Evidence Based Medicine

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Evidence Based Medicine

  1. 1. Dr. Nisreen A. Jastaniah Assist Prof KSAU-HS Consultant Geriatric Medicine KAMC-J
  2. 2. Problem solving methods other … • Hani ( 47 years) software programmer Thinking about early retirement …. (retirement and health) Discussion
  3. 3. Problem solving methods Scientific…( searching for evidence) • HANI ( 47 years) software programmer Thinking about early retirement …. Discussion , retirement and health
  4. 4. Problem solving methods Scientific…( searching for evidence)
  5. 5. Problem solving methods Scientific…( searching for evidence)
  6. 6. Problem solving methods Scientific…( searching for evidence)
  7. 7. Problem solving methods Scientific…
  8. 8. Needs • We need evidence (about the accuracy of diagnostic tests, the power of prognostic markers, the comparative efficacy and safety of interventions, etc.) • about 5 times for every in-patient (and twice for every 3 out-patients). • We get less than a third of it 9
  9. 9. Why Evidence Based Health Care? • Too many patients • Too many problems • Too many journals • Information overload • No time to read • Read what I am familiar with • Avoid difficult issues 10
  10. 10. EBM; IS IT NEW? ‫الميالدي‬ ‫التاسع‬ ‫االقرن‬ ‫في‬ ‫إليه‬ ‫دعا‬ ‫من‬ ‫أول‬ ‫الرازي‬(865 –915)‫قال‬ ‫حين‬ “‫وأيدته‬ ‫القياس‬ ‫عليه‬ ‫وشهد‬ ‫األطباء‬ ‫عليه‬ ‫أجمع‬ ‫ما‬ ‫إنه‬ ‫التجربة‬“ 11
  11. 11. April 2006 12 ..‫المقدمات‬ ‫انتقاد‬ ‫مع‬,‫في‬ ‫والتحفظ‬ ‫النتائج‬,‫ما‬ ‫جميع‬ ‫في‬ ‫نتحرى‬ ‫و‬ ‫ال‬ ‫الحق‬ ‫طلب‬ ‫ننتقده‬ ‫و‬ ‫نميزه‬ ‫اآلراء‬ ‫مع‬ ‫الميل‬......
  12. 12. Requirements of new treatment • The drug must have a defined mode of action • It must be tested on a well defined disease • The time of action must be observed • The effect of the drug must be seen to occur constantly in many cases • The experimentation must be done with the human body for testing a drug on a lion or a horse might not prove anything about its effect on man Ibn Sina 981-1037 13
  13. 13. When did EBM begin ? • Dr. Archie Cochrane (British epidemiologist and a leading EBM theoretician, estimated a decade ago that only 15-20% of all medical practice is based on scientific, statistically sound research. 14
  14. 14. Evidence-based medicine Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values. 16
  15. 15. Steps of evidence based medicine 1)Ask a question 2)Acquire some articles 3)Appraise the evidence 4)Apply the findings 5)Assess our performance 17
  16. 16. Steps of evidence based medicine Step 1: formulating an answerable question  Patient or Problem  Intervention  Comparison Intervention  Outcome. 18
  17. 17. Steps of evidence based medicine Step 2: Tracking down the best available evidence Tracking down the best evidence with which to answer that question.( diagnosis, therapy ,prognosis…) 19
  18. 18. Steps of evidence based medicine Step 2: Tracking down the best available evidence study design  Primary studies (therapy ,diagnosis ,harm &prognosis ).  Integrative studies (overview ,practice guidelines..). 20 .
  19. 19. Steps of evidence based medicine Step3: Critically appraising that evidence  validity (closeness to the truth),  impact (size of the effect) the results, and  applicability. 21
  20. 20. Steps of evidence based medicine Step4: Integrating of the best available evidence to our patients  our patient's unique biology, values and circumstances. 22
  21. 21. Steps of evidence based medicine Step 4: Integrating of the best available evidence to our patients The evidence Clinical experiencePatient values 23
  22. 22. Steps of evidence based medicine Step5: Evaluating our effectiveness in executing Steps 1-4 and seeking ways to improve them both for next time. 24
  23. 23. Steps of evidence based medicine • Do We need always carry out all 5 steps to provide E- B Care ? Searching & appraising” o provides E B care, but is expensive in time and resources “Searching only” o much, quicker, and if carried out among E B resources, can provide E B care. 25
  24. 24. POEMs & DOEs POEM Patient Oriented Evidence that Matters 26 DOE Disease Oriented Evidence HRQL (Health Related Quality of life) for example, mobility, self-care, and physical, emotional, and social function).
  25. 25. Relevance: Type of Evidence • DOE: Disease-oriented evidence o pathophysiology, pharmacology, etiology • POE: Patient-oriented evidence o mortality, morbidity, quality of life, satisfaction 27
  26. 26. Study design & Evidence based clinical practice Different questions study design • Prevalence or frequency of factor Cross sectional study •Hypotheses about possible Harm (or causes) Case-control • Harm or Causes or risk factors Cohort • Experience of illness Qualitative • Effectiveness Randomized controlled trial
  27. 27. Original Study LongitudinalDescriptive Cross sectional Case report Case series interventionalobservational Case-control cohort Integrative Studies SR Evidence Study design & Evidence based clinical practice
  28. 28. Study design & Evidence based clinical practice
  29. 29. 31 1)Ask a question 2)Acquire some articles 3)Appraise the evidence OR use appraised evidence 4)Apply the findings 5)Assess our performance ? Steps of evidence based medicine
  30. 30. Types of health care professional 32 Evidence Finders Evidence Users Evidence generator Evidence Ignorer
  31. 31. Questions?
  32. 32. 34 1)Ask a question 2)Acquire some articles 3)Appraise the evidence OR use appraised evidence 4)Apply the findings 5)Assess our performance ? Steps of evidence based medicine
  33. 33. THANK YOU 36

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