What is Evidence Based Medicine. Types of clinical questions. Formulation of clinical question. Pyramid of Evidence

1. Evidence Based
Medicine Course
(Lecture 1)
As part of
Master Degree
curriculum Of Medical
Statistics
Dr. Iman El Sayed
MSc, Ph.D, Lecturer of Medical Statistics and Systematic Reviews.
Medical Research Institute, Alexandria University, Alexandria, Egypt.
Email: Eman.abd.elftaah@alexu.edu.eg
www.linkedin.com/in/imanelsayed83

2. Intended learning outcomes of
course (ILOs)
A. Knowledge and Understanding:
After finishing the course, the student
should be able to:
a1 Define the concept of evidence based medicine(EBM) within the scope of clinical
epidemiology
a2 Recognize steps of EBM and how to formulate different clinical questions
a3. Understand Steps of netting the evidence.
a4. Recognize concepts of critical appraisal
a5. Explain the criteria for judging the validity of randomized controlled trials.
a5. Understand the principles of systematic review& Meta-analysis.
a6. Recognize the key steps of forming Evidence based guidelines
a7. Explain level of evidence

3. B- Intellectual Skills:
After finishing the course, the student
should be able to:
b1. Formulate health questions
b2. Classify different types of clinical question
Intended learning outcomes of
course (ILOs)

4. Intended learning outcomes of
course (ILOs)
C- Professional and Practical Skills:
After finishing the course, the student should be able to:
c1. Formulate health questions & Navigate the net for current
best evidence in literature
c2. Evaluate the level of strength of evidence of different
studies
c3. Apply research evidence in clinical setting.
c4. Apply critical appraisal Checklists for therapy and
diagnostic articles& observational studies and Systematic
reviews and Meta-Analysis.

5. Intended learning outcomes of
course (ILOs)
D- General and Transferable Skills A
After finishing the course, the student should be
able to:
d1. Develop the skill of critical thinking
d2. Develop skills in communication

6. Formative assessment
 Complete The following sentences:
 1. Triad of EBM :
a) …..
b) ……
c) .......
2. Types of clinical questions are:
a) ….
b) ….

7.  Complete The following sentences:
 3. PICO stands for:
a) …..
b) ……
c) .......
d) …..
4. Evidence based medicine is defined
as…………
5. Benefits of using Boolean operators are:
a)…….
b)…….
Formative assessment

8. What is Evidence Based Medicine?

9. Imagine you are going to
have surgery and it's likely
that you will experience
severe pain afterwards. Your
doctor informs you that to
stop the pain there is a
choice between morphine
tablets and injections.

10. What is Evidence Based Medicine?
Evidence-based Medicine (EBM) is the integration of best research
evidence with clinical expertise and patient values.

11. Why Evidence Based Medicine?

12. Listen to your mum!
 EBM can help you to
check claims made by
your family or the media.

13. Trust me, I'm an expert !
 EBM can help improve medical
practice.
 Objective evidence rather than
the subjective views of
medical professionals.

14. Information overload
 EBM can help healthcare professionals keep up to date.
 How many articles in medical journals do you think a doctor
would have to read each month to keep up with new
information in their area of medicine?

15. Mind the gap
 What do you think is
the percentage of
clinical trials that have
been conducted and
completed, but have
never been published in
an academic journal?

16. The 5-step process
Ask a question

17. The 5-step process
Find best evidence

18. The 5-step process
Evaluate evidence

19. The 5-step process
Apply information

20. The 5-step process
Evaluate outcomes

22. Implementing Research Findings in
Practice (EBP Cycle)
Need for
a
decision
Information need
Formulate
answerable
questionFind evidence
from research
Appraise for
validity and
usefulness
Implement
findings

23. Archibald Cochrane (1909-1988):
The father of evidence-based medicine
There's one particular person in history of EBM that we'd like you to learn more
about. It's the person after whom Cochrane collaboration was named.

24. The skill of Critical Thinking
Raising clinical Q is a Fundamental skill
keeping our health care--- Patient oriented, and up to
date.
? ?
?

25. How to formulate a clinical
question?

26. Where Do Questions Come From?
??? Basic knowledge
??? Patients: Prevention and management
- prevention
Risk factor
Diagnosis
Treatment
Prognosis Counsell C. Ann Intern Med. 1997;127:380-7

27. Clinical questions: 2 types
Background
Foreground
Experience
A CB

28. Clinical questions: 2 types
 Background Foreground
 Main user Students Clinician
 Knowledge General Specific
 Oriented? Disease Patient
 Achievement Understand Decision
 Search answer Textbooks EBM sites
who, what, where, when, why, how

29. Background Questions
 Ask for general knowledge about a disorder
 Have two essential components
1. A question root
2. A disorder / aspect of a disorder
who, what, where, when, why, how

30. Foreground Questions
 Ask for specific knowledge about
managing patients.

31. Types of Clinical Questions

32. Example1:
A 28-year-old male presents with
recurrent furunculosis for past 8 months;
these episodes have been treated with
drainage and several courses of
antibiotics but keep recurring. He asks
about the appropriate antibiotics to
decrease recurrence.

33. Clinical
question
I
C
O
P

34. P: Population/patient : patients with recurrent furuncul
I: Intervention : prophylactic antibiotics
C: Comparison : standard treatment (drainage)
O:Outcome : reduce recurrence rate of
furunculosis

35. Question:
‘In patients with recurrent furunculosis, do
prophylactic antibiotics, compared to other
standard treatment, reduce the recurrence rate?’

36. Example 2
In browsing one of the medical weeklies, you come
across mention of imiquimod cream for treatment of
basal cell carcinomas (BCC). The idea of a cream for
BCCs beside the systemic treatment is surprising, so
you wonder about the rapid cure rate of the combined
treatment over systemic only.

37. P :Basal cell carcinoma
I: Imiquimod cream+ systemic treatment
C: Systemic treatment alone
O: Rapid cure rate.

38. Question:
In patients with BCC, is combined topical and
systemic treatment preferred over systemic
treatment only for faster cure ?

39. Now practice by yourself
(Group work1)

40. Assignment
PleaseUsetheattachededucationalprescriptionto:
Solve the assignment file,
One Example of different types of questions

42. How do I find out more?
Try reading one of the following:
Evidence Based Medicine Toolkit
Douglas Badenoch, Carl Heneghan
BMJ Books
November 2001
How to Read a Paper: The Basics of
Evidence-based Medicine and
Healthcare (Kindle Edition)
Evidence Based Medicine, Second Edition
How to Practice and Teach EBM
David L. Sackett (Editor)
Churchill Livingstone
November 1999

43. References:
 Cochrane training. Cochrane Evidence Essentials.
 Green ML, Ciampi MA and Ellis PJ (2000). Residents’ medical information needs in
clinic: are they being met? Americal Journal of Medicine 109:218– 233.
 Useful links
 cochranelibrary.com
 evidentlycochrane.net
 students4bestevidence.net
 patient.co.uk
 nice.org.uk
 askforevidence.org
 testingtreatments.org
 senseaboutscience.org
 healthtalk.org