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.
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.
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
breif notes on what is pharmacoepidemiology, why do we need pharmacoepidemiology, whats is its aim and its main applications, advantages and disadvantages
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
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
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
breif notes on what is pharmacoepidemiology, why do we need pharmacoepidemiology, whats is its aim and its main applications, advantages and disadvantages
The characteristics of the Ideal Source for practicing Evidence-Based Medicine are:-
Located in the clinical setting
Easy to use
Fast, reliable connection
Comprehensive /Full Text
Provides primary data
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
Why bother with evidence-based practice?PaulGlasziou
An introduction to evidence-based medicine (EBM) with short section in history and why EBM? Then a brief overview of the 4 steps of EBM.
These slides have been used for starting a 1-day workshops in EBM
The lecture explains the steps of thinking while applying the principles of evidence based medicine on radiology.An example from real life is given and how to apply this type of thinking in order to achieve the best results.
Evidence based decision making in periodonticsHardi Gandhi
INTRODUCTION TO EVIDENCE BASED DENTISTRY
EVIDENCE BASED PERIODONTOLOGY
NEED, PRINCIPLES, GOALS AND ADVANTAGES OF EBDM
SKILLS NEEDED FOR EBDM
ASSESING THE EVIDENCE
INCORPORATING INTO THE PRACTICE
Tweet Your Pubs: How Altmetrics are Changing the Way We Measure Research ImpactRobin Featherstone
Presentation given to the Northern Alberta Health Libraries Association (NAHLA) Trends Mini Conference in Edmonton at the University of Alberta on May 2, 2014
Lecture given to Unit 8 (INDS 208) -- Pathobiology Treatment and Prevention of Disease -- in the undergraduate medical curriculum at McGill University on September 10, 2012.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
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.
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
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.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
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
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Introduction to Evidence-Based Medicine
1. Evidence-Based Medicine
(EBM)
INDS 301, Jan. 2013
Prosanto Chaudhury, MD, MSc, FRCSC, FACS
Robin Featherstone, MLIS
2. Objectives
By the end of the lecture, you will be able to:
1. Describe objectives and expectations for the
course
2. Describe the five stages of the EBM process
3. Differentiate between background and
foreground questions
4. Describe the components of a PICO question
5. Categorize PICO questions and identify the best
studies to answer each question type
3. EBM Course Contents
Format Content
Lecture 1 Overview of the course and an introduction to EBM, PICO
question formation, and EBM resources
Workshop Searching EBM resources
Small group 1 PICO question formation
Lecture 2 Critical appraisal of randomized controlled trials (RCT) and
systematic reviews (SR)
Small group 2 Appraisal of a RCT
Small group 3 Appraisal of a SR
Small group 4 Appraisal of a diagnostic test study
Course website: http://www.jamaevidence.com/
4. Evaluation
Item Description Weight
Small Groups 4 interactive sessions with clinical tutors. 40%
Evaluation based on participation.
Assignment 3 pages including: 30%
• Clinical scenario
• PICO
• Search strategy
• Name of chosen paper
• Critical appraisal
• Your conclusion
OSCE 15 minute station: 30%
• Develop a question based on a clinical scenario
• Perform a search based on your question
6. Why is EBM important?
“Evidence-based medicine is the integration of best
research evidence with clinical expertise and patient
values”
Patient - Dave Sackett
Concerns
EBM
Best research Clinical
evidence Expertise
Slide courtesy Prof Paul Glasziou, CEBM
7. EBM in practice
• Took an “evidence cart” on rounds - 1995
• Looked up 2-3 questions per patient
• Took 15-90 seconds to find evidence
• Changed about 1/3 decisions
• Rounds took longer!
Dave Sackett
8. Challenges to practicing EBM
RCTs published over the last 50 years
20000
18000
16000
14000
12000
RCTs
10000
8000
6000
4000
2000
0
1960 1970 1980 1990 2000 2010
Source: PubMed data for "randomized controlled trial"[Publication Type]
10. How you can use EBM
• Keep a logbook of questions
• Answer a few important questions
• Identify important knowledge gaps
• Discuss and share evidence with colleagues (journal
club)
11. EBM Process
Formulating
Evaluating the clinical
Assess Ask
the Process question
Your patient for whom
you are uncertain about
therapy, diagnosis, or Searching
Incorporating prognosis the Evidence
evidence into
decision-making Acquire
Appraise
Apply
Appraising
the Evidence
13. Can a 70 year old
pancytopenic patient with
suspected meningitis
receive platelets before
undergoing a lumbar
puncture?
What is pancytopenia?
What is the diagnostic test
for meningitis?
[1.]
Guyatt G, Rennie D, Cook D. Users' Guides to the Medical Literature : A Manual for Evidence-Based Clinical Practice (2nd Edition). New
York, NY, USA: McGraw-Hill Professional Publishing; 2008.
Ask
14. A 25 year-old female has been recently diagnosed with
classical Hodgkin’s lymphoma (nodular sclerosing subtype).
Staging reveals that she is a stage IIA with a 4.5 cm nodal
mass in her neck and mediastinal nodes. Her hematologist
recommends combined modality therapy
(chemotherapy/radiation therapy). The patient has done
some reading about therapy and is worried about the long
term effects of radiation especially the risk of breast cancer.
