EBM Part 1

Evidence-Based Medicine: What it is and why you need it Clista Clanton, MSLS, AHIP

Topics Covered ,[object Object],[object Object],[object Object],[object Object],[object Object]

What is EBM? ,[object Object],1. Sackett DL, et al. Evidence-Based Medicine: What it is and what it isn’t. BMJ 1996; 312:71-2. ,[object Object]

In simpler words… ,[object Object],[object Object],[object Object],[object Object]

What EBM is not ,[object Object],[object Object],[object Object],[object Object],[object Object]

EBM Milestones ,[object Object],[object Object],[object Object],Physician letting blood from a patient. British Library, London. From "Den medeltida kokboken", the Swedish translation of The Medieval Cookbook

EBM Milestones ,[object Object],[object Object],2. Codman EA. The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. Boston: Thomas Todd Co., 1934:V-XL.

EBM Milestones ,[object Object],3. Doll R. Controlled trials: the 1948 watershed. BMJ 1998;317:1217-1220. ,[object Object],[object Object]

EBM Milestones ,[object Object],[object Object],[object Object],[object Object]

Paradigm Shift in Medicine ,[object Object],4. Centre for Health Evidence. Evidence-based medicine: A new approach to teaching the practice of medicine. Available at http://www.cche.net/usersguides/ebm.asp#7 . ,[object Object],[object Object],[object Object]

Old Paradigm ,[object Object],4. Centre for Health Evidence. Evidence-based medicine: A new approach to teaching the practice of medicine. Available at http://www.cche.net/usersguides/ebm.asp#7 ,[object Object],[object Object],[object Object],[object Object],[object Object]

New Paradigm ,[object Object],4. Centre for Health Evidence. Evidence-based medicine: A new approach to teaching the practice of medicine. Available at http://www.cche.net/usersguides/ebm.asp#7 .

New Paradigm ,[object Object],4. Centre for Health Evidence. Evidence-based medicine: A new approach to teaching the practice of medicine. Available at http://www.cche.net/usersguides/ebm.asp#7 . ,[object Object],[object Object],[object Object]

What is EBM? “ Evidenced-based medicine is the concept of formalizing the scientific approach to the practice of medicine for identification of “evidence” to support our clinical decisions. It requires an understanding of critical appraisal and the basic epidemiologic principles of study design, point estimates, relative risk, odds ratios, confidence intervals, bias, and confounding. By using this information, clinicians can categorize evidence, assess causality, and make evidence-based recommendations. Evidence-based medicine allows analysis of complicated material so that we can make the best possible clinical decisions for the populations we serve.” 5 5. Williams JK. Understanding evidence-based medicine: a primer. Am J Obstet Gynecol 2001:185-275-278.

Why is EBM Important? ,[object Object],[object Object],6. Covell DG, Uman GC, Manning PR: Information needs in office practice: Are they being met? Ann Intern Med 1985;103:596-9. ,[object Object],[object Object],[object Object],[object Object]

Why is EBM Important? ,[object Object],[object Object],7. Ramsey PG, Carline JD, Inui TS et al: Changes over time in the knowledge base of practicing internists. JAMA 1991;266:1103-7. 8. Davis DA, Thompson MA, Oxman AD, Haynes RB: Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995;274:700-5. ,[object Object],[object Object]

Why is EBM important? ,[object Object],[object Object],Table 1. Lind’s study on scurvy:1747 9 9. The James Lind Library. Available from http://www.jameslindlibrary.org/ . Accessed 26 June 2008. Dramatic recovery Two oranges and a lemon No change Spoonfuls of vinegar No change Garlic, mustard and horseradish No change Seawater No change Unspecified elixir t.d.s Minor improvement Quart of cider Observed effect Additive to diet (n=2 in each group

Why is EBM important? ,[object Object],Table 2. Mortality rates and characteristic of obstetrics clinics in Vienna 1784-1859 10 35.7 30.6 1,712 1,248 47,938 40,770 Hand-washing introduced First clinic Second clinic 1848-1859 90.2 33.8 1,989 691 20,204 17,791 Clinic arrangements changed First clinic: doctors and students Second clinic: midwives 1839-1847 57.6 3,745 65,035 Routine post-mortems 1823-1838 12.5 897 71,395 No routine post-mortems 1784-1822 Maternal deaths/1000 deliveries No. maternal deaths No. deliveries Characteristics of period Period

EBM processes can help with dissemination and adoption

Role of Literature Searching ,[object Object],[object Object],[object Object],[object Object],11. Lucas BP, Evans AT, et al. The impact of evidence on physician’s inpatient treatment decisions. J Gen Intern Med 2004;19:402-409.

Complimentary/ Alternative Medicine ,[object Object],12. National Center for Complementary and Alternative Medicine. Understanding complementary and alternative medicine. Available at: http://nccam.nih.gov/health/ . ,[object Object],[object Object],[object Object]

Are Complimentary and Alternative Medicine Interchangeable Terms? ,[object Object],12. National Center for Complementary and Alternative Medicine. Understanding complementary and alternative medicine. Available at: http://nccam.nih.gov/health/ . ,[object Object]

Major Types of Complementary and Alternative Medicine ,[object Object],12. National Center for Complementary and Alternative Medicine. Understanding complementary and alternative medicine. Available at: http://nccam.nih.gov/health/ . ,[object Object]

Major Types of Complementary and Alternative Medicine cont. ,[object Object],12. National Center for Complementary and Alternative Medicine. Understanding complementary and alternative medicine. Available at: http://nccam.nih.gov/health/ . ,[object Object],[object Object],[object Object]

NCCAM ,[object Object],[object Object],[object Object],[object Object]

Use of Alternative/Complementary Medicine in the U.S. ,[object Object],[object Object],13. Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343 . Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

Practice Guidelines ,[object Object],14. Cook DJ, et al. The relation between systematic reviews and practice guidelines. Ann Intern Med. 1997;127:210-216. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Where to Find Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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