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					CEBAM The Belgian Centre for Evidence-Based Medicine
The Belgian branch of the Cochrane Collaboration Bert Aertgeerts, director

“Only about 15% of medical interventions are supported by solid scientific evidence,…” BMJ editorial 1995

“…this would put 80 to 90 % of accepted medical procedures in this country under the heading of quackery!”
What about 2006?

Definition EBM
Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.’

The integration of individual clinical expertise with the best available external evidence and patient’s values

and expectations
David Sacket 2000

Clinical problem Decision about diagnosis & treatment

develop answerable question

traditional

Expertise, experience, pathophysiology

EB supported

Critical appraisal
Search & obtain relevant articles

Independent information and critical appraisal
Textbooks Journal articles Conferences

Internet Pharmaceutical industry

T.V.

Newspaper

Which evidence ?
-Own experience -other colleagues -Expert opinion -Farmaceutical companies -Systematic reviews -EB guidelines

Evidence-Based Practice serves
Patient: treatments that help Health Care provider: CME Society: priorities
EBP needs independent Centres for EBM!

CEBAM
 CAN 90, UK 92, USA 93, NL 93  Belgium January 2002  Independent multidisciplinary centre  Funding: government  Support: universities  Aim:

– To introduce and support evidence-based thinking and working – For all parts of the country, all language groups, and all medical and paramedical disciplines

Organigram
All universities, all health care providers
Wetenschappelijke Adviesraad Directieraad Raad der Wijzen

Staf groep en administratie

CEBAM: objectives
1. Teaching the content and techniques of EBM and providing the necessary information. 2. Belgian branch of the Cochrane Collaboration: Cochrane tasks 3. Methodologically supporting the building of evidence-based guidelines. 4. Virtual Medical Library…

1. EBM activities
-Three day courses EBM - One day seminars EBM - Two day seminars EBM - Discipline related workshops - Articles HANU: PICO reeks (Ann Van den Bruel!); - Articles Revue Médical de Liège: PICO reeks (F)

2. Cochrane activities
‘It is surely a great criticism of our profession that we have not organised a critical summary,…, adapted periodically, of all relevant randomised controlled trials’
Archie Cochrane

Cochrane Centres 1992
Nordic Dutch German Spanish Italian San Antonio USA Baltimore USA

Belgian Branch CC 2002
South African Brazilian

Australian

Preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions

The Cochrane Library
 Cochrane Database of Systematic Reviews  Database of Abstracts of Reviews of Effectiveness (DARE)  Cochrane Controlled Trial Register (CCTR) www.cochrane.org

Cochrane activities
Small group learning (SR)  Developing SRs  Cochrane Methodsgroup Diagnostic research: Handbook (FB, BA)  French Cochrane Branch: SA, PC  Cochrane methodsgroup IPD  Cochrane methodsgroup Qualitative research

3. Clinical Guidelines
GOBSAT method
Formal consensus techniques (consensus conference, Delphi technique, etc) Explicit linkage of recommendations and evidence

Development process guidelines

www.sign.ac.uk

Support the methodological quality of EB guidelines and SR Independent validation of guidelines

AGREE Instrument
Examines 6 domains/aspects and guideline development
Scope and purpose Stakeholder involvement Rigour of development Clarity and presentation Applicability Editorial independence

Within universities…

After the university…

4. Virtual Library
- Workshops “searching” - Contacts with different specialisms - Contacts with OVID,.. - Contacts similar projects other countries… - RIZIV-INAMI support

CONTENT OF THE SMALL VIRTUAL MEDICAL LIBRARY
Core Collections in the primary literature Indexes (Medlin e, Invert, Inside) : Research Search Factual databases Cochrane Database for systematic reviews Clinical Excellence Guide to Guidelines EBM -CME Publications in the mother tongue

Engine
UNIQUE INTER FACE Practice Search

Engine

Help line

Clinical medical Librarian

CEBAM connections
 International
– Cochrane Centre – Universities (Oxford, leiden, Amsterdam) – GIN: founding member

 National
– – – – BCFI, Minerva, Farmaka, Universities FOD, Virtual library RIZIV, INAMI

EB platform in Belgium...
Centre
KCE BCFI Minerva Farmaka

task
Centre of Excellence (NICE) Drug therapy (BNF) Evidence-Based journal (EBM) Independent drug representatives

funding
OK OK OK OK

CEBAM Methodological support Virtual Library EB literature

(DCC,CEBM) (NELH)

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