Evidence-Based Health Care

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.

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'.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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

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’?

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

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

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.

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.

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.