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Evidence Based Medicine

Introduction To Evidence Based Medicine. Prepared by Mohamed Mostafa Elgayar.

2014mido
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Evidence Based Medicine

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  1. Introduction To Evidence Based Medicine Mohamed M. Elgayar 5th year student at Faculty of Medicine-Menoufiya University.dr.elgayar@yahoo.com

  2. What is Evidence-Based Medicine? • Evidence-based medicine is the integration of the best available research evidence with clinical expertise and patient values. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t.

  3. Three interacting Principles of EBM

  4. Which doctor do you want? Wise & experienced smart young doctor

  5. How to practice EBM (5 steps)? • Step1 (Asking) • Step 2 (Accessing) • Step 3 (Appraising) • Step 4 (Applying) • Step 5 (Assessing) Adapted slightly from Straus, Richardson, Glasziou, Haynes. “Evidence-Based Medicine: How to practice and teach EBM”, 3rd Edition

  6. Step1 (Asking) • Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question.

  7. Types of Clinical Questions • “Background” • General information about a disorder: Anatomy ,Physiology...Books might be best • Foreground” • Specific knowledge about a disorder:Detailed informationArticles usually best i.e., the type of clinical question determines the best resource to use

  8. Convert a clinical situation into a searchable, (and hopefully answerable) question using • PICO • PATIENT • INTERVENTION • COMPARISON • OUTCOME

  9. Example: Specific Well-Built Clinical ?’s • “Can Aspirin decrease the risk of stroke?” • PICO • Patient or problem being addressed: • 65 ys with past stroke and moderate carotid stenosis • Intervention or exposure being considered: • Aspirin • Comparison intervention or exposure: • Placebo • Clinical Outcome of Interest: • Future stroke • “In a 65 ys man with history of past stroke and with moderate carotid stenosis, can ASA decrease risk of recurrent stroke compared to placebo?”

  10. Step 2 (Accessing) Tracking down the best evidence with which to answer that question.-Pub-med-Cochrane-Journals-Other databases

  11. Step 3 (Appraising) Clinically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in clinical practice).

  12. validity • Exclude Chance • Exclude Bias • Exclude Confounding

  13. The Evidence Pyramid Validity/Strength of Inference Time Spent in Critical Appraisal pyramid modified from: Navigating the Maze, University of Virginia, Health Sciences Library

  14. Step 4 (Applying) Integrating the clinical appraisal with our clinical expertise and with our patient's unique biology, values and circumstances

  15. Step 5 (Assessing) Evaluating our effective and efficiency in executing steps 1-4 and seeking ways to improve them both for next time.

  16. Thank You

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