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Information Resources for Evidence-Based Medicine

Information Resources for Evidence-Based Medicine. A Review 3 rd Year Family Medicine Clerkship - EBM. What is Evidence Based Medicine?. Evidence Based Medicine =. An integration of… The best research evidence Clinical expertise Patient values.

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Information Resources for Evidence-Based Medicine

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  1. Information Resources for Evidence-Based Medicine A Review 3rd Year Family Medicine Clerkship - EBM

  2. What is Evidence Based Medicine?

  3. Evidence Based Medicine = • An integration of… • The best research evidence • Clinical expertise • Patient values Sacket DL, et. al. Evidence-based medicine: how to Teach and Practice EBM. 2nd ed. Edinburgh: Churchill Livingston, 2000

  4. Evidence Based Medicine Sackett: Integrating individual expertise with the best available clinical evidence from systematic research. Domino: Basing the care of patients on clinical research whose outcomes are our main priority.

  5. Review of Study Types

  6. Clinical Trial An intervention is given to half of a study population, and half receive a placebo Outcomes are compared to look for a difference Produces an Absolute Risk for Intervention and Placebo

  7. Cohort Study • Prospective analysis of a population believed to be free of a disease, but who vary in exposure • This population is followed over time to determine the Incidence in the Exposed group and the Incidence in the Unexposed group • Produces a Relative Risk • Incidence of the disease state in the Exposed population divided by the Incidence in the Unexposed population.

  8. Case Control Study • Patients are identified, matched to Controls (people with similar demographics but without the disorder), in hopes of finding exposures that may have increased the risk of developing the disease.

  9. Review of EBM Literature Jim

  10. Review Articles • Summaries of the literature on a certain topic • Problems • Many do not include all of the relevant evidence • They may mix the opinions and biases of the authors with the evidence.

  11. Systematic Review • A study of studies. • Explicit criteria for selecting which studies to review is included (results in less bias) • Has a structured format for consistent presentation of information

  12. Typical Systematic Review “Skeleton” AbstractBackgroundObjectivesCriteria for considering studies for this reviewTypes of participantsTypes of interventionTypes of outcome measuresTypes of studiesSearch strategy for identification of studiesMethods of the reviewDescription of the studiesMethodological qualities of included studiesResultsDiscussionConclusionsImplications for practiceImplications for researchInternal sources of support to the reviewExternal sources of support to the reviewPotential conflict of interestAcknowledgementsContribution of Reviewer(s)SynopsisCharacteristics of included studiesTable 01 resultsReferences to studies included in this reviewAdditional references

  13. Meta-Analysis • A subclass of systematic reviews • Meta-Analyses combine and statistically summarize the results of individual studies

  14. Evidence Pyramid MOST evidence Only a small amount of the medical literature contains best evidence! LEAST evidence From SUNY Downstate Medical Research Library http://servers.medlib.hscbklyn.edu/ebm/2100.htm

  15. Questions? • Bring them to your 3rd year Family Medicine Clerkship EBM session in the Lamar Soutter Library OR • Contact: • Len Levin 508-856-6028 len.levin@umassmed.edu • Jim Comes 508-856-6810 james.comes@umassmed.edu

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