, particularly primary health care in low-income countries. In such countries, maternal and child mortality is significantly greater than in the UK – one in five children die before their fifth birthday. Primary health care has the potential to save most of these lives, if it is implemented according to best evidence.
In this talk Merlin talks about the different studies and designs he has used in his work trying to address child mortality in Africa.
11/15/2016 • 49 minutes, 59 seconds
Better evidence for better health care
Professor Carl Heneghan gives a talk for the MSc in Evidence-Based Health Care programme.
10/31/2016 • 34 minutes, 40 seconds
The point of qualitative research
Prof Aksel Tjora, Professor of Sociology at the Norwegian University of Science and Technology, gives a talk for the MSc in Evidence-Based Health Care programme. Demonstrating how the potential of qualitative analysis is developed by maintaining a strong inductive strategy of concept development.
6/23/2016 • 49 minutes, 3 seconds
Evidence informed decision making? (Know your cognitive biases)
Prof Neal Maskrey gives a talk for the Centre for Evidence Based Medicine seminar series. Decisions made in health care are not strongly based on the best available evidence. There is 40 years of research which explains why this is normal, but we don’t learn much about it from health care curricula because it comes from cognitive psychology and behavioural economics. How do individuals make decisions, how might they make them better, and how does all this fit into the complex skill set I hope the health care professionals looking after me will possess when I need them, hopefully about 20 years from now.
6/1/2016 • 1 hour, 3 minutes, 42 seconds
Why on earth do we waste so much research?
Dr Kamal Mahtani is an NHS GP, NIHR Clinical Lecturer and Deputy Director at the Centre for Evidence Based Medicine. His talk explores why so much research is wasted.
6/1/2016 • 40 minutes, 27 seconds
Overdiagnosis and Too Much Medicine How did we get here and how do we get out of the mess
Professor Carl Heneghan gives a talk for the MSc in Evidence-Based Health Care programme
5/3/2016 • 42 minutes, 28 seconds
Breathalysers, babies and bumps on the road: delving into diagnostic studies
Talk by Dr Helen Ashdown regarding three rather different diagnostic studies People: Helen Ashdown
5/3/2016 • 24 minutes, 13 seconds
10 Top tips for doing applied healthcare research: How to get started
Carl Heneghan gives a talk held on January 11th 2016 Kellogg College. Recommended reading:
Strunk Jr, W. and White, E.B. (1999) The Elements of Style, 4th Ed. Longman. ISBN: 978-0205309023.
King, G. (2014) Improve Your Writing Skills, 1st Ed. Collins.
Mathews, J., Bowen, J M. and Matthews, R W. (2000) Successful Scientific Writing, 2nd Ed. Cambridge University Press. ISBN: 978-0521789622.
Seely, J. (2004) Oxford Everyday Grammar. Oxford University Press. ISBN:978-0198608745
Forsyth, M. (2014) The Elements of Eloquence: How to turn the perfect Englis phrase. Icon Books Ltd. ISBN: 978-1848317338
Gwynne, N M. (2013) Gwynne's Grammar. Ebury Press. ISBN: 978-0091951450
Murray, R. (2011) How to Write a Thesis, 3rd Ed. Open University Press. ISBN: 978-0335244287
Kane, T S. (1994) The New Oxford Guide to Writing. Oxford University Press. ISBN: 978-0195090598
King, S. (2012) On Writing. Hodder Paperbacks. ISBN:978-1444723250
1/29/2016 • 1 hour, 4 minutes, 37 seconds
What has EBM done for healthcare?
Professor Carl Heneghan gives a talk for the Centre for Evidence Based Medicine podcast series. EBM has been transformational for healthcare, however, currently it is poorly understood how this has occurred over time. Using Heart Attack as an example, Prof Carl Heneghan will demonstrate and discuss how EBM has saved lives, and invite the audience to consider the consequence of a health system without evidence. More informatiopn can be found here; www.cebm.net/what-has-ebm-done-for-healthcare/
10/22/2015 • 47 minutes, 12 seconds
Theorising with narrative: How careful analysis of stories can help us rise above the ontological desert of ‘behaviour change’ research
Professor Trish Greenhalgh gives a talk for the Centre for Evidence Based Medicine. Trish Greenhalgh is Professor of Primary Care Health Sciences and Fellow of Green Templeton College at the University of Oxford. She studied Medical, Social and Political Sciences at Cambridge and Clinical Medicine at Oxford before training as an academic GP.
8/5/2015 • 59 minutes, 47 seconds
Managing large scale international clinical trials
Managing clinical trials, of whatever size and complexity, requires efficient trial management. Barbara Farrell shares from her wide experience.
5/6/2015 • 33 minutes, 21 seconds
Storytelling in diabetes: a mixed-methods study
The patient as storyteller and the story as ‘self management’
4/7/2015 • 33 minutes, 25 seconds
Research impact: the new jargon for knowledge to action
If we are going to take impact seriously, we need to be clear about the philosophical assumptions underpinning different kinds of research and also the different kinds of links between research, practice and policy.
3/26/2015 • 46 minutes, 19 seconds
The Campaign for Real EBM Evidence Based Medicine
Professor Trish Greenhalgh gives a talk on the crisis facing evidence based medicine and offers a solution for its rennaissance within healthcare.
