Evidence based medicine nandinii080100332
Upcoming SlideShare
Loading in...5
×
 

Evidence based medicine nandinii080100332

on

  • 461 views

 

Statistics

Views

Total Views
461
Views on SlideShare
461
Embed Views
0

Actions

Likes
0
Downloads
6
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • 1980-an di Universitas Mcmasters di Orianto, Canada. Dr David Sackett dan rakan-rakannya membentangkan cara mengajar, belajar yang baru serta mempraktiskannya - 1992: Gordon guyatt at mcmaster university <br />
  • Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. <br />
  • 1980-an di Universitas Mcmasters di Orianto, Canada. Dr David Sackett dan rakan-rakannya membentangkan cara mengajar, belajar yang baru serta mempraktiskannya - 1992: Gordon guyatt at mcmaster university <br />
  • Born: 12-Jul-1849Birthplace: Bond Head, Ontario, CanadaDied: 29-Dec-1919Location of death: Oxford, England <br /> The Principles and Practice of Medicine (1892, For thirty years, the authoritative general medical text) <br />

Evidence based medicine nandinii080100332 Evidence based medicine nandinii080100332 Presentation Transcript

  • EVIDENCE BASED MEDICINE (EBM) Nandinii Ramasenderan 080100332
  • OVERVIEW Definition History Factors driving EBM Steps in EBM Case discussion
  • WHAT IS EBM? A systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values -Da ve Sa c ke tt- Patient Concerns Best research evidence EBM Clinical Expertise
  • INTEGRATED WITH CLINICAL EXPERTISE
  • RISE OF EVIDENCE BASED MEDICINE
  • LIFE LONG LEARNING The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not … a medical course, but a life course, for which the work of a few years under teachers is but a preparation. Sir Willia m O s le r (1 8 49 -1 9 1 9 ), fro m : The Stud e nt o f M d ic ine e
  • STEPS IN PRACTISING EBM
  • STEP 1 : FORMULATE QUESTION Background Question -Ask for general knowledge about a condition or thing -Have 2 essential components: a)A question root (who, what, where, when how, why) and a verb b)A disorder, test, tx, or other aspect of health care. Eg: -how does heart failure cause ascites? -what causes SARS?
  • STEP 1 : FORMULATE QUESTION Foreground Question -Ask for specific knowledge to inform clinical decision / actions -4 essential components: a)Patient and /or problem b)Intervention (or exposure) c)Comparison, if relevant d)Outcome (clinical), including time if relevant Eg: “ In adults with he a rt fa ilure who are in sinus rhythm, would a d d ing wa rfa rin to standard therapy re d uc e m o rbid ity o r m o rta lity fro m thro m bo e m bo lis m enough over 3-5 years to be worth warfarin’s harmful effects and inconveniences.”
  • STEP 1 : Formulate Question The nature of the question asked is critically experience dependent. FOREGROUND TYPE OF QUESTION BACKGROUND CLINICAL EXPERIENCE
  • STEP 2: USE BEST EVIDENCE TO ANSWER QUESTION Computerized decision support system (CDSS) Evidence-based journal abstracts Cochrane reviews Original published articles in journals
  • STEP 2: USE BEST EVIDENCE TO ANSWER QUESTION System Synopses -Evidence based clinical information, researches -A brief summary/ review of individual studies -Electronic based -Provide only information to support a clinical action BMJ Clinical Evidence ( http://www.clinicalevidence.com) UpToDate (http://www.uptodate.com) PIER: The Physician’s Information and Education Resource (http://pier.acponline.org/index.html). ACP [American College of Physicians] Journal Club(http://www.acpjc.org EBM (http://ebm.bmj.com).
  • STEP 2: USE BEST EVIDENCE TO ANSWER QUESTION Syntheses Studies -summaries of articles/ reviews -original research journal The Cochrane Library Web site (http://www3.interscience.wiley.com/ cgibin/mrwhome/106568753/HOME) Medline/ PubMed Clinical Queries (www.pubmed.com) DARE(www.york.ac.uk/inst/crd/welcome .htm) EMBASE (OVID) (www.ovid.com)
  • HIERARCHY OF EVIDENCE PYRAMID
  • LEVEL OF EVIDENCE Level type of investigation Ia Evidence obtained from meta analysis of randomized controlled trials Ib Evidence obtained from at least one randomized controlled trial IIa Evidence obtained from at least one well designed controlled study without randomization IIb Evidence obtained from at least one other type of well designed quasi experimental study III Evidence obtained from well designed non experimental studies, such as comparative studies, correlational studies, and case studies IV Evidence obtained from expert committee reports or opinions
  • STEP 3: CRITICALLY APPRAISE EVIDENCE To understand the methods and results of research and to assess the quality of the research THREE MAIN ASPECTS TO BE APPRAISED: 1. VIA VALIDITY : VALID (CLOSENESS TO THE TRUTH) → IN THE METHODOLOGY SECTION 2. IMPORTANCE : IMPORTANT (USEFULNESS) → IN THE RESULTS SECTION 3. APPLICABILITY : APPLICABLE (CAN BE APPLIED IN CLINICAL PRACTICE) → IN THE DISCUSSION SECTION
  • STEP 4: INTEGRATE FINDINGS INTO PRACTISE Making a concise decision based on research finding & information found. Discuss with patient regarding our findings & risk-benefit assessment
  • CASE DISCUSSION
  • 68 years old Malay Female Hx of Congestive Heart Failure & Hypertension Surgical Hx: CABG 10 years ago On medication: Digoxin, Lasix, Isosorbide nitrate Mild increase of dysnea on exertion past 4 days Having acute Shortness of breath 1hour prior to admission
  • On examination: BP: 188/104 mmHg Pulse rate:122 bpm Respiratory rate: 30 Temp: 37.5 Celsius SpO2: 90% (On Non-rebreather mask) Lung auscultation: Crackles to ½ bilateral Jugular vein distended, S3 gallop Pretibial edema bilaterally
  • PLAN & INVESTIGATION IV, O2, & vital sign Monitoring Chest Xray, ECG, Cardiac markers, Digoxin level ECG: Sinus tachycardia, old inferior myocardial infarction, no st-elevation changes CXR: acute pulmonary edema (pulmonary venous congestion, small bilateral effusion) Treatment  GTN  Lasix  Morphine
  • QUESTION—GENERAL STATEMENT What about using ACE inhibitors for acute pulmonary edema?
  • BACKGROUND •Describe pathophysiology of CHF and acute pulmonary edema •Discuss causes of decompensation of CHF •Discuss Differential Diagnosis of acute pulmonary edema •Relate pathophysiology of CHF to treatment, especially role of ACE-I in CHF •Describe treatment goals •Describe standard treatment of CHF
  • EBM QUESTION Patients: Acute Pulmonary Edema Intervention: ACE Inhibitor Comparison: Placebo Outcome:  Mortality  Intubation  Hemodynamic parameters  ICU/CCU admission
  • THANK YOU