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Evidence based medicine


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Evidence based medicine

  1. 1. EVIDENCE BASED MEDICINE By Dr. Lala Rukh Bangash Mayo Hospital, lhr.
  2. 3. What is a Evidence Based Medicine? <ul><li>Evidence based medicine (EBM) has been defined as a “ systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values ” . </li></ul>
  3. 5. EBM --- An old concept <ul><li>What IBN E SEENA has to say about it </li></ul><ul><li>In post revolutionary Paris </li></ul>
  4. 6. EBS ---- in modern world <ul><li>The term &quot;evidence-based medicine&quot; first appeared in the medical literature in 1992 in a paper by Guyatt et al. </li></ul><ul><li>The explicit methodologies used to determine &quot;best evidence&quot; were largely established by the McMaster University research group led by David Sackett and Gordon Guyatt . </li></ul>
  5. 7. EBM uses a series of steps: <ul><li>formulate an answerable question </li></ul><ul><li>locate the best evidence of outcomes available </li></ul><ul><li>critically appraise the evidence (i.e. find out how good it is) </li></ul><ul><li>apply the evidence by integrating results with clinical expertise and patient values </li></ul><ul><li>evaluate the effectiveness and efficiency of the process </li></ul>
  6. 8. Why do we need EBM?
  7. 9. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning.
  8. 10. Traditional vs EBM <ul><li>EBM starts with the notion that all evidence is not equal and something which traditional practice has missed out. Traditionally it was assumed anything published in research articles was correct and could be used in clinical practice. </li></ul>
  9. 11. <ul><li>Not an attempt to take over the clinical world </li></ul><ul><li>Just another TOOL to get the best possible care </li></ul>
  10. 12. Greatest achievements of evidence-based medicine <ul><li>Meta analysis and systametic reviews </li></ul><ul><li>identify different studies on a particular clinical question </li></ul><ul><li>Critical analysis of evidence </li></ul><ul><li>Summary </li></ul>
  11. 13. EBM is not simply about finding evidence of what works but finding evidence that matters .
  12. 14. <ul><li>We need to ask, 'How is this going to change the patient's overall prognosis and outcome and quality of life?'  </li></ul><ul><li>make sure we are doing things that will make a difference. </li></ul><ul><li>If it's not going to change any of these things, then we shouldn't be doing it. </li></ul>
  13. 15. Limitations: <ul><li>Although evidence-based medicine is becoming regarded as the &quot; gold standard &quot; for clinical practice there are a number of limitations and criticisms of its use. </li></ul>
  14. 16. <ul><li>Ethics </li></ul><ul><li>Cost </li></ul><ul><li>Publication bias </li></ul><ul><li>Ghost writers </li></ul><ul><li>Political criticism </li></ul>
  15. 17. <ul><li>The knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand and suggests that evidence-based medicine should not discount the value of clinical experience </li></ul>