evidence based medicine
TRANSCRIPT
Dr. Nisreen A. Jastaniah
Assist Prof KSAU-HS
Consultant Geriatric Medicine KAMC-J
Problem solving methods
other …
• Hani ( 47 years) software programmer
Thinking about early retirement …. (retirement and
health) Discussion
Problem solving methods
Scientific…( searching for evidence)
• HANI ( 47 years) software programmer
Thinking about early retirement ….
Discussion , retirement and health
Problem solving methods
Scientific…( searching for evidence)
Problem solving methods
Scientific…( searching for evidence)
Problem solving methods
Scientific…( searching for evidence)
Problem solving methods
Scientific…
Needs
• We need evidence (about the accuracy of diagnostic tests, the power of prognostic markers, the comparative efficacy and safety of interventions, etc.)
• about 5 times for every in-patient (and twice for every 3 out-patients).
• We get less than a third of it
9
Why Evidence Based Health Care?
• Too many patients
• Too many problems
• Too many journals
• Information overload
• No time to read
• Read what I am familiar with
• Avoid difficult issues
10
EBM; IS IT NEW?
865)الرازي أول من دعا إليه في االقرن التاسع الميالدي حين قال ( 915 –
إنه ما أجمع عليه األطباء وشهد عليه القياس وأيدته “ “التجربة
11
April 2006 12
والتحفظ في , مع انتقاد المقدمات..
و نتحرى في جميع ما , النتائج
نميزه و ننتقده طلب الحق ال
......الميل مع اآلراء
Requirements of new treatment
• The drug must have a defined mode of action
• It must be tested on a well defined disease
• The time of action must be observed
• The effect of the drug must be seen to occur constantly in many cases
• The experimentation must be done with the human body for testing a drug on a lion or a horse might not prove anything about its effect on man
Ibn Sina 981-1037
13
When did EBM begin ?
• Dr. Archie Cochrane
(British epidemiologist and a leading EBM
theoretician, estimated a decade ago
that only 15-20% of all medical practice is
based on scientific, statistically sound
research.
14
Evidence-based medicine
Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values.
16
Steps of evidence based
medicine
1)Ask a question
2)Acquire some articles
3)Appraise the evidence
4)Apply the findings
5)Assess our performance
17
Steps of evidence based medicine
Step 1: formulating an answerable question
Patient or Problem
Intervention
Comparison Intervention
Outcome.
18
Steps of evidence based medicine
Step 2: Tracking down the best available evidence
Tracking down the best evidence with which to
answer that question.( diagnosis, therapy
,prognosis…)
19
Steps of evidence based medicine
Step 2: Tracking down the best available evidence
study design
Primary studies (therapy ,diagnosis ,harm &prognosis ).
Integrative studies (overview ,practice guidelines..).
20
.
Steps of evidence based medicine
Step3: Critically appraising that evidence
validity (closeness to the truth),
impact (size of the effect) the results, and
applicability.
21
Steps of evidence based medicine
Step4: Integrating of the best available
evidence to our patients
our patient's unique biology, values and
circumstances.
22
Steps of evidence based medicine
Step 4: Integrating of the best available
evidence to our patients
The evidence
Clinical experience Patient values
23
Steps of evidence based medicine
Step5: Evaluating our effectiveness
in executing Steps 1-4 and seeking ways to improve
them both for next time.
24
Steps of evidence based medicine
• Do We need always carry out all 5 steps to provide E-B Care ?
Searching & appraising”
o provides E B care, but is expensive in time and resources
“Searching only”
o much, quicker, and if carried out among E B resources, can provide E B care.
25
POEMs & DOEs POEM
Patient
Oriented
Evidence that
Matters
26
DOE
Disease
Oriented
Evidence
HRQL (Health Related Quality of life) for example, mobility, self-care, and physical, emotional, and social function).
Relevance: Type of Evidence
• DOE: Disease-oriented evidence
o pathophysiology, pharmacology, etiology
• POE: Patient-oriented evidence
o mortality, morbidity, quality of life, satisfaction
27
Study design & Evidence based
clinical practice Different questions study design
• Prevalence or frequency of factor Cross sectional study
•Hypotheses about possible Harm (or causes) Case-control
• Harm or Causes or risk factors Cohort
• Experience of illness Qualitative
• Effectiveness Randomized controlled trial
Original Study
Longitudinal Descriptive
Cross sectional
Case report
Case series
interventional observational
Case-control
cohort
Integrative Studies
SR
Evidence
Study design & Evidence based
clinical practice
Study design & Evidence based
clinical practice
31
1)Ask a question
2)Acquire some articles
3)Appraise the evidence OR use appraised evidence
4)Apply the findings
5)Assess our performance
?
Steps of evidence based medicine
Types of health care professional
32
Evidence Finders
Evidence Users
Evidence generator
Evidence Ignorer
Questions?
34
1)Ask a question
2)Acquire some articles
3)Appraise the evidence OR use appraised evidence
4)Apply the findings
5)Assess our performance
?
Steps of evidence based medicine
THANK YOU
36