Prof. Aboubakr Elnashar
Benha university, Egypt
Email: elnashar53@hotmail.com
 Benefits of EBM
 Misconceptions
 Myths
 Conclusion
Yes
EBM:
Way of critical thinking
Appropriate tool for sound clinical decisions
Problem solving approach
Life-long self-di...
Use:
more effective intervention
proven therapies and diagnostic tests
only
Result in:
Better management of patients
Bet...
More efficient use of resources
Improve resource utilization
Reduced cost per patient.
Using the best available evidence :
Appropriate funding decisions.
More effective and efficient care
Upgrade knowledge routinely.
Up-to-date, Keeping up knowledge
explosion &med literature based on valid
evidence.
Improv...
Gives team a framework for group
problem solving & for teaching
Enables juniors to contribute fully to
the team.
VI. The...
•There is a significant gap between
EBM & application of this to clinical
practices
Clinical
Practice
Research
Haynes calls this the “evidence transfer gap”. EBM seeks to close the gap
between completed res...
•A mistaken thought, idea, or notion; a misunderstanding.
•Can happen anywhere, in any situation: not understanding a
topi...
The clinically-important knowledge of
physicians deteriorates rapidly after we
complete our training.
2. Expert opinion is the best evidence.
•Experience: “I always did it this way”
 Clinical experience is crucial.
 Clinic...
Traditional CME is completely ineffective in
changing our behavior.
A great deal of research reported in journals
is poo...
Setting Type I Type II No Evid.
Cancer center (USA) 24% 21% 55%
Tertiary surgical center (USA) 14% 64% 22%
Primary care ce...
Decision based on pathophysiologic
principles may be incorrect
Certain rules of evidence are
necessary.
Systematic unbiased observation
increases the confidence of the
physician knowl...
CAT = Critical appraisal of topic is
necessary
Critical appraisal: assessment of evidence
by systematically reviewing its...
1. Relevance:
Common to our practice &
patient-oriented outcome (POEM) not DOE
2. Validity: Free from bias (Truth)
 Rando...
•Derived from the Greek word mythos, which means "word of mouth."
•Something that is widely thought to be false
•Holy story
EBM focus on:
patient preference
clinical judgment of the
practitioner
best available evidence to
produce the best patien...
Three (Es) - EBM Components
EBP is a patient-centered approach &
is highly individualized
Begin & end with the patient in mind
Any practice that fa...
The traditional medical paradigm is based on
authority.
EBM is dependent on the use of RCT, systematic
reviews & meta-an...
RCT:
a group of patients is randomised into
study group & control group. These
groups are followed up for the
variables/ou...
Randomized Controlled study
 SR
A review of a clearly formulated question that
uses systematic & explicit methods to
1. identify, select and critical...
Why SR on the top:
Rigorous methodology
Peer reviewed
Relatively large sample size
Ensures the highest quality evidence
There are now many advocates of a more
inclusive approach to evidence:
Qualitative research is as valid a form of
evidenc...
It is not disputed that practice should be
grounded in theory, however it should be
predicated on the best available evid...
Disease-Oriented
Evidence
DOE (intermediate
outcomes)
▪ Pathophysiology,
pharmacology,
etiology, test result
▪ using drug ...
This indicates a fundamental
misunderstanding of the financial
consequences
Physicians identify & implement the
most eff...
EBP incorporates the more
extensive processes of
SECONDARY & TERTIARY
RESEARCH
searching,
appraisal,
synthesis and
incorp...
Refuted by audits from
within clinical care where at
least some inpatient clinical
teams have provided EB
care to patient...
EBP critically examines all
clinical procedures, critically
evaluating their appropriateness
for the specific situation.
...
The use of evidence is only one piece of
the clinical decision-making process.
Patient situations, preferences & values
...
It is impossible for any practitioner
to keep up with the entire health care
literature {2 million articles published
ann...
Do not need skills in biomathematics or
statistics
Physicians can gain skills to make
independence decisions & can evalu...
Search Cascade
EBM approach depends on high-quality
literature, which is lacking in many areas of
medicine
There are more RCT each year...
 Many myths & misconceptions exist in
health care practice
 Myths & misconceptions must be overcome
to implement EBM
 E...
Life is short &
the evidence is too
hard to find???
Thank you
Questions?
Ebm misconception myths facts
Ebm misconception myths facts
Ebm misconception myths facts
Ebm misconception myths facts
Ebm misconception myths facts
Upcoming SlideShare
Loading in...5
×

