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EVIDENCE BASED MEDICINE IN ACTION
BUSINESS AND INDUSTRY NEWS
analyses; Google Scholar is filtered for
sources, not quality and has no EBM filter.
3) Finding the study best able to
answer your question.
Finding the most current research is an
important factor in the practice of EBM.
By limiting or sorting the results to the
most current research, you may find a
more manageable list of references.
The ability to incorporate EBM into clinical
care requires a basic understanding of
the main research designs underlying
the published evidence. Some research
designs provide a stronger level of
evidence than others based on their
inherent characteristics. This hierarchy is
often shown graphically as a pyramid as
in Figure 1.
Most resources place meta-analyses at
the top and expert opinion at the very
bottom. Furthermore, limiting to the best
study design for the question is another
way to narrow the focus.
Although pharmacists will most likely be
dealing with questions about therapy,
there may be occasions when HCPs will
ask pharmacists questions from other
areas (e.g. diagnostic tests).
Certain study designs should be focussed
on depending on the issue (Table 1).
A key underlying theme in the practice
of EBM is understanding the hierarchy of
evidence and the inherent limitations of
different study designs.
The next three articles in the EBM series
will focus in detail on understanding
the strength of each level of evidence
by defining study designs and their
1. Cook DJ, Guyatt GH, Laupacis A, Sackett DL. Rules of evidence
and clinical recommendations on the use of antithrombotic
agents. Chest. 1992;102(4 Suppl):305S--11S.
2. Evidence-Based Practice in the Health Sciences: Evidence-
Based Practice in Pharmacy Tutorial. University of Illinois
at Chicago. At: http://ebp.lib.uic.edu/pharmacy/node/3
[Accessed Jan 8 2013].
3. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson
WS. Evidence based medicine: what it is and what it isn't. BMJ.
4. Guyatt G, Rennie D, Meade MO, and Cook DJ. Users' Guide to
the Medical Literature: Essentials of Evidence-Based Clinical
Practice, Second Edition. JAMA and Archives Journals 2008.
5. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits
of estrogen plus progestin in healthy postmenopausal
women: principal results From the Women's Health Initiative
randomized controlled trial. JAMA. 2002;288(3):321--33.
6. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, et
al. Randomized trial of estrogen plus progestin for secondary
prevention of coronary heart disease in postmenopausal
women. Heart and Estrogen/progestin Replacement Study
(HERS) Research Group. JAMA. 1998;280(7):605--13.
7. Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K,
Mitchinson MJ. Randomised controlled trial of vitamin E in
patients with coronary disease: Cambridge Heart Antioxidant
Study (CHAOS). Lancet. 1996;347(9004):781--6.
8. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E
supplementation and cardiovascular events in high-risk
patients. The Heart Outcomes Prevention Evaluation
Study Investigators. New England Journal of Medicine.
9. Miller ER, 3rd, Pastor-Barriuso R, Dalal D, Riemersma RA,
Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E
supplementation may increase all-cause mortality.[Summary
for patients in Ann Intern Med. 2005 Jan 4;142(1):I40; PMID:
15537683]. Annals of Internal Medicine. 2005;142(1):37--46.
10. Mayer D. Essential Evidence-Based Medicine. Second Edition.
Published by Cambridge University Press 2010.
11. Aveyard H and Sharp Pam. A Beginner's Guide to Evidence-
based Practice in Health and Social Care Professions. First
Edition. Published by McGraw Hill Open University Press 2009.
12. Nissen L. translating research results into practice. Aust
Pharmacist Oct 2012;803--06. Pharmaceutical Society of
13. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-
Based Medicine: How to practice and teach it. Fourth Edition.
Published by Churchill Livinstone Elsevier 2011.
14. Albrecht S. Evidence-Based Medicine in Pharmacy Practice. US
Pharmacist 2009;34 (10):HS14--HS18.
Centre for Evidence-based Medicine:
Project Stop fee starts
Pharmacy Guild subsidiary company
GuildLink Pty Ltd, which operates Project
STOP, will charge non-Guild member
pharmacies an annual fee of $300 to access
the Project STOP platform from 1 March.
According to a statement released by the
Guild the decision was taken because of
the significant ongoing cost of maintaining
and operating the system -- estimated at
$650,000 a year.
President, Kos Sclavos,
said: 'The decision
to charge non-Guild
members an annual
levy to access the
platform has not been
'The Guild will continue to lobby
Commonwealth and State Governments to
secure funding for this important program,
however, at this time we have no choice but
to explore alternative commercial funding
models in order to ensure the longer term
viability of Project STOP'.
Project STOP is an online recording
system that records the sale of
pseudoephedrine-based products in 'real
time' to assist pharmacies to determine
the legitimacy of sales. The system's
success has made it extremely difficult for
pseudoephedrine 'runners' to travel from
pharmacy to pharmacy to accumulate
sufficient pseudoephedrine-based products
to manufacture illicit amphetamine-type
Online recording of pseudoephedrine sales
is a mandatory requirement in some but not
all States and Territories. Across Australia,
a majority of pharmacies participate in
Project STOP. The program is provided free
of charge to all users, including government
departments and law enforcement agencies.
After initial funding support from the
Federal Attorney-General's Department for
the national roll-out of Project STOP from
2007, this work has been funded entirely
by the Guild and GuildLink with no charge
levied on pharmacy users of the service.
The significant ongoing cost of maintaining
and operating Project STOP as a law
enforcement tool means that the Guild and
GuildLink cannot sustain this self-funding
model into the future.
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