Upload
suffian-sani
View
220
Download
0
Embed Size (px)
Citation preview
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
1/26
Evidence-Based Medicine
Introduction
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
2/26
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
3/26
Course Web Sitehttp://courses.washington.edu/ebmed/EBM/index.shtml
You can link to this site from the Medicine Residency webpage, the Roosevelt GIMC Residents web page, or HSL
Evidence Based Practice web page.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
4/26
Evidence-based medicine isthe integration of the best
available research evidencewith clinical expertise and
patient values.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
5/26
Why Teach and Practice EBM?
It is required to be taught by ABIM. Outcomes research has documented that
patients who do receive evidence-basedtherapies have better outcomes than thosewho dont.
It may be a more efficient means of remainingcurrent than traditional methods (e.g. journal
subscriptions). A host of developments make EBM more
possible than ever.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
6/26
Developments
Efficient strategies for tracking andappraising evidence.
Availability of evidence-based journals.
Creation of systematic reviews andconcise summaries.
Information systems allowing access to
resources in seconds.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
7/26
Objectives
Hands-on, real-time learning of skillsnecessary to incorporate EBM into your dailypractice of medicine.
Provide the opportunity to apply these skills toactual clinical encounters.
Have fun learning and teaching others.
Minimize work outside of day to day clinicalresponsibilities.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
8/26
Responsibilities
Attend all the sessions.
Each week during your clinicalencounters generate at least one
question about patient care you wouldlike to try and answer in EBM. We willtackle these questions thematically(therapy, prognosis, diagnosis).
Apply and teach what you learn.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
9/26
Steps in Practicing EBM
1. Convert the need for information into ananswerable question.
2. Track down the best evidence with which to
answer that question.3. Critically appraise the evidence for its
validity, impact, and applicability.
4. Integrate the evidence with our clinical
expertise and our patients characteristics
and values.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
10/26
Limitations*
Time. Shortage of coherent and consistent
scientific evidence (therapeutic nihilism).
Challenges of applying evidence to careof individual patients.
General barriers to the practice ofquality medicine (e.g. costs, patientexpectations, etc.).
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
11/26
Putting Skills into Practice
Find evidence supporting one clinicaldecision made on each of your inpatients.
Find evidence supporting one clinical
decision made on one patient per clinic day. Encourage the students and colleagues you
work with to follow your lead.
Work as a team to find evidence-basedanswers.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
12/26
Course Structure - 8 week cycleWeek 1
Introduction
Asking a clinical question Critical appraisal of therapy articles Therapy questions Searching
Week 2
Critically appraise therapy articles
Write CAT New question and real-time practicesession
Week 3
Review asking a clinical question Critical appraisal of prognosis articles
Prognosis questions Searching
Week 4
Critically appraise prognosis articles Write CAT
New question and real-time practicesession
Week 5
Introduction Asking a clinical question Critical appraisal of diagnosis articles
Diagnosis questions Searching
Week 6
Critically appraise diagnosis articles Write CAT New question and real-time practice
session
Week 7
Review asking a clinical question Critical appraisal of articles about harm Searching
Week 8
Critically appraise harm articles Write CAT New question and real-time practice
session
Think ofTherapy ?s
Think ofPrognosis
?s
Think ofDiagnosis
?s
Think ofHarm ?s
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
13/26
The Answerable Question
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
14/26
Steps in Practicing EBM
1. Convert the need for information into ananswerable question.
2. Track down the best evidence with which to
answer that question.3. Critically appraise the evidence for its
validity, impact, and applicability.
4. Integrate the evidence with our clinical
expertise and our patients characteristicsand values.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
15/26
Good questions are thebackbone of practicing EBM.
It takes practice to ask thewell-formulated question.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
16/26
The nature of the question
asked is critically experiencedependent.
GENERAL KNOWLEDGE
SPECIFIC KNOWLEDGE
TYPE OF
QUESTION
CLINICAL EXPERIENCE
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
17/26
Differences in Type of ?s
Background questioncomposed of questionmodifier and condition.
Cover the full range ofbiologic, psychologic, orsociologic aspect of humanillness
Can be answered byreference works.*
Can be used as a trampolinefor generating specificquestions to be answered byEBM.
Foreground questioncomposed of patient and/orproblem, intervention(therapy, diagnostic test,etc.), comparison andoutcome.
Often requires morecomprehensive andintensive search strategies
(not necessarily more timeconsuming).
Suitable to answering usingthe techniques of EBM.
General Specific
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
18/26
Well-Built Clinical ?s
Directly relevant to the care of the patient andour knowledge deficit.
Contains the following elements:
the patient or problem being addressed the intervention or exposure being considered
the comparison intervention or exposure, whenrelevant
the clinical outcomes of interest.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
19/26
Well Formulated ?s
Focus scarce learning time on evidence directlyrelevant to patients needs and our particular
knowledge needs.
Suggest high-yield search strategies.
Suggest forms that useful answers might take.
Help us to model life-long learning techniques for ourcolleagues and students.
Are answerable and, thus, reinforce the satisfactionof finding evidence that makes us better, fasterclinicians.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
20/26
Q: How do you find currentbest evidence?
A: Ask your librarian!Sherry Dodson - Clinical Medical Librarian
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
21/26
Q: What is best evidence?
OR
Q: What kind of evidence is least likely to bewrong?
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
22/26
Steps in Practicing EBM
1. Convert the need for information into ananswerable question.
2. Track down the best evidence with which to
answer that question.3. Critically appraise the evidence for its
validity, impact, and applicability.
4. Integrate the evidence with our clinical
expertise and our patients characteristicsand values.
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
23/26
The Evidence Pyramid
Validity/Strengtho
fInference
TimeSpent
inCriticalAp
praisal
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
24/26
Levels of Evidence
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
25/26
ResourcesMETA-SEARCH ENGINES
PrimeAnswersTRIP+SUMSearch
SYSTEMATIC REVIEWS/META-ANALYSES
Cochrane LibraryPubMed Clinical Queries using Research Methodology Filters
EVIDENCE GUIDELINES/SUMMARIES
AHRQ Evidence ReportsClinical EvidenceAHRQ Preventive Services
CLINICAL RESEARCH CRITIQUES
ACP Journal Club 1996-
Bandolier 1994-BestBETs
CASE REPORTS/SERIES, PRACTICE GUIDELINES, ETC
National Guideline ClearinghousePubMed
8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07
26/26
Steps in Practicing EBM
1. Convert the need for information into ananswerable question.
2. Track down the best evidence with which to
answer that question.3. Critically appraise the evidence for its
validity, impact, and applicability.
4. Integrate the evidence with our clinical
expertise and our patients characteristicsand values.