Ebm misconception myths facts

384

Published on

Ebm misconception myths facts

  1. 1. Prof. Aboubakr Elnashar Benha university, Egypt Email: elnashar53@hotmail.com
  2. 2.  Benefits of EBM  Misconceptions  Myths  Conclusion
  3. 3. Yes
  4. 4. EBM: Way of critical thinking Appropriate tool for sound clinical decisions Problem solving approach Life-long self-directed learning
  5. 5. Use: more effective intervention proven therapies and diagnostic tests only Result in: Better management of patients Better patient outcomes. Less harm or side-effects Better communication with patients about the rationale behind the management decisions.
  6. 6. More efficient use of resources Improve resource utilization Reduced cost per patient.
  7. 7. Using the best available evidence : Appropriate funding decisions. More effective and efficient care
  8. 8. Upgrade knowledge routinely. Up-to-date, Keeping up knowledge explosion &med literature based on valid evidence. Improve clinicians’ understanding of research methods & make them more critical in using data. Improves confidence in management decisions. Relieve anxiety about uncertainty Improves reading habits.
  9. 9. Gives team a framework for group problem solving & for teaching Enables juniors to contribute fully to the team. VI. The graduates: EBM curricula Self-directed Problem-based
  10. 10. •There is a significant gap between EBM & application of this to clinical practices
  11. 11. Clinical Practice Research Haynes calls this the “evidence transfer gap”. EBM seeks to close the gap between completed research activity and the practice of medicine. The “Evidence Transfer Gap” EBM
  12. 12. •A mistaken thought, idea, or notion; a misunderstanding. •Can happen anywhere, in any situation: not understanding a topic; not knowing the full story; hearing the wrong story… there’s many reasons how one can misunderstand something.
  13. 13. The clinically-important knowledge of physicians deteriorates rapidly after we complete our training.
  14. 14. 2. Expert opinion is the best evidence. •Experience: “I always did it this way”  Clinical experience is crucial.  Clinical guideline should be based on critical appraisal of medical literature
  15. 15. Traditional CME is completely ineffective in changing our behavior. A great deal of research reported in journals is poorly done, poorly analyzed: not valid & irrelevant to our patients and practices. Only 20% of health care is EB (Kerr White, 2002)
  16. 16. Setting Type I Type II No Evid. Cancer center (USA) 24% 21% 55% Tertiary surgical center (USA) 14% 64% 22% Primary care centers (Spain) 38% 4% 58% General medicine hospital (UK) 53% 29% 18% General psychiatric ward (UK) 65% 35% Anesthesia (Australia) 32% 65% 3%
  17. 17. Decision based on pathophysiologic principles may be incorrect
  18. 18. Certain rules of evidence are necessary. Systematic unbiased observation increases the confidence of the physician knowledge.
  19. 19. CAT = Critical appraisal of topic is necessary Critical appraisal: assessment of evidence by systematically reviewing its relevance, validity, results and applicability (RVRA)
  20. 20. 1. Relevance: Common to our practice & patient-oriented outcome (POEM) not DOE 2. Validity: Free from bias (Truth)  Randomization.  Follow up complete.  Intention to treat.  Blindness.  Similar groups at start.  Both groups treated equally. 3. Results: Clinically important (magnitude and precession) 4. Applicability: Applicable at my setting & useful for my patients
  21. 21. •Derived from the Greek word mythos, which means "word of mouth." •Something that is widely thought to be false •Holy story
  22. 22. EBM focus on: patient preference clinical judgment of the practitioner best available evidence to produce the best patient outcomes EBM takes into account the circumstances of the patient
  23. 23. Three (Es) - EBM Components
  24. 24. EBP is a patient-centered approach & is highly individualized Begin & end with the patient in mind Any practice that fails to take into account of the individual patient is not EBP Clinical evidence can never replace individual clinical expertise because this expertise decides whether the external evidence applies to the patient (Sackett, 1998)
