The document discusses evidence based healthcare and the process of evidence based medicine. It describes the 5 step process as asking questions, acquiring information, appraising the quality of evidence, applying the results, and assessing performance. Simple skills can help focus questions and basic rules can improve ability to critique literature. Simple math, not complex statistics, can help clearly describe study results.
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.
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
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
discussing all aspects of evidence based medicine, Introduction
History of EBM
Need of EBM
Steps to practice
Discussion - advantages/disadvantages/critical analysis
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.
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
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
discussing all aspects of evidence based medicine, Introduction
History of EBM
Need of EBM
Steps to practice
Discussion - advantages/disadvantages/critical analysis
This topic is very essential for Pharm.D students. It includes application, benefits, limitations of EBM. It also includes EBM history and background which helps you for examinations. EBM is very important topic in Pharmacotherapeutics-III so you may find this needful.
All the best!!!
Well-trained clinical research professionals are in high demand. The tremendous increase in medical technology and information in the last decade has resulted in an explosion of potential new drugs, devices and biologics that must be tested before being released for use by the public. The profession is constantly challenged to improve and streamline the clinical research programs in order to shorten the development timelines and control the cost for new product development
Concise explaining of Evidence-Based Medicine and discussing the following: 1-What is Evidence-Based Medicine?
2-Why Evidence-based Medicine?
3-Options for changing clinicians' practice behaviour
4- EBM Process- Five Steps
5-Seven alternatives to evidence-based medicine
This topic is very essential for Pharm.D students. It includes application, benefits, limitations of EBM. It also includes EBM history and background which helps you for examinations. EBM is very important topic in Pharmacotherapeutics-III so you may find this needful.
All the best!!!
Well-trained clinical research professionals are in high demand. The tremendous increase in medical technology and information in the last decade has resulted in an explosion of potential new drugs, devices and biologics that must be tested before being released for use by the public. The profession is constantly challenged to improve and streamline the clinical research programs in order to shorten the development timelines and control the cost for new product development
Concise explaining of Evidence-Based Medicine and discussing the following: 1-What is Evidence-Based Medicine?
2-Why Evidence-based Medicine?
3-Options for changing clinicians' practice behaviour
4- EBM Process- Five Steps
5-Seven alternatives to evidence-based medicine
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
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Is the ability to access, assess 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.
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Evidence Based Practice is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care.
Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values.
The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
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2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
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Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
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Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
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Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. •Evidence based medicine is the trio of good science, clinical excellence, and
patient focus
•It is undertaken by the five steps of:
Asking questions
Acquiring information
Appraising the quality of evidence
Applying the results
Assessing performance
•Simple skills in focusing questions can be learnt easily
•Basic rules of appraisal can greatly improve your ability to critique the
clinical literature
•Simple maths, not complicated statistics, can help you describe the results
of scientific studies more clearly
3.
4. Quality of Health Care Services in
Pakistan & United States of America.
5. • Health Care Professionals
• Health Care Settings
• Financial aspects
• Awareness of health
• Impacts on community health.
Factors
6. • Attracts best minds from whole world.
• Career opportunities more than rest of the
world.
• Private & Public Sectors both open.
• Still areas of deficiency exist geographically as
well as per specialty.
• Immigration policies to retain.
• Continuous Medical Education programs.
• New Ideas respected.
Healthcare Professional in USA.
7. • More than 110 medical school.
• Still severe shortage of doctors and nurses.
• 90% from best medical schools emigrate to
western world, Australia, Middle east.
• Gaps are filled by Russian, Chinese and central
Asian trained doctors.
• Unsatisfied financially as well as career wise.
• Nepotism Law&Orders issue make it worse.
• Always looking for private practice.
Healthcare Professionals in Pakistan.
8. • University Hospitals.
• State hospitals.
• Community Hospitals.
• Veteran Affairs Hospitals.
• Private Hospitals.
• Diagnostic Centers.
• Research Centers.
• Specialty Institutes.
Healthcare Settings in USA
9. • Teaching Hospitals.
• District Head Quarter Hospitals.
• Tehsil Head quarter hospitals.
• Rural Health Centers.
• Basic Health Units.
• Military Hospitals.
