Evidence based medicine


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  • Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2. This definition of what EBM is and isn’t has gained wide acceptance and made it easier for us to get our points across.
  • “ Explicit , judicious , and conscientious use of current best evidence from medical care research to make decisions about the medical care of individuals ” Clinical expertise IS important! Why? Experience with patients: improves efficiency of diagnosis and treatment Improves ability to determine applicability of research data to your patients Allows consideration of patient preferences EBM is the process of systematically finding the most recent applicable research, appraising its validity, and using it as the basis for clinical decisions. Clinical Expertise improves efficiency of Dx and Rx considers patient preferences Overestimates usefulness of therapy -placebo effect - loss to follow-up “ Have not all concerned physicians been doing this (EBM) for ages... ? The steps and recommendations of the EBM acolytes reek of obfuscations and platitudes.” WKC Morgan, London, Ontario Lancet , October 28, 1995
  • Convert clinical information needs into answerable questions. Track down the best evidence to answer question. Critically appraise evidence for its validity and usefulness. Apply results to your clinical practice. Evaluate our performance.
  • Evidence based medicine

    1. 1. Evidence Based Medicine Where to go??????????
    2. 2. <ul><li>Clinical medicine is currently in transition from experience -oriented practice to an evidence -based one which requires the best available evidence that answers our clinical questions </li></ul>
    3. 3. What evidence-based medicine is: <ul><li>“ Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values ” - Sackett, et al 2001 </li></ul>
    4. 4. EBM - What is it? Clinical Expertise Research Evidence Patient Preferences
    5. 5. Is All Evidence created Equal!!
    6. 6. RCT ’ s <ul><li>Randomised controlled trials (RCTs) are considered the “ gold standard ” for judging whether a new intervention does more good than harm. </li></ul><ul><li>The number of randomised controlled trials under primary care has increased 5-fold since 1986 . </li></ul>
    7. 7. Search Strategy <ul><li>First search appraised resources </li></ul><ul><li>Next using Traditional search medical resources </li></ul>
    8. 8. Keep in mind <ul><li>Evidence is available in many topics and insufficient in much more </li></ul>
    9. 9. Where to look? <ul><ul><li>Multiple source </li></ul></ul><ul><ul><li>OR </li></ul></ul><ul><ul><li>Single source!!! </li></ul></ul>
    10. 10. Cochrane Library <ul><li>The current resource with the highest methodological rigor </li></ul><ul><ul><li>$235/year or abstracts only </li></ul></ul><ul><li>www.cochrane.org </li></ul><ul><li>Specific point: e.g role of albumin in OHSS </li></ul><ul><ul><li>most of medicine has not been studied enough to allow for conclusions </li></ul></ul>
    11. 11. Cochrane Library <ul><li>For each clinical question, all of the English literature meticulously searched for randomized trials </li></ul><ul><li>Large systematic reviews with valid methods + collaborative effort </li></ul><ul><li>Conclusions are based on all the evidence from valid randomized trials </li></ul>
    12. 12. Clinical Evidence <ul><li>www.clinicalevidence.com </li></ul><ul><li>Discuss topic as a whole : e.g Infertility </li></ul>
    13. 13. Bimonthly journal <ul><li>80 journals scanned </li></ul><ul><li>valid </li></ul><ul><ul><li>Intervention: RCT </li></ul></ul><ul><ul><li>Prognosis: cohort </li></ul></ul><ul><li>relevant </li></ul>www.evidence-basedmedicine.com
    14. 14. UpTodate <ul><li>www.uptodateonline.com </li></ul><ul><li>Needs subscription </li></ul>
    15. 15. Evidence based guidelines <ul><li>http://www.guideline.gov/ </li></ul><ul><li>Free access </li></ul>
    16. 16. PubMed <ul><li>Includes almost 40% of published journals </li></ul><ul><li>Well categorized </li></ul><ul><li>PubMed Central : selected Free Full text </li></ul><ul><li>Search for meta-analysis </li></ul><ul><li>Search for RCTs </li></ul>
    17. 17. Drilling for the Best Evidence
    18. 18. Apply results to your patients Understand evidence Find the best evidence to answer questions clinical information needs Answerable questions EBM Method