3/24/2015 • 49 minutes, 14 seconds
From inspiration to publication: bumps along the road (as part of the Postgraduate Programme in Evidence-Based Health Care)
Dr Helen Ashdown is a GP and Clinical Researcher in the Nuffield Department of Primary Care Health Sciences, University of Oxford. During her clinical academic training, she designed and led a study to investigate whether pain on going over speed bumps when travelling to hospital is a good diagnostic test for appendicitis. This was published in the 2012 Christmas edition of the British Medical Journal. She will describe her own bumpy journey through the process of answering a clinical question - navigating the tortuous course from research question, ethics, study design and recruitment through to Christmas radio shows.
12/3/2014 • 48 minutes, 46 seconds
Realist Review: Mixing Method
This talk will introduce the realist review methodology as a strategy for combining qualitative and quantitative data to answer the question “what works, for whom, and in what circumstances” This methodology is proving popular in addressing questions around complex and social interventions. The talk will provide a brief overview of approaches to synthesizing qualitative and quantitative research for mixed methods reviews, discuss approaches to dealing with different study types in realist reviews, and question the adequacy of published studies when developing theory for complex interventions.
12/1/2014 • 1 hour, 11 minutes, 2 seconds
Systematic Reviews, the need for change
The need to generate systematic reviews is relatively uncontroversial and until recently so were the methods of production. The presentation will highlight a number of problems associated with the current system and propose a radical departure to ensure we meet Archie Cochrane's desire to see all RCTs included in critical summaries.
12/1/2014 • 30 minutes, 40 seconds
EBM - What it is, what it isn't, how might you contribute?
Carl Heneghan is a Professor of Evidence-Based Medicine and a Primary Care Physician and has over 20 years experience of using evidence in practice for changing health care. This talk will give you an understanding of how you might get involved in the modern era of EBM improvement and what you could do to support the application of evidence into practice.
12/1/2014 • 51 minutes, 30 seconds
An introduction to Medical Statistics with Carl Heneghan and Rafael Perera
Dr Carl Heneghan talks to Rafael Perera about medical statistics and gives an introduction to the subject.
8/9/2013 • 42 minutes, 4 seconds
A behavioural perspective of translating evidence to policy and practice
Susan Michie, Professor of Health Psychology, UCL, gives a talk at Kellogg College for the Centre for Evidence Based Medicine.
7/16/2013 • 54 minutes, 49 seconds
How Youtube is being used as a platform to share opinions and experiences of a controversial treatment for Multiple Sclerosis
Brandon O'Neill, DPhil Candidate, PCHS, gives a lecture on treating Multiple Sclerosis and how social media is being used to share experiences of patients.
7/16/2013 • 40 minutes, 19 seconds
Dr Carl Heneghan and John Balla discuss the evidence relating to diagnostics
Dr Carl Heneghan and John Balla discuss the evidence relating to diagnostics.
6/26/2013 • 39 minutes, 3 seconds
MSc in EBHC: Introduction to the Practice of Evidence-Based Health Care
Annette Pluddermann, Senior researcher DPCHS, gives an introduction to the Practice of Evidence-Based Health Care
5/28/2013 • 1 minute, 49 seconds
A Welcome to the Programme in Evidence-Based Health Care
Dr Carl Heneghan, the Director of the Centre of Evidence-Based Medicine, gives a brief welcome to the Programme in Evidence-Based Health Care.
2/7/2013 • 2 minutes, 50 seconds
An introduction to the Masters in Evidence-Based Health Care
Sharon Mickan, a Knowledge Translation Fellow in the Centre for Evidence Based Medicine, gives an introduction to the Masters in Evidence-Based Health Care.
2/7/2013 • 4 minutes, 49 seconds
Know4Go - EBM lecture
Dr Janet Martin, Director of Health Technology Assessment, London Health Services Centre gives a special lecture for EBM entitled; Know4Go: An Instrument for decision-making when resources are limited and demands are relentless.
2/24/2011 • 49 minutes, 27 seconds
The Information Revolution
Sir Muir Gray, Chief Knowledge Office, NHS, gives a special guest lecture for the Centre for Evidence Based Medicine.
2/24/2011 • 29 minutes, 18 seconds
The Future of Evidence Based Medicine
Professor Paul Glasziou, Director of the Centre for Evidence Based Medicine, gives a special lecture on the future of EBM.
2/24/2011 • 29 minutes, 58 seconds
Interpreting Results - Stats in Small Doses
Dr Amanda Burls delivers a talk for the Centre for Evidenced Based Medicine.
2/24/2011 • 1 hour, 15 minutes, 41 seconds
Diagnostic Tests
Dr Carl Heneghan delivers a talk for the Centre for Evidence Based Medicine.
2/24/2011 • 59 minutes, 18 seconds
Appraisal of Clinical Trials
Dr Rafael Perera delivers a talk for the Centre for Evidence Based Medicine.
2/24/2011 • 1 hour, 1 minute, 53 seconds
Introduction to Evidence Based Medicine
Professor Paul Glasziou gives an introduction to evidence-based medicine and healthcare.