a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
complete description of causality assessment with the definition of basic terminologies.& relation with an adverse event and adverse drug reaction, causality terms & assessment criteria.
a brief overview about how and why to practice evidence based medicine, its clinical application, what it is and what it is not? benefits and challenges
EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.
complete description of causality assessment with the definition of basic terminologies.& relation with an adverse event and adverse drug reaction, causality terms & assessment criteria.
If you are marketing your product in India you should comply these area of regulation.We give Services in getting manufacturing licences
ACCREDITED CONSULTANTS PVT.LTD
info@acplgroupindia.co.in
+919310040434
inform consent form before participate in clinical trials.for purpose of understanding the nature of research,risk,benefits,and decision about participation
A concise overview of pharmacoeconomics, health economics, various costs, various pharmacoeconomic study designs and its application in the field of medicine and drug development
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
If you are marketing your product in India you should comply these area of regulation.We give Services in getting manufacturing licences
ACCREDITED CONSULTANTS PVT.LTD
info@acplgroupindia.co.in
+919310040434
inform consent form before participate in clinical trials.for purpose of understanding the nature of research,risk,benefits,and decision about participation
A concise overview of pharmacoeconomics, health economics, various costs, various pharmacoeconomic study designs and its application in the field of medicine and drug development
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Study designs, Epidemiological study design, Types of studiesDr Lipilekha Patnaik
Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
5 Reasons the Practice of Evidence-Based Medicine Is a Hot TopicHealth Catalyst
Evidence-based medicine is an important model of care because it offers health systems a way to achieve the goals of the Triple Aim. It also offers health systems an opportunity to thrive in this era of value-based care. In specific, there are five reasons the industry is interested in the practice of evidence-based medicine: (1) With the explosion of scientific knowledge being published, it’s difficult for clinicians to stay current on the latest best practices. (2) Improved technology enables healthcare workers to have better access to data and knowledge. (3) Payers, employers, and patients are driving the need for the industry to show transparency, accountability, and value. (4) There is broad evidence that Americans often do not get the care they need. (5) Evidence-based medicine works. While the practice of evidence-based medicine is growing in popularity, moving an entire organization to a new model of care presents challenges. First, clinicians need to change how they were taught to practice. Second, providers are already busy with increasingly larger and larger workloads. Using a five-step framework, though, enables clinicians to begin to incorporate evidence-based medicine into their practices. The five steps include (1) Asking a clinical question to identify a key problem. (2) Acquiring the best evidence possible. (3) Appraising the evidence and making sure it’s applicable to the population and the question being asked. (4) Applying the evidence to daily clinical practice. (5) Assessing performance.
RMNCH+A is a NEW approach to address the health problems Mother, Newborn, Child & Adolescence simultaneously at different stages of life through 'CONTINUUM OF CARE'.
Hope this presentation will help to have a glimpse of the program.
How health analytics are changing the way we understand and manage healthcare. Presented by Professor Enrico Coiera, Faculty of Medicine at the University of NSW, Australia, at HINZ 2014, 11 November 2014, 10am, Plenary Room
In the present days of increasing consumer awareness and distrust among the public towards the medical profession its time to introspect & rectify ....
suicide - a public health problem
history, global scenario, Indian scenario, etiology, risk factors. protective factors, suicide in adolescents, treatment, prevention, recommendations
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Immunity to Veterinary parasitic infections power point presentation
Evidence based medicine
1. Evidence Based Medicine
Presenter : Dr. Suhasini K.
Dept. Community Medicine
J.N.M.C., Belagavi
23 January 2015 1Evidence Based Medicine
2. Heading
• Introduction
• Definition of Evidence Based Medicine
• Evidence-based health care practice
• Importance of EBM
• Evolution of EBM
• Decision making in EBM
• Five-Step Approach to Practicing EBM
• Benefits of adopting EBM
• Misconceptions in EBM
• Evidence-based Public Health
• Conclusion
23 January 2015 Evidence Based Medicine 2
3. Which doctor do you want?
23 January 2015 3Evidence Based Medicine
4. Which doctor do you want?
23 January 2015 4Evidence Based Medicine
5. Bloodletting
3000years ago
Egyptians, Greeks then
Romans, Arabs and so
on.
The cure for (hot, moist
diseases) several
medical conditions.
