Evidence based medicine

1. EVIDENCE
BASED
MEDICINE
Dr. SANKALP DIXIT
RESIDENT
Dept of Psychiatry, KGMU, Lucknow

2. EVIDENCE
BASED
MEDICINE
“Evidence-based medicine is the integration of
best research evidence with clinical expertise
and patient values” - David Sackett
May be defined as “Explicit, judicious, and
conscientious use of current best evidence
from medical care research to make decisions
about the medical care of individuals”

3. • “the process by which the best available
research evidence ( from well-designed
studies), clinical expertise, and patient
preferences are used for making clinical
decisions.”

5. EVIDENCE
BASED
HEALTH
CARE
PRACTICE
• The integration of: –
– individual clinical expertise
– best available external clinical evidence
from systematic research

6. INDIVIDUAL
CLINICAL
EXPERTISE
• Skills
• Judgement
– which individual health care
workers acquire through clinical
experience and clinical practice

7. BEST
AVAILABLE
CLINICAL
EVIDENCE
Clinically relevant research derived from:
1. basic medical sciences and
2. patient-centered clinical research into the
safety and efficacy of therapeutic interventions
3. Systematic Reviews

8. Why is EBM important?
• New types of evidence are being generated
which can create changes in the way patients
are treated

9. • Clinical experience without timely
upgradation of knowledge can result in
decline of clinical performance
• The need for valid information about
diagnosis, therapy, prognosis, and prevention
in the era of consumer activism
• Limited time available to the clinician

10. EBM
believes
that…
• Not all evidence is equivalent
• There is a hierarchy of study design
• External evidence can inform but can never
replace individual clinical expertise (Sackett et
al)
• Helps in incorporation of best clinical
evidence
• Cultural and social values always influence
decisions

15. Randomized controlled
trials (RCTs)
considered the "gold standard" in medical research
• An experimental comparison study in which participants are
allocated to treatment/intervention or control/placebo groups
using a random mechanism (randomization)
• Best for studying the effect of an intervention.

16. Randomized controlled trial

17. Systematic review
• Systematic reviews methodically and comprehensively
– identify studies focused on a specified topic
– appraise their methodology
– summate the results
– identify key findings and reasons for differences across
studies
– cite limitations of current knowledge
• A systematic review can be presented in text or graphic form

18. Meta-analysis
• A particular type of systematic review that uses quantitative
methods to combine the results from a number of studies
• Retrospectively looks at the data

19. Systematic review Meta analysis
A summary of medical literature that
uses explicit methods to perform a
comprehensive literature search and
critical appraisal of individual studies
A type of Systematic review that uses
quantitative methods to synthesize and
summarize the results
Results are too heterogenous to pool
and analyze as a single data set
Results are homogenous enough to
pool and analyze as a single data set

21. Case control
studies
• Patients with a certain outcome or disease
and an appropriate group of controls without
the outcome or disease are selected
• Information is obtained on whether the
subjects have been exposed to the factor
under investigation.

22. Cohort
study
• Data are obtained from groups who have
been exposed, or not exposed, to a factor of
interest
• No allocation of exposure is made by the
researcher

23. Evidence based medicine and decision
making
• Decision-making is the cognitive process
resulting in the selection of a course of action
among several alternative possibilities

24. Decision
making
process

25. • Shaw-Kokot & Philpotts in 2015 gave 5As of EBP
1. Ask - Identify a problem or need for change for a specific patient or
situation.
2. Acquire literature that address the issue
3. Appraise - Evaluate and synthesize the research evidence
regarding its validity, relevance, and applicability
4. Apply the evidence and choose interventions that are based on the
best available evidence
5. Assess the outcomes, using clearly defined criteria and document
results

27. BENEFITS
OF
CHOOSING
EBM
Minimize the
errors in
patient care
Reduces the
cost of
treatment
Optimizes the
quality of
patient care
Accessing
literature on a
daily basis
ensures
advancement
of knowledge

28. Prof Archibald Cochrane
(1909 - 1988)
• The Cochrane Collaboration is named in honor of
Archibald Cochrane, a British researcher.
"It is surely a great criticism of our profession that we
have not organized a critical summary, by specialty or
subspecialty, adapted periodically, of all relevant
randomized controlled trials”

29. • Established in 1993 , the Cochrane
Collaboration aims to produce and
disseminate reliable and up-to-date
information to support decision making in
health care
• A wide and growing range of health, social,
and economic topics are covered
can be utilized to
determine the
effectiveness and
appropriateness of
interventions, to
develop guidelines,
and to use in policy
making.

30. EBM
provides…

31. • Evidence-based MedicineWorkbook-Finding and
applying the better research , Paul Glasziou,Chris Del
Mar and Janet Salisbury
• Sackett, D. L., Straus, S. E., Richardson,W. S.,
Rosenberg,W., Haynes, R. B.: Evidence- Based
Medicine – How to Practice andTeach EBM 2nd Ed.,
Churchill. Livingstone, 2000
• Essentials of psychiatric mental health nursing 3rd
Edition, Elizabeth MVarcolis