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Evidence-Based Pathology

Overview

Evidence-Based Pathology (EBP) is an international movement aimed at promoting the understanding and use of evidence-based principles in Cellular Pathology (Histopathology). Through the research studies, guideline production, education, and promotion, EBP hopes to improve patient care by strengthening the rationale behind the clinical practice of Cellular Pathology. In NDS this work is being carried out with a particular emphasis on urological cancers. 


What is Cellular Pathology?

Cellular Pathology - also known as histopathology, surgical pathology, or anatomic pathology - is a laboratory-based medical specialty that focuses on making diagnoses by looking at patient tissue samples using a microscope. These samples are usually biopsies (which some might call 'tests') or tissues and organs removed during an operation. Cellular Pathologists are involved in making diagnoses (or confirming diagnoses suspected clinically or from X-rays and scans) and along with radiologists are an important part of the team caring for patients. 


What is Evidence-Based Health Care?

One definition of evidence-based health care is clinical care that integrates the best available medical research with clinical expertise and patient values. Clinical care includes making a diagnosis and choosing a treatment plan, whether that be drugs or surgery. As pathologists, this means using the best available evidence, along with our clinical experience and understanding of patient needs, when making diagnoses and prognoses for our patients. 


Evidence-Based Principles

'Best evidence' is hinting at the idea that some evidence is more robust than others, with systematic reviews and randomised controlled trials being the gold standards (having the least bias), followed by less well controlled trials such as cohort or case-control studies, then basic laboratory research (because this does not involve patients). Of course, the best available may not be the ideal or gold standard. It's also worth bearing in mind that this hierarchy of evidence does not imply any particular type of evidence is intrinsically 'better' or more worthy, but that some types of evidence are more useful for predicting what will help patient care in a clinical, real world setting.  


How is NDS involved?

NDS is contributing to EBP by setting up primary studies and running systematic reviews, as well as working with the IC3R (WHO) EPB project. NDS projects involve collaboration with Pathologists in the Department of Cellular Pathology at Oxford University Hospitals NHS Foundation Trust as well as academics from other University departments, including the Centre for Evidence-Based Medicine (Nuffield Department of Primary Care Health Sciences). Some of our collaborators and a few example projects are listed on the left hand side.