Galen was able to
propagate his ideas
through the force of
personality and the
power of the pen23 January 2015 5Evidence Based Medicine
6. Pierre Louis (1787-1872)
Inventor of the “numeric method” and the “method of
observation”
French physician who wanted
to analyze the efficacy of
bloodletting in the treatment
of acute pneumonia
Examined the clinical
course and outcomes of 77
patients
23 January 2015 6Evidence Based Medicine
7. Overall Results (n=77)
“Experimental”
oup
Comparision
Group
Absolute
Risk Reduction
Bled Early
Phase
Bled Late
Phase
Difference
Mortality 44% 25% - 19%
Conclusion: Effect of bloodletting procedure was actually much
less helpful than has been commonly believed
23 January 2015 7Evidence Based Medicine
8. William Osler (1849 -1919)
First “attending physician” at Johns Hopkins
Author of hugely influential textbook, 'The
Principles and Practice of Medicine'
believed that most drugs in his day were
useless, but still advocated blood-letting
in some cases
23 January 2015 8Evidence Based Medicine
9. Bloodletting today
Today phlebotomy therapy is primarily used in Western
medicine for a few conditions such as
hemochromatosis, polycythemia vera, and porphyria
cutanea tarda.
Why did it persist?
It resulted from the dynamic interaction of social,
economic, and intellectual pressures, a process that
continues to determine medical practice
23 January 2015 9Evidence Based Medicine
11. Patient: Mr. A
Mr. A is a 60 year old presenting with
1 hour of retrosternal chest pain.
ECG shows lateral ST-elevation consistent with acute
MI.
QUESTION: In patients with acute MI,
does treatment with aspirin reduce mortality?
What is the best evidence?
23 January 2015 11Evidence Based Medicine
12. Evidence: 1988
• Reduction of mortality in acute myocardial infarction
with streptokinase and aspirin therapy. Results:
– Patients with acute MI treated with Aspirin vs.
placebo had a significant 23% relative risk
reduction in five-week cardiovascular mortality,
with an absolute risk reduction of 11.8% to 9.4%
– The combination of SK and Aspirin resulted in a
42% relative risk reduction in cardiovascular
mortality after five weeks compared with the
placebo
23 January 2015 12Evidence Based Medicine
13. Application: 1997
• How many patients receive ASA following acute
myocardial infarction?
– Aspirin was not given to 55%!!!
– 78% of patients who did receive aspirin received it
more than 30 minutes after arrival to the
emergency department.
Annals of Intern Medicine. Jul 1997;127(2):12623 January 2015 13Evidence Based Medicine
14. • But as late as 2000, even in the US, aspirin was being
prescribed for at most one third of patients with
coronary artery disease (for whom there were no
contraindications to its use)
• Relatively simple, and cheap practices shows that we
have a problem in getting providers to apply knowledge
gained through research
• The paradigm for the translation of new information
from research bench to bedside has been conceptualized
as a “translational highway”.
23 January 2015 14Evidence Based Medicine
15. What is evidence-based medicine?
“Evidence-based medicine is the integration of best
research evidence with clinical expertise and patient
values”
- David Sackett
• “Explicit, judicious, and conscientious use of current
best evidence from medical care research to make
decisions about the medical care of individuals”
23 January 2015 15Evidence Based Medicine
16. EBM - What is it?
Clinical
Expertise
Research
Evidence
Patient
Preferences
23 January 2015 16Evidence Based Medicine
17. Evidence-based health-care practice
• The integration of:
– individual clinical expertise
– best available external clinical evidence from
systematic research
Evidence Based Medicine 1723 January 2015
18. I - Individual clinical expertise
• Skills
• Judgement
– which individual health care workers acquire
through
– clinical experience and clinical practice
Evidence Based Medicine 1823 January 2015
19. II - Best available clinical evidence
• Clinically relevant research derived from:
– basic medical sciences and
– patient-centred clinical research into the safety
and efficacy of therapeutic interventions.
– Systematic Reviews
Evidence Based Medicine 1923 January 2015
20. Why is EBM important?
New types of evidence are being generated which
can create changes in the way patients are treated
Although evidence is needed on a daily basis, usually
physicians don’t get it.
How much is actually being applied to patient
care?
lack of time
out-of-date textbooks
the disorganization of the up-to-date journals
23 January 2015 20Evidence Based Medicine
21. Importance of EBM for practicing
clinicians?
TIME AVAILABLE TO READ:
Less than
1 Hour per Week
TIME NEEDED TO KEEP CURRENT
ON GENERAL MEDICINE:
19 Articles per DAY
365 Days per Year
Source: Davidoff F, Haynes B, Sackett D, Smith R. BMJ. 1995;310:1085-1086.
