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Evidence Based Medicine Module 1: Introduction to EBM Module 2: Applying EBM--Diagnosis Module 3: Applying EBM--Treatment   Prepared by: Jennifer Kleinbart, MD, Asst. Professor of Medicine, Director, EBM Curriculum Emory University School of Medicine Mark V. Williams, MD, Associate Professor of Medicine, Director, Hospital Medicine Unit Emory University School of Medicine Lawrence Blond, MD, Associate Director Graduate Medical Education, Alton Ochsner Medical Foundation
Evidence Based Medicine An evidence-based approach to answering clinical questions
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Bloodletting The cure for hot, moist diseases
Pierre Louis (1787-1872) Inventor of the “numeric method” and the “method of observation” Found that,  on average, patients who were bled did  worse   than those who were not.
Overall Results (n=77) “ Experimental” Group “ Control” Group Absolute Risk Reduction - 19% 25% 44% Mortality Difference Bled Late Bled Early
William Osler (1849 -1919) First “attending physician” at Johns Hopkins Hugely influential textbook author, believed that most drugs in his day were useless,  but still  advocated blood-letting  in some cases.
But…. We practice EBM today
Patient:  Mr. A ,[object Object],[object Object],[object Object],What is the best evidence?
Evidence: 1988 ,[object Object],[object Object],[object Object]
Application: 1997 ,[object Object],[object Object],[object Object],Annals of Intern Medicine. Jul 1997;127(2):126
EBM Misconceptions EBM is useless when there is no good evidence EBM means appropriately using the best available evidence to care for patients EBM is algorithms that ignore clinical judgment/expertise Clinical judgment must be used in deciding how to apply the evidence EBM is just numbers and statistics EBM is not numbers in a vacuum – the evidence must be individualized to each patient FACT FALLACY
EBM - What is it?   Clinical Expertise Research  Evidence Patient Preferences
Why EBM? ,[object Object],[object Object],[object Object],[object Object]
Why EBM? ,[object Object],[object Object],[object Object]
Besieged with Information ,[object Object],[object Object],[object Object],[object Object],[object Object]
Besieged with Information ,[object Object],[object Object]
So, how does it work?   EBM Method
EBM Method A cquire  the  best evidence A ppraise  the evidence A pply evidence to  patient care A ssess  your patient A sk  clinical  questions
Assess Your Patient ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ask Clinical Questions Components of Clinical Questions Patient/ Population Outcome Intervention/ Exposure Comparison In patients with acute MI In post- menopausal women In women with suspected coronary disease does early treat- ment with a statin what is the  accuracy of exercise ECHO does hormone replacement  therapy compared to  placebo compared to  exercise ECG compared to no HRT decrease cardio- vascular mortality? for diagnosing significant CAD? increase the risk of  breast cancer?
Acquire the Best Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appraise the Evidence ,[object Object],[object Object],[object Object]
Appraise the Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A pply the Evidence ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rules of Evidence ,[object Object],[object Object],[object Object]

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Evidence Based Medicine Intro

  • 1. Evidence Based Medicine Module 1: Introduction to EBM Module 2: Applying EBM--Diagnosis Module 3: Applying EBM--Treatment Prepared by: Jennifer Kleinbart, MD, Asst. Professor of Medicine, Director, EBM Curriculum Emory University School of Medicine Mark V. Williams, MD, Associate Professor of Medicine, Director, Hospital Medicine Unit Emory University School of Medicine Lawrence Blond, MD, Associate Director Graduate Medical Education, Alton Ochsner Medical Foundation
  • 2. Evidence Based Medicine An evidence-based approach to answering clinical questions
  • 3.
  • 4. Bloodletting The cure for hot, moist diseases
  • 5. Pierre Louis (1787-1872) Inventor of the “numeric method” and the “method of observation” Found that, on average, patients who were bled did worse than those who were not.
  • 6. Overall Results (n=77) “ Experimental” Group “ Control” Group Absolute Risk Reduction - 19% 25% 44% Mortality Difference Bled Late Bled Early
  • 7. William Osler (1849 -1919) First “attending physician” at Johns Hopkins Hugely influential textbook author, believed that most drugs in his day were useless, but still advocated blood-letting in some cases.
  • 9.
  • 10.
  • 11.
  • 12. EBM Misconceptions EBM is useless when there is no good evidence EBM means appropriately using the best available evidence to care for patients EBM is algorithms that ignore clinical judgment/expertise Clinical judgment must be used in deciding how to apply the evidence EBM is just numbers and statistics EBM is not numbers in a vacuum – the evidence must be individualized to each patient FACT FALLACY
  • 13. EBM - What is it? Clinical Expertise Research Evidence Patient Preferences
  • 14.
  • 15.
  • 16.
  • 17.
  • 18. So, how does it work? EBM Method
  • 19. EBM Method A cquire the best evidence A ppraise the evidence A pply evidence to patient care A ssess your patient A sk clinical questions
  • 20.
  • 21. Ask Clinical Questions Components of Clinical Questions Patient/ Population Outcome Intervention/ Exposure Comparison In patients with acute MI In post- menopausal women In women with suspected coronary disease does early treat- ment with a statin what is the accuracy of exercise ECHO does hormone replacement therapy compared to placebo compared to exercise ECG compared to no HRT decrease cardio- vascular mortality? for diagnosing significant CAD? increase the risk of breast cancer?
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.