  25. 25. The traditional medical paradigm is based on authority. EBM is dependent on the use of RCT, systematic reviews & meta-analysis, although it is not restricted to these.  RCT is  the epitome of all research designs because its design provides the strongest validity  It provides the best assurance that the result was due to the intervention
  26. 26. RCT: a group of patients is randomised into study group & control group. These groups are followed up for the variables/outcomes of interest. If the sample size is large enough, this study design avoids problems of bias and confounding variables
  27. 27. Randomized Controlled study
  28. 28.  SR A review of a clearly formulated question that uses systematic & explicit methods to 1. identify, select and critically appraise relevant research 2. collect & analyse data from the studies that are included in the review  Meta-Analysis The use of statistical techniques in a SR to integrate the results of included studies.
  29. 29. Why SR on the top: Rigorous methodology Peer reviewed Relatively large sample size Ensures the highest quality evidence
  30. 30. There are now many advocates of a more inclusive approach to evidence: Qualitative research is as valid a form of evidence as quantitative research There are now methodologies to systematic review both numerical and textual findings of research  EBP insists that each client is treated with the best available evidence, that practitioners make a genuine effort to find the best solution given their resources.
  31. 31. It is not disputed that practice should be grounded in theory, however it should be predicated on the best available evidence This is addressed by systematic reviews
  32. 32. Disease-Oriented Evidence DOE (intermediate outcomes) ▪ Pathophysiology, pharmacology, etiology, test result ▪ using drug x decreases the level of serum Lipid Patient-Oriented Evidence that Matters to the Patient POEM (final outcomes)  Mortality Morbidity quality of life  using drug x decreases morbidity & mortality
  33. 33. This indicates a fundamental misunderstanding of the financial consequences Physicians identify & implement the most efficacious treatments to maximize the outcomes for patients, this may increase costs EBP does not reduce the need for treatments, it attempts to ensure that each patient gets the best treatment appropriate for his/her condition.
  34. 34. EBP incorporates the more extensive processes of SECONDARY & TERTIARY RESEARCH searching, appraisal, synthesis and incorporation of the best available evidence into practice
  35. 35. Refuted by audits from within clinical care where at least some inpatient clinical teams have provided EB care to patients Busy clinicians who can devote their scarce time can practice EBM
  36. 36. EBP critically examines all clinical procedures, critically evaluating their appropriateness for the specific situation. Text books: Fail to recommend Rx up to 10 ys after it’s been shown to be efficacious. Continue to recommend therapy up to 10 ys after it’s been shown to be useless.
  37. 37. The use of evidence is only one piece of the clinical decision-making process. Patient situations, preferences & values are a key component in the process.
  38. 38. It is impossible for any practitioner to keep up with the entire health care literature {2 million articles published annually, 6000 articles published daily]. To keep up to date, physician should read 19 articles/d.  Lag time from time of “knowing” to time of implementation: 13 ys for thrombolytic therapy. 10 ys for corticosteroids to enhance fetal lung maturity.
  39. 39. Do not need skills in biomathematics or statistics Physicians can gain skills to make independence decisions & can evaluate expert opinions. EBP does not mean continous running to the library, but that clinicians should remember to search for evidence to support or refute their practice methods. EBM reduces reading by quality filters
  40. 40. Search Cascade
  41. 41. EBM approach depends on high-quality literature, which is lacking in many areas of medicine There are more RCT each year There are many other types of evidence to make good decisions.
  42. 42.  Many myths & misconceptions exist in health care practice  Myths & misconceptions must be overcome to implement EBM  EBM:
  43. 43. Life is short & the evidence is too hard to find??? Thank you Questions?
  1. Gostou de algum slide específico?

    Recortar slides é uma maneira fácil de colecionar informações para acessar mais tarde.

×