Transcript Introduction to Evidence Based Medicine

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-theuninitiated/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.
2.
3.
4.
5.
I have no idea
I will be a practicing doctor
I will be working on researches
I will help others use evidence
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 Medicine
Paul 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 ?
Research
design
Critical
appraisal
EBM
EBM learning
1.
2.
3.
4.
5.
6.
7.
What is Evidence-based practice?
Asking well-formulated Questions
Searching for evidence
Critical Appraisal
Diagnostic studies
Intervention studies
Prognostic studies
Introductory Lecture: Objectives
1. What


What is evidence-based medicine?
What does it look like in practice?
2. How

1.
2.
3.
Formulate Clinical Questions
Search for Evidence
Appraisal of research
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
EBM
Best research
evidence
Clinical
Expertise
Rule 31 – Review the World Literature Fortnightly*
Medical Articles Per Year
*"Kill as Few Patients as Possible" - Oscar London
5,000?
per day
1,500
per day
95 per
day
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.
2.
3.
4.
Formulate an answerable question
Track down the best evidence
Critically appraise the evidence
Individualise, based clinical expertise and patient
concerns
Step 1
Formulate 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
Types of question: stroke
Risk Factors
Cohort Study
Frequency
Prognosis
Survey
Inception Cohort Study
ECG
Angiography
MRI
Degenerative
process in the
Coronary
artery
Treatments
Symptoms
Signs, Tests
Cause(s)
Treatment Effect
Randomised Trial
Cross Sectional Study
Past
current
future
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?