Objective What is EBM. How to apply it. How to make evidence
base presentation.
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What is evidence base medicine "using the best research
evidence available, along with clinical expertise and patient
values to inform decisions regarding clinical practice. (Sackett D,
2000)
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BMJ. 2002 June 8; 324(7350): 1350.
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Type of Questions. Background: This is the knowledge that
usually stays the same over times (basics). Asked by what, when,
why,..etc For example: definition of disease, sign and symptomsetc.
Usually we can collect this type of information from
textbooks.
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Type of Questions. Foreground: This is the knowledge that
usually changes with times, modified or updated. For example:
recommended treatment for certain disease. Usually we can collect
this type of information from guidelines, systemic reviews and
researches.
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Difference between Textbooks and Articles. Books: Good for
background questions(basics) Not updated articles: Good for
foreground questions Up to date
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Expansion of Knowledge
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Steps to apply EBM ASSESS ASK ACQUIRE APPRAISE APPLY AND
EVALUATE
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Steps to apply EBM 1-ASSESS the patient A clinical problem or
question arises from the care of the patient. ASSESS
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Example This is a new patient who recently moved to the area to
be closer to her son and his family. She is 73 years old and has a
history of congestive heart failure and a left ventricular ejection
fraction of 40%. She has been hospitalized twice within the last 9
months for worsening of heart failure. She is taking her
medications (aspirin and b-blockers) in time and wants to stay out
of the hospital. She lives alone with several cats and a
canary.
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Example She comes to you with an advertisement for a new drug
(enalapril) and wants to know if this would help her. You are not
certain of the evidence supporting this drug. You decide to
research this question before discussing this with her during the
next visit.
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Steps to apply EBM 2- ASK the question If you search over
internet in non-systematic way for certain evidence, it will take
long time, but to minimize time and getting accurate result during
search for evidence use this formula: ASK
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Steps to apply EBM 2- ASK the question
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Steps to apply EBM EXAMPLE:
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Steps to apply EBM EXAMPLE: In elderly patients with heart
failure and an ejection fraction of 40%, is enalapril effective in
reducing the need for rehospitalization?
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Example 2 Patient/Proble m Intervention Comparison Intervention
Outcome Your next patient is a 72-year-old woman with
osteoarthritis of the knees, accompanied by her daughter and she
takes regular NASID. The daughter wants you to give her mother a
prescription for one of the new COX-2 inhibitors. She has heard
that they cause less GI bleeding.
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Example 2 Patient/ProblemIntervention Comparison Intervention
Outcome osteoarthritis of the knee COX-2 Inhibitor Regular NSAIDS
less GI bleeding Your next patient is a 72-year-old woman with
osteoarthritis of the knees, accompanied by her daughter and she
takes regular NASID. The daughter wants you to give her mother a
prescription for one of the new COX-2 inhibitors. She has heard
that they cause less GI bleeding.
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Steps to apply EBM 3- ACQUIRE the evidence ACQUIRE
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Steps to apply EBM 4- APPRAISE the evidence: Critical
appraisal. Level and type of evidence. APPRAISE
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Steps to apply EBM 4- APPRAISE the evidence: Critical
appraisal: It is the process of assessment of evidence by
systematically reviewing its relevance, validity and the results
(out of our scope). APPRAISE
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Type of evidence Types of sources for evidence: Primary
sources: Original articles (studies): randomized clinical trial,
cohort, case-controletc. Secondary sources: Clinical practice
guidelines (summaries) Evidence based abstraction journals
(synopses of syntheses) Systematic reviews (syntheses)
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Type of evidence
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As the pyramid show, guidelines are the best and more valid
evidence you can choose.
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Level of evidence US Preventive Services Task Force (USPSTF):
ranking the evidence based on the quality of it.
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Level of evidence So if you have more than evidence it is
better to choose the one with high grade and levels, if you did not
do Critical appraisal.
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Steps to apply EBM 5- APPLY and Evaluate. APPLY AND
EVALUATE
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Steps to apply EBM 5- APPLY and Evaluate. APPLY AND
EVALUATE
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How to make evidence base presentation
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Getting the information Background: from textbook. Foreground:
from articles.
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Summarize the evidence Usually evidence range from 5 to 50
pages, you cannot add all of it. So make sure to add in your slide:
title, high light of result, conclusion, summery table or graph,
reference.
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Summarize the evidence
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Difference Journals and Pubmed.
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Plagiarism representation of others works as one's own original
work. academic dishonesty
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summary ASSESS ASK ACQUIREAPPRAISE APPLY AND EVALUAT E
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References: Fundamental tools for understanding and applying
the medical literature and making clinical diagnoses. Includes
online version of the Users' Guide to the Medical Literature (2008)
and The Rational Clinical Examination (2009). Users' Guides to the
Medical Literature: A Manual for Evidence- Based Clinical Practice,
2nd Edition Gordon Guyatt, Drummond Rennie, Maureen O. Meade, and
Deborah J. Cook. 2008 Sharon E Straus, W. Scott Richardson, Paul
Glasziou and R. Brian Haynes. Evidence-based Medicine: How to
Practice and Teach EBM. 3nd edition. Elsevier, 2005. Evidence-Based
Medicine Working Group Evidence-Based Medicine: A New Approach to
Teaching the Practice of Medicine. JAMA 1992 Nov
4;268(17):2420-5.
