ASCO2013 Carmen

1. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

2. Steps in Practicing EBM
1. Convert the need for information into an answerable
question.
2. Track down the best evidence with which to answer
that question.
3. Critically appraise the evidence for its validity, impact,
and applicability.
4. Integrate the evidence with our clinical expertise and
our patient’s characteristics and values.
● Evidence-based medicine is the integration of the best
available research evidence with clinical expertise and
patient values.
Matt Hollon MD MPH, Assistant Professor, UWMC General Internal Medicine,
e-mail: mfhollon@u.washington.edu

3. The nature of the question asked is critically
experience dependent.
GENERAL KNOWLEDGE
SPECIFIC KNOWLEDGE
TYPE OF
QUESTIO
N
CLINICAL EXPERIENCE
Sherry Dodson MLS, Clinical Medical Librarian,
UW Health Sciences Library,
e-mail: sdodson@u.washington.edu

4. The Evidence Pyramid
Validity/Strength
of
Inference
Time
Spent
in
Critical
Appraisal

5. 0
500000
1000000
1500000
2000000
2500000
Biomedical MEDLINE Trials Diagnostic?
Medical
Articles
per
Year
5,000?
per day
2,000
per day
75 per
day
Articles
Per
Year
why do we need to use evidence efficiently?
EBP: informing decisions with the best up-to-date evidence

6. Levels of Evidence

7. core components of ‘traditional’
evidence based decision-making
‘modern’ EBM explicitly emphasises ‘current’ best
clinical epidemiological evidence

8. Best
Available
Evidence
Clinical
Expertise
Patient Values
and
Preferences
Quality
of Life
Costs
Integrates Evidence With

9. The Five “A’s”
1. Ask the right question
2. Acquire the evidence
3. Appraise the evidence
4. Apply the evidence
5. Assess its impact
PICOS
P roblem/population
I ntervention
C omparison
O utcome
S tudy design
Steps of EBM-5 A’s
• Ask
• Acquire
• Appraise
• Apply
• Assess

10. DIAGNOSTIC TEST
D I S E A S E
Present Absent TOTALS
Test
positive
True
Positive
False
Positive
All positive
Test
negative
False
Negative
True
Negative
All
negative
TOTALS
All with
disease
All
without
disease
Entire
population
T
E
S
T

11. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

12. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

13. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

14. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

15. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

16. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

17. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

18. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

19. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

20. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

21. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

22. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting

23. [TITLE]
Presented By Michael J. Glantz, MD at 2013 ASCO Annual Meeting