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What?
Qazale Moayedian
EBM
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WHAT IS THE BASIS OF YOUR MEDICAL PRACTICE?
Training, clinical experience and consultation with other professionals ?
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BUT… Past knowledge and practice might be outdated or inadequate
Graduate Medical School
Practiced Physician
Preferences of the patient?
I WON’T take that medicine… The side effects are INTOLERABLE!
No salt?
Lose weight?
Forget it!
Just give me a pill!
But doctor, I DO want to have children!
And conflicts WILL occur!
Convincing evidence (non-experimental) from articles, case reports, product literature, etc.?
BUT… This evidence may be biased, outdated, incorrect, or not applicable to your patient
so what should we do?
What is Evidence-Based Medicine?
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“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”
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The basic steps of EBM
LIST OF RULES
Clinical Question
Patient-focused, problem-oriented
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.Find Best Evidence
Literary Search
2
LIST
OF RULES
3
Critical Appraisal
Evaluate evidence for quality and usefulness
4
Apply the Evidence
Implement useful findings in clinical practice
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Evaluate
The information, intervention, and EBM process
The Clinical Question
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The FIRST step
The HARDEST step
The MOST IMPORTANT step!
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2
PATIENT type of patient or population
P
I
INTERVENTION clinical intervention
Activity list
C
COMPARISON compare alternative treatment
O
OUTCOME clinical outcome of interest
PATIENT type of patient or population
Ex: 47 yr male w/DM2 and cellulitis toe, 25 yr female w/DVT and chest pain
I INTERVENTION clinical intervention
Ex: medication, procedure, test, surgery, radiation, drug, vaccine
C COMPARISON compare alternative treatment
Ex: other prior, new or existing therapy
O OUTCOME clinical outcome of interest
Ex: Reduced death rate in 5 yrs, decreased infections, fewer hospitalizations
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Diagnostic tests
Prognosis
Therapy
Patients’ Preferences
Cross sectional study
Cohort study
RCT vs Meta analysis
Qualitative research
Narrow search using limiters:
Date of publication
Type of study
Language
Human
Specific age group
Sensitivity and Specificity
Examples:
Cochrane,
Best Evidence,
Up to Date
Review Services
Subjective
Systematic Reviews
Meta-analysis
Bibliographic Database
Example: Medline, PubMed
CRITICAL APPRAISAL
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Validity
Can I trust this information?
Clinical Importance
If true, will the use of this information make an
important difference?
Applicability
Can I use the information in this instance?
Validity
Scan the articles for:
Is it a clinical study?
Is the research current?
Is the journal well-regarded?
Are the research questions similar to my question with regards to Population, Intervention, Comparison groups and Outcomes?
Critically appraise
GATE Frame
RAMMbo
CASP
CAT maker
JADAD score
Apply the Evidence
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Evaluate
Is oral rehydration in the emergency room more cost-effective than IV rehydration?
Patient/Population
Not identified.
Examples: infants, infants with vomiting.
Intervention
Oral rehydration.
Comparison
IV rehydration.
Outcome
Cost-effectiveness.
A 60 y/o male with no prior history of any cardiovascular event presents to the clinic for follow up.
He asks for advice regarding the use of aspirin , as it was recommended for his friend who had a heart attack recently.
P healthy adults
I aspirin
C placebo
O prevention of cardiovascular
disease
In a healthy adult does aspirin administration offers protection from cardiovascular disease?