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  • Evidence-Based Medicine: Tools, Techniques, Results

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    Primarini Riati
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    This document discusses evidence-based medicine (EBM), which involves integrating individual clinical expertise with the best available empirical evidence from systematic research. EBM uses empirically-verified treatments in patient care and incorporates research results into the process of care. Clinical evidence refers to clinical or patient-centered outcomes rather than physiological measures. The best available evidence comes from sources like randomized controlled trials, studies comparing diagnostic tests to a reference standard, and prospective cohort studies of patient prognosis. EBM involves systematically searching literature and appraising evidence according to defined levels of quality and methodology.

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    This document discusses evidence-based medicine (EBM), which involves integrating individual clinical expertise with the best available empirical evidence from systematic research. EBM uses empirically-verified treatments in patient care and incorporates research results into the process of care. Clinical evidence refers to clinical or patient-centered outcomes rather than physiological measures. The best available evidence comes from sources like randomized controlled trials, studies comparing diagnostic tests to a reference standard, and prospective cohort studies of patient prognosis. EBM involves systematically searching literature and appraising evidence according to defined levels of quality and methodology.

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    32 views42 pages

    Evidence-Based Medicine: Tools, Techniques, Results

    Uploaded by

    Primarini Riati
    This document discusses evidence-based medicine (EBM), which involves integrating individual clinical expertise with the best available empirical evidence from systematic research. EBM uses empirically-verified treatments in patient care and incorporates research results into the process of care. Clinical evidence refers to clinical or patient-centered outcomes rather than physiological measures. The best available evidence comes from sources like randomized controlled trials, studies comparing diagnostic tests to a reference standard, and prospective cohort studies of patient prognosis. EBM involves systematically searching literature and appraising evidence according to defined levels of quality and methodology.

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    Download as PPT, PDF, TXT or read online from Scribd
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    of 42

    Evidence-Based Medicine: Tools, Techniques, Results

    Uses of EBM
    Use of empirically-verified treatments in the care of patients Incorporation of research results into the process of care Ability to critically appraise research results

    What is Evidence-Based Medicine?


    The integration of individual clinical expertise with the best available clinical evidence from systematic research.
    David L Sackett, W Scott Richardson, William Rosenberg, R Brian Haynes Evidence Based Medicine--How to Practice and Teach EBM, 1996
    Various definitions

    Clinical Evidence
    Clinical vs physiological outcome
    E.g., Sleeplessness rather than O2 saturation
    Clinical outcomes

    Effectiveness vs efficacy
    In practice vs biology
    Effectiveness

    Best Available Clinical Evidence


    Therapy
    Double-blind, placebo-controlled, randomized clinical trial

    Diagnosis
    Independent, blind comparison with a reference standard

    Prognosis
    Representative and well-defined prospective cohort of patients at a similar point in the course of disease

    Levels of Evidences
    (I-1) a well done systematic review of 2 or more RCTs (I-2) a RCT (II-1) a cohort study (II-2) a case-control study (II-3) a dramatic uncontrolled experiment (III) respected authorities, expert committees, etc..

    Systematic Research
    Meta-analysis
    Literature synthesis

    Integration of Individual Clinical Expertise

    Informal
    Formal

    Questions

    ARIF

    Questions: PICO

    Centre for EBM: http://163.1.212.5/docs/focusquest.html

    Search for the Best Evidence


    Review articles Community/professional standards Systematic reviews Original results

    What are the Sources of Good Evidence?

    www.welch.jhu.edu

    National Guideline Clearinghouse


    Website

    www.guideline.gov

    Cochrane
    Website

    TRIP Database
    Website

    (75 resources)

    www.tripdatabase.com

    Getting to PubMed

    PubMed Response

    PubMed Clinical Query

    www4.ncbi.nlm.nih.gov/PubMed/

    PubMed, Clinical Query, contd


    Website

    Question

    Context

    Subject matter

    UpToDate
    Website

    CISMeF
    Website

    www.chu-rouen.fr/cismef/

    Dynamic Meta-Searching
    Website

    sumsearch.uthscsa.edu/searchform45.htm

    Clinically Appraised Topic


    Websites

    CAT Content

    CAT Synthesis

    EBM Sites
    Website

    www.shef.ac.uk/~scharr/ir/netting/

    Washington University: PedsCCM


    Website

    pedsccm.wustl.edu/EBJ/EB_Resources.html

    Glossary
    Website

    www.psychiatry.ox.ac.uk/cebmh/glossary/index.html

    Details
    Therapy/prevention Diagnostic test Prognosis Harm CPG Systematic review Economic analysis Outcomes research
    Website

    www.med.ualberta.ca/ebm/ebm.htm

    Therapy
    Website

    Evidence-Based MEDICINE
    Do you tell what you know?
    Does the patient want to participate?

    What is the emotional impact of what you have to say? What is the meaning to the patient of this evidence?

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