21Evidence Based Medicine
22. Evidence increasing so rapidly we need better skills to keep up-
to-date more efficiently than previous generations of clinicians
23 January 2015 22Evidence Based Medicine
25. Gets worse with “duration in practice”
23 January 2015 25Evidence Based Medicine
26. Evolution of EBM
Pre EBM: Passive diffusion (“publish it and they
will come”)
Early EBM: Pull diffusion (“teach them to read it
and they will come”)
Current EBM: Push diffusion (“read it for them
and send it to them”)
Future EBM: Prompt diffusion (“read it for them,
connect it to their individual patients”)
23 January 2015 26Evidence Based Medicine
27. For I once saved one group
by it, while I intentionally
neglected another group.
By doing that, I wished to
reach a conclusion .
Al-Rhazi
900 AD 1780 1840 1937/48 1967 1970’s
Alvan
Feinstein
publishes his book
Clinical Judgement
James Lind
publishes review &
clinical trial in
Treatise on Scurvy
Pierre Louis
Develops his “numerical
method” and changes blood
letting practice in France
Bradford-Hill
publishes Principles of
Medical Statistics &
MRC trial of streptomycin
Some milestones in the history of EBM
23 January 2015 27Evidence Based Medicine
28. An EBM Approach to Education
• Evidence cart on ward rounds - 1995
• Looked up 2-3 questions per patient
• Took 15-90 seconds to find
• Change about 1/3 decision
David Sackett
23 January 2015 28Evidence Based Medicine
29. Prof Archibald Cochrane, CBE
(1909 - 1988)
• The Cochrane Collaboration is
named in honor of Archie
Cochrane, a British researcher.
• In 1979 he wrote, "It is surely a
great criticism of our profession
that we have not organized a
critical summary, by specialty or
subspecialty, adapted
periodically, of all relevant
randomized controlled trials”
23 January 2015 29Evidence Based Medicine
30. Why the sudden interest in EBM?
• Increasing realization among clinicians that years of
experience unaccompanied by updating of
knowledge can result in decline of clinical
performance
• The need for valid information about diagnosis,
therapy, prognosis, and prevention in this era of
consumer activism
23 January 2015 30Evidence Based Medicine
31. • The common man has access to the very same
medical literature as the clinicians through numerous
sources
• Limited time available to the clinician for acquiring
information is a major impediment for updating the
knowledge from traditional sources
23 January 2015 31Evidence Based Medicine
32. Assumptions of evidence-based practices
• Not all evidence is equivalent
• There is a hierarchy of study design
• External evidence can inform but can never replace
individual clinical expertise (Sackett et al., 1996)
• Starting from the best external evidence and work
from there.
• Values always influence decisions
23 January 2015 32Evidence Based Medicine
33. Where do we go for
help with
decisions when
we are not sure
how to proceed?
23 January 2015 Evidence Based Medicine
34. Decision making in clinical practice
using evidence
Decision-making is the cognitive process resulting in
the selection of a course of action among several
alternative possibilities
23 January 2015 Evidence Based Medicine
36. Type of Question Suggested best type of Study
Therapy RCT>cohort > case control > case series
Diagnosis Prospective, blind comparison to a gold standard
Etiology/Harm RCT > cohort > case control > case series
Prognosis Cohort study > case control > case series
Prevention RCT>cohort study > case control > case series
Clinical Exam Prospective, blind comparison to gold standard
Cost Economic analysis
Identifying the Best Study
23 January 2015 36Evidence Based Medicine
41. Outcome – the only thing that matters
23 January 2015 41Evidence Based Medicine
42. What EBM additionally provides is
Opportunity for change
Opportunity for better treatment
23 January 2015 42Evidence Based Medicine
43. How evidence affects clinicians
•Happy !!!
•I am the best !!!
•Will the patient recover or
not??
•Will they sue me??
•What about my reputation ??
23 January 2015 43Evidence Based Medicine
45. Think 100 times before refuting an old
time tested method of treatment
• Classic example is vaginal hysterectomy for benign
diseases
• “Give me 2 retractors, 2 scissors , 2 clamps, one
tissue holding forceps and one needle holder, I will do
a vaginal hysterectomy in any setup”
Surgeon
23 January 2015 45Evidence Based Medicine
47. • New developments ( unnecessary) in minimally invasive
surgery
• Studies sponsored by pharma companies
• Use of meshes in different clinical conditions
• Mesh Erosion in bladder or bowel, infection or rejection
of mesh, vaginal pain or painful intercourse, groin
infection/abscess, extrusion , obstruction , voiding
dysfunction and erosion.
