The document discusses evidence-based medicine (EBM) and addresses common misconceptions about it. EBM involves using the best available evidence from clinical research and patient preferences to guide medical decisions. It emphasizes generating evidence through well-designed studies and systematically reviewing research to distill useful findings. While EBM requires effort, it can improve patient outcomes by focusing on the most effective interventions and making knowledge more up-to-date. The document rebuts myths that EBM is too difficult or reduces costs, noting it enhances care and decision-making.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
Declaration of Geneva and International Code of Medical Ethics..pptxSinghPrabh
The Declaration of Geneva is one of the World Medical Association's (WMA) oldest policies adopted by the 2nd General Assembly in Geneva in 1948. It builds on the principles of the Hippocratic Oath and is now known as its modern version.
It is a declaration of a physician's dedication to the humanitarian goals of medicine
The Declaration of Geneva was intended as a revision of the Hippocratic Oath to formulate that oath's moral truths that could be comprehended and acknowledged modernly.
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Series of lectures I gave for the PEER (Professionalism and Ethics Education for Residents) Project sponsored and organized by the Saudi Commission for Health Specialties (SCHS).
OUTLINE:
What is an informed consent to treatment?
What is the elf basis to consent?
What makes the consent an ethically valid one?
Types of Consent
When it is needed? When could it be waived?
How to take an informed consent?
What if the patient is not able to give consent?
Documentation of Consent
Special Issues about Consent
Declaration of Geneva and International Code of Medical Ethics..pptxSinghPrabh
The Declaration of Geneva is one of the World Medical Association's (WMA) oldest policies adopted by the 2nd General Assembly in Geneva in 1948. It builds on the principles of the Hippocratic Oath and is now known as its modern version.
It is a declaration of a physician's dedication to the humanitarian goals of medicine
The Declaration of Geneva was intended as a revision of the Hippocratic Oath to formulate that oath's moral truths that could be comprehended and acknowledged modernly.
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
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
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
evidence based practice is best for the people working with patients
ebp should be used by the heath care provider.
ebp based upon clinical experties
best research evidence
patient preference and values
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.
EVIDENCE BASED NURSING PRACTICE M.Sc. nursing.pptAnurag Sharma
Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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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.
Key Topics:
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
4. EBM:
Way of critical thinking
Appropriate tool for sound clinical decisions
Problem solving approach
Life-long self-directed learning
5.
6. Use:
more effective intervention
proven therapies and diagnostic tests
only
Result in:
Better management of patients
Better patient outcomes.
Less harm or side-effects
Better communication with patients about the
rationale behind the management decisions.Aboubakr Elnashar
7. More efficient use of resources
Improve resource utilization
Reduced cost per patient.
Aboubakr Elnashar
8. Using the best available evidence :
Appropriate funding decisions.
More effective and efficient care
Aboubakr Elnashar
9. Upgrade knowledge routinely.
Up-to-date, Keeping up knowledge
explosion &med literature based on valid
evidence.
Improve clinicians’ understanding of research
methods & make them more critical in using
data.
Improves confidence in management
decisions. Relieve anxiety about uncertainty
Improves reading habits.
Aboubakr Elnashar
10. Gives team a framework for group
problem solving & for teaching
Enables juniors to contribute fully to
the team.
VI. The graduates:
EBM curricula
Self-directed
Problem-based
Aboubakr Elnashar
11. •There is a significant gap between
EBM & application of this to clinical
practices
12. Clinical
Practice
Research
Haynes calls this the “evidence transfer gap”. EBM seeks to close the gap
between completed research activity and the practice of medicine.
The “Evidence Transfer Gap”
EBM
Aboubakr Elnashar
13. •A mistaken thought, idea, or notion; a misunderstanding.
•Can happen anywhere, in any situation: not understanding a
topic; not knowing the full story; hearing the wrong story… there’s
many reasons how one can misunderstand something.
15. 2. Expert opinion is the best evidence.
•Experience: “I always did it this way”
Clinical experience is crucial.
Clinical guideline should be based on
critical appraisal of medical literature
Aboubakr Elnashar
16. Traditional CME is completely ineffective in
changing our behavior.
A great deal of research reported in journals
is poorly done, poorly analyzed: not valid &
irrelevant to our patients and practices.
Only 20% of health care is EB (Kerr White, 2002)
Aboubakr Elnashar
17. Setting Type I Type II No Evid.
Cancer center (USA) 24% 21% 55%
Tertiary surgical center (USA) 14% 64% 22%
Primary care centers (Spain) 38% 4% 58%
General medicine hospital (UK) 53% 29% 18%
General psychiatric ward (UK) 65% 35%
Anesthesia (Australia) 32% 65% 3%
Aboubakr Elnashar
18. Decision based on pathophysiologic
principles may be incorrect
Aboubakr Elnashar
19. Certain rules of evidence are
necessary.
Systematic unbiased observation
increases the confidence of the
physician knowledge.
