Introduction to Evidence Based Medicine

Dr. Tina Dewi Judistiani, dr. SpOG

Dept Epidemiology and Biostatistics

School of Medicine – Universitas Padjadjaran

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.

I am here to learn EBM because ….

1. I have no idea 2. I will be a practicing doctor 3. I will be working on researches 4. I will help others use evidence5. I plan to teach EBM

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

What kind of doctor would you become ?

William Osler, 1900 Smart young doctor

Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford

Do you want to get there ?

Wise & experienced smart young doctor

Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford

How is the construction building of Learning EBM like ?

EBM learning

1. What is Evidence-based practice?2. Asking well-formulated Questions3. Searching for evidence 4. Critical Appraisal 5. Diagnostic studies 6. Intervention studies7. Prognostic studies

Introductory Lecture: Objectives

1. What What is evidence-based medicine? What does it look like in practice?

2. How Formulate Clinical Questions1. Search for Evidence2. Appraisal of research3. Apply to clinical problem

What is evidence-based medicine?

“Evidence-based medicine is the integration of best research evidence available with clinical expertise and patient values”

- Dave Sackett

Patient Concerns

Clinical Expertise

Best research evidence

EBM

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

Medic

al A

rtic

les

Per

Year

Is keeping up to date Mission Impossible?

Bluegreenblog 2006

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 journal club with your practice

Reminding : The 4 steps of “pull” EBM

1. Formulate an answerable question2. Track down the best evidence 3. Critically appraise the evidence4. Individualise, based clinical expertise and

patient concerns

Step 1Formulate an answerable clinical question

Structure of researchable questions – PICO-T

Population/Patients

Intervention

Comparison

Outcome

Time

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

Risk Factors

Cause(s)

SymptomsSigns, Tests

Prognosis

Treatment Effect

Past current future

Types of question: stroke

Frequency

Cohort Study Survey

Inception Cohort Study

Treatments

Randomised Trial

Cross Sectional Study

Degenerative process in the Coronary artery

ECG Angiography MRI

2. Searching: finding good answers?

Searching made easy

3. Rapid Critical Appraisal

It’s peer-reviewed, therefore it must be OK?

USE THE TOOLS

WORKSHEET FOR EACH STUDY TYPES

Step 4: Applying to the individual

What do the results mean on average?

What do they mean for this individual?