23 January 2015 47Evidence Based Medicine
48. Changes in clinical practice shouldn’t
be like this
23 January 2015 48Evidence Based Medicine
49. Changes should be like this
23 January 2015 49Evidence Based Medicine
50. The Five-Step Approach to Practicing EBM
• Step 1- Framing a Proper, Pertinent, Focused and
Answerable Question
• Step 2 - Searching the Literature
• Step 3 - Critical Appraisal of the Literature
• Step 4 –Integrating the Evidence with Clinical
Expertise and Patient Values
• Step 5 – Evaluating the Process23 January 2015 50Evidence Based Medicine
51. Acquire the
best evidence
Appraise
the evidence
Apply
evidence to
patient care
Assess
your patient
Ask clinical
questions
EBM Method
23 January 2015 51Evidence Based Medicine
53. Ask Clinical Questions
Patient/
Population Outcome
Intervention/
Exposure
Comparison
Components of Clinical Questions
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?
23 January 2015 53Evidence Based Medicine
54. Step-1
Clinical Scenario :
• 12 years old only male child
• admitted to ICU
• history of accidental ingestion of OP compound 4
hours back
• On admission the patient was comatose but
hemodynamically stable
23 January 2015 54Evidence Based Medicine
55. • The anaesthesiologist used his past experience,
knowledge, skill & expertise and treated the patient
with an infusion of atropine
• Inspite of that patient developed respiratory
paralysis in the next 2 hours
• The clinician used his expertise puts him on
mechanical ventilation
23 January 2015 55Evidence Based Medicine
56. • Now, the consultant understands the gap in his
knowledge & he identifies the same.
• The consultant wanted to administer Inj Pralidoxime.
• But he was not sure of the dosage and the mode of
administration (a single bolus dose or an infusion).
23 January 2015 56Evidence Based Medicine
57. • ‘P’ — Patient Problem: How would I describe a group
of patients similar to mine?
In this clinical situation it is a male pediatric patient (12
years) who has developed organophosphorous
poisoning following its ingestion.
• ‘ I ’ — Intervention strategy: Which main intervention,
prognostic factor or exposure am I considering?
Here the intervention is the therapy with Pralidoxime in
optimum dosage.
23 January 2015 57Evidence Based Medicine
58. • ‘C’ — Comparison: What is the main alternative to
compare with the intervention?
In his patient the clinical dilemma pertains to the
dosage and mode of administration of Pralidoxime
(low dose infusion vs. single large bolus dose)
• ‘O’ — (Outcome): - What can I hope to accomplish?
Recovery from OP poisoning and decrease in
morbidity & mortality
23 January 2015 58Evidence Based Medicine
59. Step-2 Literature Search
• ‘Traditional’ print resources like textbooks or
journals
• ‘Browse’ online electronic databases
23 January 2015 59Evidence Based Medicine
60. Step 3 - Critical Appraisal of the Literature
1. Screening for internal validity and relevance
2. Determining the intent of the article
3.Evaluating the validity based on its intent
23 January 2015 60Evidence Based Medicine
61. • The article that was tracked down is Prospective
randomized placebo controlled clinical trial of
Pralidoxime in two similar groups of patients.
(Control group-low dose and study group-high dose)
• Block randomization was used
• The investigators were not blinded
23 January 2015 61Evidence Based Medicine
62. • The intent of the article is to evaluate two treatment
regimes of PAM in the management of OP poisoning
• The next thing to determine is the strength of the
outcome. How large was the treatment effect?
• Low dose group fared better than high dose group
23 January 2015 62Evidence Based Medicine
63. • PAM is a very expensive imported drug requiring
considerable amount off foreign exchange and there
are difficulties in procuring it.
• It is imperative for the clinician to find a cost-
effective
• and yet effective treatment.
• Patient’s father, being a primary school teacher,
cannot afford the exuberant cost of the drug.
• The out come of this research study is very much
relevant and beneficial in solving the clinical dilemma
23 January 2015 63Evidence Based Medicine
64. Step 4 –Integrating the Evidence with Clinical
Expertise and Patient Values
• The best documented critically appraised research
evidence is already with the clinician
• Take into consideration the patient values for example:
The patient is a precious, lone male child of the
parents.
The economical/financial status of the parents does not
permit expensive therapies
No contraindications for the drug to be administrated
Low dose regime requiring 1/16 of the high dose has better
effect
23 January 2015 64Evidence Based Medicine
65. Step 5 – Evaluating the Process
• Was he able to formulate a focused question?