• Private Hospitals.
Health Care Settings in Pakistan
10. • Insurance based practice.
• Private practice.
• Salary based practice.
• Share practice.
Financial Aspects in USA
11. • Government Salary.
• Private Practice.
• No Insurance.
• Share practice less liked.
Financial Aspects in Pakistan.
12. • Health Education Programs.
• Print Media
• Electronic Media.
• Social Media.
• General awareness.
• Companies imitative programs.
• Research Programs.
• Employer regulatory programs.
Awareness about health in USA
13. • No official Screening program.
• Media campaign are mostly centered on
alternative care.
• Companies conduct hidden drug trials.
• No participation by community.
• Generally low education level.
• Health is a least priority by government and
community both.
Awareness about Health in Pakistan
14. • Generally healthy community.
• Average age longer.
• Working age is longer.
• Diseases diagnosed at earlier stage.
• More productive life style.
• Independent living supported.
• Financially secured.
Impacts on Community Health in USA
15. • Generally poor health in rural communities.
• Diseases present at advanced stage.
• Financially not secured so look for
government or private support.
• Controllable infections leads to worse
outcome.
• TB is still a major burden.
• No follow up exits when treated.
Impacts on Community health in
Pakistan
16. • For Government:
• Plan with more finances for health care
professionals and healthcare setting.
• Start medical insurance schemes.
• Emphasize on health education.
• For Communities:
• To focus on personal health.
• Take part in screening programs.
• Keep on investing in future.
• Adopt Healthy Life style.
Recommendation
17. • Comparison between advanced world and
developing countries gives you to understand
the factor lacking in development phases.
• Health Care Quality Control programs should
be given more space than just provision of
health care services.
• Professional trained in health care quality
programs should keep on looking new
strategies to develop subjective & objective
tools for evaluation.
Conclusion
18. FSU College of Medicine 18
The EBM Process
“The practice of evidence-based medicine is a process of lifelong, self-
directed, problem-based learning in which caring for one's own patients
creates the need for clinically important information about diagnosis,
prognosis, therapy and other clinical and health care issues.”
(Bordley, D.R. Fagan M, Theige D. Evidence-based medicine: a powerful educational tool for clerkship
education. Am J Med. 1997 May;102(5):427-32.)
19. FSU College of Medicine 19
The EBM Process
The patient 1. Start with the patient -- a clinical problem or question
arises out of the care of the patient
The question 2. Construct a well built clinical question derived from the
case
The resource 3. Select the appropriate resource(s) and conduct a search
The evaluation 4. Appraise that evidence for its validity (closeness to the
truth) and applicability (usefulness in clinical practice)
The patient 5. Return to the patient -- integrate that evidence with
clinical expertise, patient preferences and apply it to
practice
Self-evaluation 6. Evaluate your performance with this patient
20. FSU College of Medicine 20
Constructing A Clinical Question
P
patient
I
intervention
C
comparison
O
outcome
Who? What?
Alternative
Intervention?
Outcomes
“How would I
describe a group
of patients
similar to this
particular
patient?”
”Which
treatment, test
or other
intervention?”
“Compared to what
other treatment, test,
or perhaps compared
to doing nothing”
What is the
patient oriented
outcome – better
prognosis?
Higher rate of
cure? Etc.?”
21. FSU College of Medicine 21
Examples
P I C O
Kids with acute otitis
media -2-4 y/o
Antibiotics
No treatment except
acetaminophen
for pain/fever
No pain after two
days?
Adult with
microhematuria
IVP CT scan
Diagnostic accuracy
(Predictive value or
likelihood ratio)
Adult patients <70 TIA No TIA
Rates of CVA within
90 days
Healthy adolescents
Routine
scoliosis
screen
No screening –
evaluate only if
problems
Pain, disability, need
for intervention
22. Why EBP?
• To improve care
– To bridge the gap between research & practice
– “Kill as few patients as possible” (O. London)
– A new treatment might have fewer side effects.
– A new treatment could be cheaper or less invasive
– A new treatment may be necessary in case people
develop resistance to existing therapies, etc.
