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What Is This Thing Called EBM?

What Is This Thing Called EBM?. Cleo Pappas, MLIS, AHIP Maureen Clark, MHS, MLIS. Definitions. Sackett et al define EBM as “the integration of best research evidence with clinical expertise and patient values”.

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What Is This Thing Called EBM?

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  1. What Is This Thing Called EBM? Cleo Pappas, MLIS, AHIP Maureen Clark, MHS, MLIS

  2. Definitions • Sackett et al define EBM as “the integration of best research evidence with clinical expertise and patient values”. • Sackett D L, Straus S E, Richardson W S, Rosenberg W Haynes R B. Evidence-based Medicine: How to Practice and Teach EBM. Edinburgh: Churchill Livingstone; 2000.

  3. Acronyms • EBM • EBP • EBHC • EBD • EBS

  4. MeSH • Evidence-Based Medicine is a Medical Subject Heading.

  5. Modern Environment Demands EBM • Increase in federal funding for research • Explosion of medical knowledge and article publication • Technological development of databases capable of holding huge datasets • NLM creation of MedLine

  6. How much effort effort is required and how long would it take to “translate” the research into clinical practice?

  7. Explosion of Medical Knowledge • A 2004 study estimated it would take 29 hours per weekday or 351 hours per month for a physician to stay abreast of primary care literature. • Alper et al. How Much Effort Is Needed to Keep Up with the Literature Relevant for Primary Care? Journal of the Medical Library Association. 2004 October; 92 (4): 429 – 37.

  8. Another definition • EBM is…”an evolutionary progression of knowledge based on the basic and clinical sciences and facilitated by the age of information technology.” • Doherty, Steve. Evidence-based medicine: Arguments for and Against. Emergency Medicine Australasia 2005; 17: 307-13.

  9. Awakening to the Need For Evidence-Based Practice In 1972, Dr. Archie Cochrane publishes: Effectiveness and Efficiency: random reflections on health services

  10. 1909: Born in Galashiels, Scotland. 1917: Father killed in the Battle of Gaza 1927-30: King's College Cambridge. Honours: Natural Sciences. 1931: Research student with Dr N. Wilmerat on tissue cultures 1931-34: Psychoanalysis with Theodor Reik (Vienna, Berlin) 1934-6: Medical student, University College Hospital 1936: International Brigade, Spanish Civil War. 1939-46: Captain, Royal Army Medical Corps. 1941: PoW medical officer in Greece and Germany. 1947-48: Studied tuberculosis epidemiology in the US. 1948-60: Medical Research Council Pneumoconiosis Research. 1960-69: Professor of Tuberculosis and Chest Diseases, Wales. 1960-74: Dir., Medical Research Council Epidemiology Research 1972: Effectiveness and Efficiency - Random Reflections on Health Services. 1974-86: Completed 20 & 30-year follow-up of Welsh miners. Who Was Dr. Cochrane?

  11. The body’s innate healing power 1976, Cochrane estimated: less than 10% of medical interventions objectively demonstrated more good than harm Laymen had an uncritical belief in medicine’s cure for everything Concern: the “pursuit of a cure at all costs may restrict the supply of care” Solution: randomized clinical trials: “open up a new world of evaluation and control which will… be the key to a rational health service” What Dr. Cochrane Saw

  12. Cochrane Collaboration

  13. David Sackett • “Why on earth should you take any advice from any of us old farts who (through inattention, greed, or simple incompetence) got academic medicine into the simply awful mess in which you find it today?” BMJ 2004; 329:294 (31 July)

  14. Dr. David Sackett • M.D. (UIC), Doctor of Science (Bern), M.S. in Epidemiology (Harvard) • Professor Emeritus of Clinical Epidemiology and Biostatistics at McMaster University. • Physician-in-chief of medicine at Chedoke-McMaster hospitals

  15. Dr. David Sackett • Head of the division of general internal medicine at McMaster • Professor of clinical epidemiology at Oxford • Founding director of the National Health Service R&D Centre for Evidence-Based Medicine at Oxford • Canadian Medical Hall of Fame in 2000

  16. The Process • EBM begins and ends with the individual clinician treating the individual patient.

  17. What are we asking? • Etiology • Diagnosis • Therapy • Prognosis/Harm

  18. Process • Formulating the question

  19. PICO • Patient • Intervention • Comparison • Outcome

  20. Patient

  21. Intervention

  22. Comparison

  23. Outcome

  24. The Process • Conducting the search

  25. The Process • Appraising the evidence -

  26. Validity • Is there a clearly defined question? • Was the question focused in terms of the population group actually studies, the intervention received, and the outcomes considered? • Is there a control group

  27. Validity • Were the groups randomized? • Were all the patients accounted for at the conclusion? (Intention to Treat) • After finding a study that addresses our question, the study needs to be analyzed further in terms of its statistical quality.

  28. EBM begins and ends with the individual clinician treating the individual patient.

  29. Tools • Clinical Queries in PubMed • Meta-analysis in PubMed • Online calculators • Specialized databases: Cochrane, Pier

  30. Resources • Studying a Study and Testing a Test (Lippincott Williams & Wilkins; 5th edition (October 1, 2004) ISBN:0781745764) • Evidence-based Medicine Toolkit (Blackwell Publishing Limited; 2 edition (April 1, 2006) ISBN:0727918419) • Evidence-based Medicine: How to Practice and Teach EBM (Churchill Livingstone; 3 edition (April 29, 2005) ISBN: 0443074445)

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