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Evidence based general kasr einy
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Evidence based general kasr einy

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Transcript

  • 1. Good clinical practice
    • Evidence-based medicine
    • Biological knowledge of health and disease (Rational of clinical judgment).
    • Awareness of social and cultural values.
  • 2. Clinical Reasoning
    • Evidence
    • Doctor
    • Patient
  • 3. Clinical reasoning: different scenarios 1 Cancer treatment 2 Infertility treatment
  • 4. Problems With Evidence-Based Medicine in Infertility
    • Insufficient evidence to support
    • some diagnostic tests.
    • Many treatment modalities.
  • 5. Problems with Evidence Based Infertility Treatment Problems of Diagnosis (Example) Semen analysis: Count : 80,60,40,20, less Motility Abnormal forms
  • 6. Problems with evaluating evidence Errors
    • Type I error:
      • P<0.05: we accept this chance of error (5%). The error could be inflated by a subgroup analysis.
    • Type II error: (more common)
      • Investigators did not detect a difference when a difference actualy exists.
      • We accept 20% error = power of the study is 80%.
  • 7. Problems with evaluating evidence
    • Confounding factor:
    • Factor associated with both treatment (as risk factor) and the outcome under study.
    • e.g.: low dose contraceptive pills.
  • 8. Problems with evaluating evidence
    • Bias: is systematic error in collection or interpretation of study information.
      • Selection bias:
        • Dissimilar selection criteria.
      • Information bias:
        • IUI*PID
  • 9. Problems with evaluating evidence Number needed to treat
    • Until recently, it was acceptable to look for (P values) in the results and the difference is considered significant if P <0.05.
    • The magnitude of the effect of the intervention is of utmost clinical importance to evaluate the implications of this significance.
  • 10. we should remember that what is statistically significant might not always be clinically relevant