Evidence Based Pathology


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?

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?

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?

Go to EBM page
Comments to Dr. David Jenkins