THE CENTRE FOR EVIDENCE-BASED PATHOLOGY
OUEENS MEDICAL CENTRE
UNIVERSITY OF NOTTINGHAM
Evidence-based Pathology (EBP) aims to advance clinical diagnosis, classification and prognosis of disease through researching and disseminating generalisable, new knowledge which meets standards of critical review, on clinically effective practice of laboratory investigation.
The Centre for Evidence-based Pathology (CEBP) is part of a developing network of evidence-based medicine centres intended to develop an explicit culture of research-based, evaluative, clinical practice within the NHS. CEBP is a joint venture between the University of Nottingham and the NHS R & D programme.
Clinical pathology?
Clinical pathology applies laboratory methods to screening, diagnosis, classification and prognosis of disease. It is important in clinical decisions and as a route for science and technology into practice. These roles change practice and hence resource use and costs.
Pathology is not entirely objective and depends heavily on subjective, expert, particularly visual diagnosis. This creates problems with standardisation, accuracy and communication.
Pathology is a good model of clinical investigation and decision-making. Pathology also provides important clinical standards and outcome measures.
As with all medicine, problems arise from authoritarian tradition, with wide variations in practice, use and costs by both pathologists and clinicians. Poor handling of uncertainty and lack of standardisation have contributed to bad publicity, litigation and official reports commenting on ignorance of effectiveness of investigations.
What are the principles of EBM and EBP?
- EBM is about linking research to patients and service problems, and about clinical effectiveness.
- EBP combines methods from epidemiology, statistics and social sciences with traditional and molecular "bench" science to evaluate the role of investigations in clinical decisions and outcomes for patients, including patients' attitudes and quality of life.
The approach identifies real clinical problems which are translated into questions answerable by literature search and critical review, or by appropriate generalisable research. The results are then properly interpreted to yield a solution which is applied and evaluated in practice. The elements of the process should be formally defined, explicit and, where appropriate, subject to objective, quantitative analysis. The results should be disseminated effectively.
What does CEBP do?
- Disseminate knowledge of approaches to studying clinical laboratory practice
- Promote systematic, critical review of diagnostic, classificatory and prognostic research
- Develop research into practice and outcome of clinical investigation
- Develop evidence-based, information and support systems for laboratory investigation of patients
Training is provided through short courses with professional organisations and at meetings. Longer research training will be provided through modular M.Med.Sci. courses and projects.
Publication will include articles on EBP in the J Clin Pathol leading to a handbook on critical appraisal of investigations and test-use. An EBP supplement to J Clin Pathol will complement Evidence-based Medicine.
Research is aimed at the clinical application of tests to ensure that investment in basic scientific research is realised in the practice of the NHS. Completed research includes: accuracy and use of old and new tests in cervical screening; the National Audit of Liver Biopsies; and developing and disseminating objective criteria for pathological diagnosis in suspected inflammatory bowel disease.
Resources and information systems will be developed to support evidence-based practice and reduce uncertainty in clinical decision-making.
What is the connection with other health service research and clinical audit?
- EBM is a clinical research activity
- CEBP is part of a network of EBM centres to develop research-based, evaluative, clinical practice.
- The special skills of CEBP are in laboratory investigation and diagnosis, classification and prognosis.
- EBP relates to technology assessment of diagnostic and prognostic technology
- EBM works at the interface between clinical practice policy and individual patients.
- EBM applies general methods of HSR to specific clinical and practice problems.
- Collaboration with HSR, audit and clinicians is part of developing and disseminating EBM.
- CLINICAL AUDIT, like EBM involves a "spiral" process of development. EBM can assist in establishing standards for audit based on systematic, critical review and research .
- Quality and evaluation are part of EBP/M; EBM needs an environment of TQM.
- EBP aims to develop fail-safe, support systems including checklists and decision-advice to put good, auditable practices into routine practice.
