Transcript College Tutorial

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
▪ The concept of different levels of evidence
What is evidence?
▪ Evidence refers to the basis of the claim
▪ The claim could be diagnostic test, therapeutic
intervention, prediction rule etc
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
Your patient asks you for pain relief
▪ You wonder what is the best treatment for him?
▪ (Paracetamol)
▪ NSAID
▪ Colchicine
▪ Steroid
You ultimately have decided to try
systemic (oral) steroid on him
▪ You wonder:
▪ Is steroid effective in treating ACUTE gout?
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]?
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)
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)
Grade of evidence – A, B, C
Level of evidence – I, II, III, IV
▪ To complicate the matter…
The Cochrane search ended 2007
hence did not include last paper
Levels of evidence in DynaMed
From here
To here
▪ Filtered information
Clinical Bottom Line
▪ Prednisolone as effective as NSAID for reducing
pain and disability in acute gouty attack (Level 1
evidence)
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
Questions
The End
THANK YOU