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Medical Information on the Internet

Medical Information on the Internet. U.A. Garred Sexton M. D. GOALS of Presentation. E VIDENCE B ASED M EDICINE EVALUATION OF INFORMATION STRENGTH OF STUDIES HOW DO I MAKE IT USEFUL TO ME WEB SITES THAT CAN HELP. For the general public. In the past source of evidence

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Medical Information on the Internet

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  1. Medical Information on the Internet U.A. Garred Sexton M. D.

  2. GOALS of Presentation • EVIDENCE BASED MEDICINE • EVALUATION OF INFORMATION • STRENGTH OF STUDIES • HOW DO I MAKE IT USEFUL TO ME • WEB SITES THAT CAN HELP

  3. For the general public • In the past source of evidence • Always been that way (GRANDMOTHER) • Custom • INFOMERCIALS • FELLOW WORKER • INTERNET • THE HEALTH CARE PROVIDER

  4. PAST VALIDATION OF TREATMENT BY MEDICAL • HISTORICALLY IT WAS DONE THIS WAY • ALWAYS DID IT THIS WAY • OBSERVATION • WORKED BEFORE (anecdotal) • KOCH’S POSTULATES • EXPERIMENTATION

  5. Evidence Based Medicine EBM is taking all the available data on a particular question, synthesizing it, reviewing it, putting it into the context of what it really means, and then taking it and applying it to the patient.

  6. STUDIES • TYPES • ANECDOTAL • OBSERVATION • COHORT • RANDOM • RANDOM CONTROLLED • RANDOM CONTROLLED DOUBLE BLIND

  7. EBMWHAT TO LOOK FOR • SIZE OF STUDY • CONFIDENCE LEVEL – WHAT ARE THEY TESTING – DO CONCLUSION FIT THE TEST

  8. EBM • TEST 98% ACCURATE • TEST 98% SENSITIVE • OCCURRENCE OF DISEASE IN POPULATION 10% • A POSITIVE SCREENING TEST HAS A 50/50 CHANCE OF BEING CORRECT

  9. EBM • FROM THE GENERAL TO THE SPECIFIC • WE ARE ALL DIFFERENT • DRUG EFFECTS • PLACEBO • UNKNOWNS

  10. Problems with EBM Time to publish Need for funding Some one has to think results will be valuable Has to be published

  11. NUMBER NEEDED TO TREAT • Calculation • To calculate the NNT, you need to know the Absolute Risk Reduction (ARR); the NNT is the inverse of the ARR: • NNT = 1/ARR • Where ARR = CER (Control Event Rate) - EER (Experimental Event Rate).NNTs are always rounded up to the nearest whole number.

  12. NUMBER NEEDED TO TREAT • Reference http://en.wikipedia.org/wiki/Number_needed_to_treat

  13. ARR = CER (Control Event Rate) - EER (Experimental Event Rate). For example, if your drug reduces the risk of a bad outcome from 50 per cent to 30 per cent, the ARR is: ARR = CER - EER = 0.5 - 0.3 = 0.2 (20 per cent) therefore NNT = 1/ARR = 1/0.2 = 5

  14. EBM • E-MAIL U.A. Garred Sexton M.D. uags@aol.com

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