Aboubakr Elnashar
20. CAT = Critical appraisal of topic is
necessary
Critical appraisal: assessment of evidence
by systematically reviewing its relevance,
validity, results and applicability (RVRA)
Aboubakr Elnashar
21. 1. Relevance:
Common to our practice &
patient-oriented outcome (POEM) not DOE
2. Validity: Free from bias (Truth)
Randomization.
Follow up complete.
Intention to treat.
Blindness.
Similar groups at start.
Both groups treated equally.
3. Results:
Clinically important (magnitude and precession)
4. Applicability:
Applicable at my setting &
useful for my patients
Aboubakr Elnashar
22. •Derived from the Greek word mythos, which means "word of mouth."
•Something that is widely thought to be false
•Holy story
23. EBM focus on:
patient preference
clinical judgment of the
practitioner
best available evidence to
produce the best patient
outcomes
EBM takes into account the
circumstances of the patient
Aboubakr Elnashar
25. EBP is a patient-centered approach &
is highly individualized
Begin & end with the patient in mind
Any practice that fails to take into
account of the individual patient is not
EBP
Clinical evidence can never replace
individual clinical expertise because this
expertise decides whether the external
evidence applies to the patient (Sackett,
1998)
Aboubakr Elnashar
26. The traditional medical paradigm is based on
authority.
EBM is dependent on the use of RCT, systematic
reviews & meta-analysis, although it is not restricted
to these.
RCT is
the epitome of all research designs because its
design provides the strongest validity
It provides the best assurance that the result was
due to the intervention
Aboubakr Elnashar
27. RCT:
a group of patients is randomised into
study group & control group. These
groups are followed up for the
variables/outcomes of interest.
If the sample size is large enough, this
study design avoids problems of bias
and confounding variables
Aboubakr Elnashar
29. SR
A review of a clearly formulated question that
uses systematic & explicit methods to
1. identify, select and critically appraise relevant
research
2. collect & analyse data from the studies that are
included in the review
Meta-Analysis
The use of statistical techniques in a SR to
integrate the results of included studies.
Aboubakr Elnashar
31. Why SR on the top:
Rigorous methodology
Peer reviewed
Relatively large sample size
Ensures the highest quality evidenceAboubakr Elnashar
32. There are now many advocates of a more
inclusive approach to evidence:
Qualitative research is as valid a form of
evidence as quantitative research
There are now methodologies to systematic
review both numerical and textual findings of
research
EBP insists that each client is treated with
the best available evidence, that practitioners
make a genuine effort to find the best solution
given their resources.
Aboubakr Elnashar
33. It is not disputed that practice should be
grounded in theory, however it should be
predicated on the best available evidence
This is addressed by systematic reviews
Aboubakr Elnashar
35. This indicates a fundamental
misunderstanding of the financial
consequences
Physicians identify & implement the
most efficacious treatments to maximize
the outcomes for patients, this may
increase costs
EBP does not reduce the need for
treatments, it attempts to ensure that
each patient gets the best treatment
appropriate for his/her condition.
Aboubakr Elnashar
36. EBP incorporates the more
extensive processes of
SECONDARY & TERTIARY
RESEARCH
searching,
appraisal,
synthesis and
incorporation of the best available
evidence into practice
Aboubakr Elnashar
38. Refuted by audits from
within clinical care where at
least some inpatient clinical
teams have provided EB
care to patients
Busy clinicians who can
devote their scarce time can
practice EBM
Aboubakr Elnashar
39. EBP critically examines all
clinical procedures, critically
evaluating their appropriateness
for the specific situation.
Text books: Fail to recommend
Rx up to 10 ys after it’s been
shown to be efficacious.
Continue to recommend therapy
up to 10 ys after it’s been shown to
be useless.
Aboubakr Elnashar
40. The use of evidence is only one piece of
the clinical decision-making process.
Patient situations, preferences & values
are a key component in the process.
Aboubakr Elnashar
41. It is impossible for any practitioner
to keep up with the entire health care
literature {2 million articles published
annually, 6000 articles published
daily].
To keep up to date, physician should
read 19 articles/d.
Lag time from time of “knowing” to
time of implementation:
13 ys for thrombolytic therapy.
10 ys for corticosteroids to enhance
fetal lung maturity.Aboubakr Elnashar
42. Do not need skills in biomathematics or
statistics
Physicians can gain skills to make
independence decisions & can evaluate
expert opinions.
EBP does not mean continous running to
the library, but that clinicians should
remember to search for evidence to support or
refute their practice methods.
EBM reduces reading by quality filters
Aboubakr Elnashar
45. EBM approach depends on high-quality
literature, which is lacking in many areas of
medicine
There are more RCT each year
There are many other types of evidence to
make good decisions.
Aboubakr Elnashar
46. Many myths & misconceptions exist in
health care practice
Myths & misconceptions must be overcome
to implement EBM
EBM:
Aboubakr Elnashar