Evidence based general kasr einy

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Evidence based general kasr einy

  1. 1. Good clinical practice <ul><li>Evidence-based medicine </li></ul><ul><li>Biological knowledge of health and disease (Rational of clinical judgment). </li></ul><ul><li>Awareness of social and cultural values. </li></ul>
  2. 2. Clinical Reasoning <ul><li>Evidence </li></ul><ul><li>Doctor </li></ul><ul><li>Patient </li></ul>
  3. 3. Clinical reasoning: different scenarios 1 Cancer treatment 2 Infertility treatment
  4. 4. Problems With Evidence-Based Medicine in Infertility <ul><li>Insufficient evidence to support </li></ul><ul><li>some diagnostic tests. </li></ul><ul><li>Many treatment modalities. </li></ul>
  5. 5. Problems with Evidence Based Infertility Treatment Problems of Diagnosis (Example) Semen analysis: Count : 80,60,40,20, less Motility Abnormal forms
  6. 6. Problems with evaluating evidence Errors <ul><li>Type I error: </li></ul><ul><ul><li>P<0.05: we accept this chance of error (5%). The error could be inflated by a subgroup analysis. </li></ul></ul><ul><li>Type II error: (more common) </li></ul><ul><ul><li>Investigators did not detect a difference when a difference actualy exists. </li></ul></ul><ul><ul><li>We accept 20% error = power of the study is 80%. </li></ul></ul>
  7. 7. Problems with evaluating evidence <ul><li>Confounding factor: </li></ul><ul><li>Factor associated with both treatment (as risk factor) and the outcome under study. </li></ul><ul><li>e.g.: low dose contraceptive pills. </li></ul>
  8. 8. Problems with evaluating evidence <ul><li>Bias: is systematic error in collection or interpretation of study information. </li></ul><ul><ul><li>Selection bias: </li></ul></ul><ul><ul><ul><li>Dissimilar selection criteria. </li></ul></ul></ul><ul><ul><li>Information bias: </li></ul></ul><ul><ul><ul><li>IUI*PID </li></ul></ul></ul>
  9. 9. Problems with evaluating evidence Number needed to treat <ul><li>Until recently, it was acceptable to look for (P values) in the results and the difference is considered significant if P <0.05. </li></ul><ul><li>The magnitude of the effect of the intervention is of utmost clinical importance to evaluate the implications of this significance. </li></ul>
  10. 10. we should remember that what is statistically significant might not always be clinically relevant

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