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Introduction to Evidence Based Medicine

Introduction to Evidence Based Medicine. Dr. Tina Dewi Judistiani, dr. SpOG Dept Epidemiology and Biostatistics School of Medicine – Universitas Padjadjaran. KEY REFERENCES.

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Introduction to Evidence Based Medicine

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  1. Introduction to Evidence Based Medicine Dr. Tina Dewi Judistiani, dr. SpOG Dept Epidemiology and Biostatistics School of Medicine – Universitas Padjadjaran

  2. KEY REFERENCES Greenberg RS, Daniels SR, Flanders D, Elley JW, Boring JR. Medical Epidemiology. 1st ed. Prentice-Hall International Inc. London .1993 West S. Basic Public Health Concepts : What is Screening? Wilmer Eye Institute - Johns Hopkins University. Available from www.crag.uab.edu/safemobility/Screening.ppt Coggon D, Rose J, Barker DJP. Epidemiology for the uninitiated. Available from http://resources.bmj.com/bmj/readers/readers/epidemiology-for-the-uninitiated/10-screening Loong TW. Understanding sensitivity and specificity with the right side of the brain. BMJ 2003: 327: 716-19. Sedlmeier P and Gigerenzer G. Teaching Bayesian reasoning in less than two hours. Journal of Experimental Psychology: General. 130 (3):380-400, 2001. Glaziou , P. Centre of Evidence Based Medicine, Oxford.

  3. I am here to learn EBM because …. • I have no idea • I will be a practicing doctor • I will be working on researches • I will help others use evidence • I plan to teach EBM

  4. Life long learning The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not … a medical course, but a life course. For which the work of a few years under teachers …is preparation. Sir William Osler (1849-1919), from: The Student of MedicinePaul Glasziou , Centre for Evidence-Based Medicine University of Oxford

  5. What kind of doctor would you become ? Smart young doctor William Osler, 1900 Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford

  6. Do you want to get there ? Wise & experienced smart young doctor Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford

  7. How is the construction building of Learning EBM like ?

  8. EBM learning • What is Evidence-based practice? • Asking well-formulated Questions • Searching for evidence • Critical Appraisal • Diagnostic studies • Intervention studies • Prognostic studies

  9. Introductory Lecture: Objectives 1. What • What is evidence-based medicine? • What does it look like in practice? 2. How • Formulate Clinical Questions • Search for Evidence • Appraisal of research • Apply to clinical problem

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

  11. Rule 31 – Review the World Literature Fortnightly**"Kill as Few Patients as Possible" - Oscar London 5,000? per day 1,500 per day 95 per day Medical Articles Per Year

  12. Is keeping up to date Mission Impossible? Bluegreenblog 2006

  13. Coping with the overload: three possible things you might try A. Read an evidence-based abstraction journal(and cancel other journals) B. Keep a logbook of your own clinical questions C. Run a case-discussion journalclub with your practice

  14. Reminding : The 4 steps of “pull” EBM • Formulate an answerable question • Track down the best evidence • Critically appraise the evidence • Individualise, based clinical expertise and patient concerns

  15. Step 1Formulate an answerable clinical question Structure of researchable questions – PICO-T • Population/Patients • Intervention • Comparison • Outcome • Time

  16. What are your clinical questions? • A 35 year old man says his brother recently died of an acute myocardial infarction He is worried about whether he might have one and what the chances are that it would happen to him -> PICO Table

  17. Types of question: stroke Cohort Study Inception Cohort Study Survey Frequency Prognosis Risk Factors ECG Angiography MRI Degenerative process in the Coronary artery Treatments Randomised Trial Treatment Effect Symptoms Signs, Tests Cause(s) Cross Sectional Study Past current future

  18. 2. Searching: finding good answers?

  19. Searching made easy 

  20. 3. Rapid Critical Appraisal It’s peer-reviewed, therefore it must be OK?

  21. USE THE TOOLS WORKSHEET FOR EACH STUDY TYPES

  22. Step 4: Applying to the individual • What do the results mean on average? • What do they mean for this individual?

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