• Was he able to devise a precise search strategy for
locating the evidence?
• Did he use the most appropriate resource?
• Were more pertinent resources like practice guidelines
available to him?
• Did the ‘evidence’ work in his patient?
• The clinician should document the outcomes of the
application of the evidence and based on his experiences
• Those of his colleagues should be able develop
management protocols
23 January 2015 65Evidence Based Medicine
66. What are the benefits of adopting EBM?
• Minimize the errors in patient care
• Reduces the cost of treatment to the patient
• Optimizes the quality of patient care
• Skills learnt in practicing EBM are the very same ones
needed for being a lifelong, self-directed learner
• Habit of accessing literature on a daily basis is the
best guarantor of ensuring advancement of
knowledge and keeping abreast of scientific progress
23 January 2015 66Evidence Based Medicine
67. EBM Misconceptions
FALLACY FACT
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 patient23 January 2015 67Evidence Based Medicine
68. Who benefits?
Practitioners current knowledge to assist with
decision making
Researchers reduced duplication
identify research gaps
Community recipients of evidence-based interventions
Funders identify research gaps/priorities
Policy maker current knowledge to assist with policy
formulation
23 January 2015 68Evidence Based Medicine
69. Evidence-based Public Health
• “The development, implementation, and evaluation of
effective programs and policies in public health through
application of principles of scientific reasoning, including
systematic uses of data and information systems, and
appropriate use of behavioral science theory and
program planning models”
Source: Brownson, R.C. et al, Evidence-based public health, Oxford University Press, 2003.
23 January 2015 69Evidence Based Medicine
70. Clinical vs. Public health interventions
Clinical
• Individuals
• Single interventions
• Outcomes only (generally)
• Often limited consumer input
• Quantitative approaches to
research and evaluation
Public health
• Populations and
communities
• Combinations of strategies
• Processes as well as
outcomes
• Involve community members
in design and evaluation
• Qualitative and quantitative
• Health promotion theories
and beliefs
Evidence Based Medicine23 January 2015 70
71. Challenges - The research-practice gap
Research Evidence Practice
Diffusion
/Adoption
Information overload
Application to other populations
Lack of consideration of local
community groups, agencies and
governments role and needs
Cultural factors
Economic factors
Social factors
Evidence Based Medicine23 January 2015 71
72. Research Evidence Policy making
Challenges: The research-policy gap
Service level
National policy level
Evidence Based Medicine23 January 2015 72
74. 23 January 2015 Evidence Based Medicine 74
Develop
statement of
the issue
Determine what is
known through
scientific literature
Quantify the
issue
Develop
Program or
policy
options
Evaluate the
program or
Policy
Develop an
action plan
Tools: meta-
analysis, risk
assessment, expert
panel
Tools: rates,
risks,
Surveillance
data
Implement
Re- tool
Disseminate widely
Or Discontinue Program/Policy
75. Conclusion
• Medicine is not an exact science, but a science of
probability
• The challenge to physicians is to provide up to-date
medical care
• The ultimate goal for clinicians should be to help
patients live long, functional, satisfying, and pain and
symptom free life
• By adopting the principles of Evidence Based
Medicine, it will be possible to maximize the benefits
of scientific research for patient care
23 January 2015 Evidence Based Medicine 75
76. • Medical educators and medical colleges have the
singular responsibility of indoctrinating the principles
of EBM
as a concept,
a philosophy,
a religion necessary for being efficient,
compassionate, caring, and responsible clinician
among the future physicians during their formative
years of training
23 January 2015 Evidence Based Medicine 76
77. References
1. Evidence-based Medicine Workbook-Finding and applying the better
research , Paul Glasziou, Chris Del Mar and Janet Salisbury
2. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg,W., Haynes,
R. B.: Evidence- Based Medicine – How to Practice and Teach EBM
2nd Ed., Churchill. Livingstone, 2000.
3. Sackett DL, Rosenberg WMC, Gray JA, Haynes RB Richardson WS.
Evidence based medicine: What it is and what it isn’t Br. Med J
1996;312:71-72.
4. Evidence Based Medicine And Its Impact On Medical Education Dr. H.
B. Rajashekhar1 Dr. B. S. Kodkany2 Dr. Vijaya A. Naik3 Dr. P. F. Kotur4
Dr. Shivaprasad S. Goudar5:Indian J. Anaesth. 2002; 46 (2) : 96-103
5. Guyatt GH, Evidence–based Medicine. Ann Intern Med. 1991;114(ACP
J Club. Suppl 2): A-16
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