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Introduction to EBM

Introduction to EBM. dr. Ryan Herardi. Patient Concerns. Best research evidence. Clinical Expertise. EBM. What is evidence-based medicine ?.

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Introduction to EBM

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  1. Introduction to EBM dr. Ryan Herardi

  2. Patient Concerns Best research evidence Clinical Expertise EBM What is evidence-based medicine? “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values” - DaveSackett

  3. History • In the Past • Ancient Chinese medicine • Post-revolutionary Paris • In the current era, • named EBM in 1992 by a group led by Gordon Guyatt at McMaster University in Canada

  4. How do we actually practice EBM

  5. Asking • Background questions • General knowlegde about a disorder • (5W + H) + (a disorder / aspect of a disorder) • Foreground questions • Specific knowledge about managing patients • PICO

  6. PICO • P = Patient / Population / Problem • I = Intervention / Indicator / Index • C = Comparation (if relevant) • O = Outcomes

  7. PICO

  8. The uses of EBM • Improving outcomes for patients (no such evidence) • Improving clinical communication skills • Improving skills for use in finding, appraising, and implementing evidence • Doing a new research ?

  9. Types

  10. VIA methods • Validity: type of study, blinded?, number of subjects?, controlled? • Importance: result? • Applicability: patient’s characteristic

  11. Levels of Evidence

  12. What do we need ?

  13. Find Evidence

  14. Develop a search strategy Using OR then ANDto broaden then focus the search and and

  15. Combine terms withOR pharyngitis Pharyngitis OR sore throat – either term can be present Sore throat

  16. Combine terms withAND Antibiotics AND sore throat – both terms must be present antibiotics sore throat

  17. PubMed demonstrationwww.pubmed.gov

  18. Pubmed

  19. Pubmed

  20. The Cochrane Library • Specialist database including articles on clinical and cost effectiveness of interventions: • Systematic reviews – Cochrane Database of Systematic Reviews & DARE • RCTs – Central • Economic evaluations - NHSEED • Free access in the UK at http://www.thecochranelibrary.com • Other countries check “access options” at http://www.cochrane.org

  21. Practice “Practice makes perfect, but nobody's perfect, so why practice?” ― Kurt Cobain

  22. Scenario Gerry, has had a bad throat for a few days and it’s making him feel miserable. He goes to his friendly GP wanting some antibiotics. However, his doctor isn’t sure whether there’s any benefit in prescribing them. What’s the evidence?

  23. Example 1 Jean is a 55 year old woman who quite often crosses the Atlantic to visit her elderly mother. She tends to get swollen legs on these flights and is worried about her risk of developing deep vein thrombosis (DVT), because she has read quite a bit about this in the newspapers lately. She asks you if she would wear elastic stockings on her next trip to reduce her risk of this. Type : P I C O

  24. Example 2 Susan is expecting her first baby in two months. She has been reading about the potential benefits and harms of giving newborn babies vitamin K injections. She is alarmed by reports that vitamin K injections in newborn babies may cause childhood leukaemia. She asks you if this is true and, if so, what the risk for her baby will be. Type : P I C O

  25. Example 3 Julie is pregnant for the second time. She had her first baby when she was 33 and had amniocentesis to find out if the baby had Down Syndrome. The test was negative but it was not a good experience, because she did not get the result until she was 18 weeks pregnant. She is now 35 and 1 month pregnant, and asks if she can have a test that would give her an earlier result. The local hospital offers serum biochemistry plus nuchal translucency ultrasound screening as a first trimester test for Down syndrome. You winder if this combination of tests is as reliable as a conventional amniocentesis Type P I C O

  26. Example 4 Mr Thomas, who is 58 years old, has correctly diagnosed his inguinal lump as a hernia. He visits you for confirmation of his diagnosis and information about the consequences. You mention the possibility of strangulation, and the man asks ‘How likely is that?’ You reply ‘pretty unlikely’ (which is as much as you know at the time) but say that you will try to find out more precisely. Type P I C O

  27. Your Clinical Questions Write down one recent patient problem What is the PICO of the problem?

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