Background Foreground
What is the pathophysiology of For a 25 year old female with
Hodgkin’s lymphoma? stage IIA Hodgkin’s lymphoma,
is combined modality therapy
superior to chemotherapy
alone?
Ask
15. A 35 year-old patients presents to the ER with a left leg swelling x
3 days. The patient recently returned from a business trip in
Malaysia and therefore you suspect a deep vein thrombosis
(DVT). It is the weekend and so the patient receives a CT
angiogram that does not reveal any pulmonary embolism and the
venous portion of the study does not reveal any above or below
knee clots. That said, you are still convinced that the patient may
have a lower limb DVT and so you ask for a lower limb doppler
which requires the radiologist to come into the hospital in the
middle of the night to perform the study. The radiologist is
reluctant to come as the venous phase of the CT angiogram was
negative.
Discuss with your
neighbour. Record one
background and one
foreground question.
Creative copyright image. Attribution: James Heilman, MD. Accessed from Ask
http://upload.wikimedia.org/wikipedia/commons/0/0a/DVT2010.JPG
17. EBM Question Formation
2. P.I.C.O.
Patient, Population, or Problem
Intervention or exposure
Comparison
Outcome
18. Simple
You have been asked to review the
practice guidelines for treating warts. You
are confident that cryotherapy is the most
effective treatment but a colleague
suggested some alternatives to
investigate, including duct tape.
Ask
19. Simple
Patient, Population, or Patients with common warts
Problem
Intervention or Duct tape
exposure
Comparison Cryotherapy
Outcome Eliminating warts
Answerable clinical question:
In patients with common warts, is duct tape as effective as
cryotherapy in eliminating warts?
Ask
20. Intermediate
You are following a 35 year-old pregnant female for low
platelets thought to be due to immune thrombocytopenia as
she had thrombocytopenia prior to her pregnancy. She
undergoes a delivery without complications. She and the
baby are medically ready to leave the hospital 48 hours
later. She asked if she should be concerned for her
newborn, knowing that her antibodies, the same that are
causing her immune thrombocytopenia, are passed along
to the baby.
Ask
21. Intermediate
Patient, Population, or Newborns with suspected immune thrombocytopenia
Problem
Intervention or Blood test to check platelets
exposure
Comparison No blood test
Outcome Diagnosis of immune thrombocytopenia
Answerable clinical question 1:
For newborns with suspected immune thrombocytopenia, is a blood test to determine
platelet count recommended to diagnose immune thrombocytopenia?
Answerable clinical question 2:
For newborns with suspected immune thrombocytopenia, when should a blood test
be given to diagnose immune thrombocytopenia?
Ask
23. Question Best Evidence
Cost • Cost-effectiveness study
Diagnosis • Diagnostic validation studies
• Prospective studies / blind comparison to a
gold standard
Etiology/Harm • Cohort study
• Case control study
Prognosis • Cohort study
• Case control study
Quality of life • Qualitative studies
Therapy • Systematic review of Randomized Controlled
Trials (RCTs)
• Single RCT
1
2
Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ Books/Blackwell Pub., 2006.
Glover, Jan, and Lei Wang. Find it Fast: The Clinical Question : www.med.yale.edu/library/education/guides/screencasts/finditfast/finditfast_2/
Acquire
24. Levels of Evidence
for Therapy Question
Level of Evidence Type of Study
1a Systematic reviews of randomized controlled trials
(RCTs)
1b Individual RCTs with narrow confidence interval
2a Systematic reviews of cohort studies
2b Individual cohort studies and low-quality RCTs
3a Systematic reviews of case-control studies
3b Case-control studies
4 Case series and poor quality cohort and case-control
studies
5 Expert opinion
Levels of evidence (2001). Centre for Evidence Based Medicine. Retrieved 26 Aug 2008 from
http://www.cebm.net/index.aspx?o=1025
Acquire
24
25. Filtered vs Unfiltered Information Sources
Less time 1a - SRs of
Less work RCTs
Less evidence
Summaries
Filtered
1b 1b
2b 2a 2b 2a
Unfiltered
More time
3b 3b
More work 4 4 5
5
More evidence
Acquire
28. EBM Process
Formulating
Evaluating the clinical
? ?
the Process question
Your patient for whom
you are uncertain about
therapy, diagnosis, or Searching
Incorporating prognosis the Evidence
evidence into
decision-making ?
?
?
Appraising
the Evidence
29. What kind of question is this:
What causes jaundice?
A. Background
B. Etiology
C. Foreground
D. PICO
30. What is the “O” in this question:
When should fibreoptic phototherapy be initiated to
prevent brain damage for a jaundiced newborn?
A. Fibreoptic phototherapy
B. Jaundiced newborn
C. Prevent brain damage
31. Which of the following is the best source of
evidence to answer the question:
In jaundiced infants, is single volume exchange
transfusion superior to double volume exchange?
A. Case series
B. Cohort study
C. Diagnostic validation study
D. RCT
Editor's Notes
Q:What are the five A’s?A:Ask, Acquire, Appraise, Apply and Assess
Either A or B are correct.
Outcomeis to prevent brain damage – C
This is a therapy question – answer is D (even better to have a SR of an RCT)