Evidence based medicine 30 - PowerPoint Presentation

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Evidence based medicine

30\4\20194th stage By Dr Muslim N.Saeed

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Learning Objectives

To discuss the relevance of Evidence-Based MedicineTo define Evidence-Based Medicine

To list the different levels of evidence

To discuss the process of Evidence-Based Medicine

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Relevance of Evidence-Based Medicine

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Why Do We Need Evidence-Based Medicine?

Continuous growth of evidence that is available to guide clinical decisions. Growth is at a rapid pace. Better understanding of the ways to produce valid clinical research as a result of improvements in research design, clinical measurements, and methods used to analyze data.

Many published study results are false or have misleading conclusions, despite advances in research methods.

Many health care providers including doctors, do not practice medicine according to the best current research evidence.

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definition

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Definition of Evidence Based Medicine

Evidence Based Medicine (EBM) is the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.These decisions include for example clinical decisions about the choice of test or treatment for individual patients as well as policy decisions for populations.

EBM is an integration of clinical expertise , best available research evidence, and patients values and preferences.

EBM gives healthcare decisions a structured that help healthcare professionals as well as patients in choosing the best available healthcare interventions for the outcomes they are looking for.

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EBM Process

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Basic Elements of EBM

To formulate a clinical questionTo find the best available evidence

To assess the validity of the evidence (appraisal/evaluation of the data)

To apply the evidence in practice, in addition to clinical expertise and patient preferences

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1. Formulate a Clinical Question

Several questions arise in clinical practice. Examples include: Is the finding abnormal?

What is the diagnosis?

How often does it occur?

What are the risk factors for a disease?

How effective is the treatment? How harmful is the treatment?

How effective are preventive measures? How harmful are preventive measures?

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PICO

The Mnemonic PICO is usually used to respond to clinical questions related to diagnosis, prognosis or effectiveness of a specific intervention (test or a treatment). For Example, in evaluating the effectiveness of an intervention, PICO stands for:

P

: What is the relevant 

patient

 population?

I

: What 

intervention

 is being considered?

C

: What is the 

comparison

 intervention or patient population?

O

: What 

outcomes

 are of interest?

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Components of PICO Questions

Intervention

Diagnosis

Prognosis

P

Relevant Patient population

Relevant Patient population

Relevant Patient population

I

Intervention being considered

Test being applied

Risk factor being evaluated

C

Comparison intervention

Comparison patient

population

O

Outcomes

Outcomes/Diagnosis

Outcomes

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PICOTT

PICO can be extended to PICOTTP: What is the relevant 

patient

 population?

I

: What 

intervention

 is being considered?

C

: What is the 

comparison

 intervention or patient population?

O

: What 

outcomes

 are of interest?

T

: what is the type of the question? Therapy/Diagnosis/Harm/Prognosis/Prevention

T

: What is the type o the study? Systematic Review/Randomized Controlled Trial/ Cohort Study/Case Control

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2. Find The Best Available Evidence

Three main categories of Evidence:Primary original research:

it involves data collected from individuals or clusters of individuals.

Systematic reviews:

they scientifically structured reviews and not simple traditional reviews. This takes into consideration the method used by the authors to find relevant articles, judgment of the scientific quality of each study considered, and weighing evidence from different studies with conflicting results.

Summaries and guidelines:

these represent the highest levels of complexity. Guidelines are a synthesis of systematic reviews, original research, clinical expertise and patient preferences.

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Sources for Evidence

Online Summary Resources: UpToDate,

DynaMed

Clinical Practice Guidelines: Clinical Evidence, Best Practice, US National Guidelines Clearinghouse

Synopsis of Systematic Reviews:

ACP Journal Club, McMaster

PLUS

, Cochrane

Sources for Non Pre-appraisal Research:

PubMed

, MEDLINE

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3. Assess the Validity of the Evidence

Internal Validity: it refers to the question of whether the results of clinical research are correct for the patients studied. Threats to internal validity are bias and chance.External Validity: it refers to the question of whether the results of the study apply to patients outside the study.

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4. Apply Evidence to Practice

Responding to the clinical raised question after conducting the structured analysis of available data.

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From Evidence to Practice

Strength of Recommendation

Definition

Implications for Practice

A

Recommendation based on consistent and good quality patient-oriented

evidence

You should do this unless there is a

compelling reason not to.

B

Recommendation based on inconsistent or limited quality patient-oriented

evidence

You should strongly consider doing this.

C

Recommendation based on consensus, usual practice, opinion, disease- oriented

evidence, and case series for studies of diagnosis, treatment,

prevention, or screening.

The evidence that this improves patient

outcomes is weaker for this

recommendation.

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