• To keep knowledge and skills current (continuing
education)
• To save time to find the best information
23. How does EBP help?
A patient comes to a clinic with a fresh dog bite. It looks
clean and the nurse and patient wonder if prophylactic
antibiotics are necessary. The nurse searches PubMed and
found a meta analysis indicating that the average infection
rate for dog bites was 14% and that antibiotics halved this risk
to 7%.
• For every 100 people with dog bites, treatment with antibiotics will
save 7 from infection
• Treating 14 (NNT) people with dog bites will prevent 1 infection
• You explain these numbers to the patient along with possible
consequences and patient decides not to take antibiotics.
On a follow up visit you find out that he did not get infected.
Glasziou P, Del Mar C, Salisbury J. EBP Workbook, 2nd. ed. BMJ Books, 2007.
24. What are some Barriers for EBP?
• Overuse, underuse, misuse of evidence
• Time, effort, & skill needed
• Access to evidence
• Intimidation by senior clinicians
• Environment not supportive of EBP
• Poor decision making
25. The 5 Step EBP Process
Ask
Access
AppraiseApply
Assess
26. Health care professionals
• a person who by education, training,
certification, or licensure is qualified to and is
engaged in providing health care.
27. What kinds of clinical uncertainty
do HCP face?
• Interventions
– Therapy
– Prevention
– Targeting
– Timing
• Diagnosis
• Communicating risks and
benefits
• Referral
• Service Delivery/Organisation
One choice every 10 minutes in
acute care
28. Six challenges for health care
organizations
• 1. Design seamless, coordinated care
• 2. Make effective use of IT, including automating
patient records
• 3. Manage knowledge so that it is delivered into
patient care
• 4. Coordinate care across patient conditions,
services, and settings over time
• 5. Advance the effectiveness of teams
• 6. Incorporate measurement of care processes and
outcomes into daily practice
29. Process in creating collective organizational commitment of
•Quality improvement.
• Organizational analysis.
•Self-assessment.
•Strategic formulation of the organizational development
planning, Human resources development.
•Team work and service systems focusing on patient-
oriented mindedness.
"Hospital Accreditation"
30. What is Hospital Accreditation?
"The Hospital Accreditation"approach is a concept and
practice that yields beneficial results to patients,
customers, hospital personnel, the hospital, the Faculty
of Medicine, the society and the country as a
whole.History
In 1917, the American College of Surgeons established a
set of minimum standards for hospitals.
In 1951, the American College of Surgeons joined with
several other professional associations to form the Joint
Commission on Accreditation of Hospitals.
31. Thirty years later, this voluntary accrediting body changed its name
to the Joint Commission on Accreditation of Healthcare Organizations
to more accurately reflect its scope of health services evaluation
Inadditiontohospitals,thebodyevaluatedlong-termcarefacilitieslike,
•home health agencies,
•hospices,
•clinics,
•pharmacies,
•managed care organizations and,
•healthcarenetworks.
32. JOINT COMMISSION INTERNATIONAL ACCREDITATION
(JCIA)
*Experience in accrediting health care organizations in U.S,
the Joint Commission on Accreditation of Healthcare
Organizations initiated the development of an international
accreditation program in 1998 and was fully implemented in
late 1999.
The JCIA standards, organized according to either
Patient care functions
or
Management functions.
33. BENEFITS TO ACCREDITATION
1.BENEFITS OF PATIENTS:-
Continuity of care&Safe transport
Pain management& Focus on patient safety
Patient satisfaction is evaluated
Rights are respected and protected
Access to a quality focused organization
Credentialed and privileged medical staff
High quality of care
Understandable education and communication
34. 2. BENEFITS FOR THE STAFFS:-
Improves professional staff development.
Provides education on consensus standards.
Provides leadership for quality improvement within medicine
and nursing.
Increases satisfaction with continuous learning, good working
environment, leadership and ownership.
35. 3. BENEFITS FOR THE HOSPITAL:-
Improves care.
Stimulates continuous improvement.
Demonstrates commitment to quality care.
Raises community confidence.
Opportunity to benchmark with the best.
4. BENEFITS TO THE COMMUNITY:-
Quality revolution
Disaster preparedness
Epidemics
Access to comparative database
37. References
• Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it
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