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Evidence based medicine Basic concepts and building blocks

HKCEM College Tutorial. Evidence based medicine Basic concepts and building blocks. author Dr . TSOI chun hing ludwig May 2013. After this tutorial, you will be able to tell. What is “evidence” in Evidence-based medicine Nature of different types of studies in relation to evidence

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Evidence based medicine Basic concepts and building blocks

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  1. HKCEM College Tutorial Evidence based medicineBasic concepts and building blocks author Dr. TSOI chunhingludwig May 2013

  2. After this tutorial, you will be able to tell • What is “evidence” in Evidence-based medicine • Nature of different types of studies in relation to evidence • The concept of different levels of evidence

  3. What is evidence? • Evidence refers to the basis of the claim • The claim could be diagnostic test, therapeutic intervention, prediction rule etc

  4. Case • M/45 • Cat 4 • c/o Right foot pain x 2 days, not relieved by oral paracetamol • PMH: Gout • o/e Right 1st MP joint red, swollen and tender • Clinically gouty attack

  5. Your patient asks you for pain relief • You wonder what is the best treatment for him? • (Paracetamol) • NSAID • Colchicine • Steroid

  6. You ultimately have decided to try systemic (oral) steroid on him • You wonder: • Is steroid effective in treating ACUTE gout?

  7. With the assistance of a senior, you formulated a 3-part question: • [In an adult with acute gouty attack], is [oral steroid] effective in [alleviating pain]?

  8. What sources of information do you want to get? • Ask your friend in A&E (< 1 min) • Ask your senior (~ 5 min) • Consult a textbook (e.g. Tintinalli, 5 min) • Practice of Emergency Medicine, HKCEM 2010 (~ 5 min) • Google search (“gout” 60 million hits) • Medline search (MESH 6526 hits; /th 515 hits) • Cochrane Library (“gout” 54 hits) • DynaMed (~ 5 min)

  9. DynaMed (from HA terminal) • Free to all HA staff • Relatively cheaper than UpToDate • A distilled source of Evidence-based medicine for bedside • More up-to-date than Cochrane Library (*2007)

  10. Grade of evidence – A, B, C

  11. Level of evidence – I, II, III, IV • To complicate the matter…

  12. The Cochrane search ended 2007 hence did not include last paper

  13. Levels of evidence in DynaMed

  14. From here

  15. To here • Filtered information

  16. Clinical Bottom Line • Prednisolone as effective as NSAID for reducing pain and disability in acute gouty attack (Level 1 evidence)

  17. Summary • In this tutorial, you have learnt: • What is “evidence” in Evidence-based medicine • Nature of different types of studies in relation to evidence • The concept of different levels of evidence

  18. Questions

  19. The End Thank you

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