Evidence-Based Health Care

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

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.

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.

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.

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.

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.

Dr Jeffrey Aronson gives a talk for the Evidence Based Healthcare series.

Professor Mike Clarke gives a talk for the Evidence Based Healthcare series.

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

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.