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Evidence Based Medicine Guide

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Rizwan S A
Rizwan S A

This document discusses evidence-based medicine and public health. It defines evidence-based medicine as the conscientious use of current best evidence in patient care decisions. Evidence-based public health similarly uses scientific principles and data to develop effective public health programs and policies. The document outlines the evolution of evidence-based practice from individual experiences and anecdotes to using scientific evidence. It also describes the hierarchy of evidence sources from randomized controlled trials to case reports. Finally, it discusses the domains, sources and five step process of evidence-based medicine: asking questions, acquiring evidence, appraising evidence, applying to practice, and assessing performance.

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Evidence based medicine/practice Dr. S. A. Rizwan, M.D. Public Health Specialist SBCM, Joint Program – Riyadh Ministry of Health, Kingdom of Saudi Arabia
Learning objectives Critical appraisal of health literature SBCM, Joint Program – Riyadh • Define evidence based medicine/practice • Define evidence based public health practice • Describe the evolution of EBM • Describe the hierarchy of evidence • Describe the sources for EBM • Describe the domains & steps of EBM • Application of EBM to some case scenarios 2
Section 1: Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh
Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 4 • Experiences and personal preferences of individual treating doctors • Experiences handed down from teachers to students
Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 5 • Bloodletting: withdrawing blood to treat disease, common for 2,000 years until 1800s
Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 6 • Anecdotal evidence since 1500s for use of lemons and limes to treat scurvy
Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 7 • Does a treatment work? • Antibiotics are successful at treating bacterial infections, but not viral infections • Beta blockers lower the risk of a heart attack
Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 8 http://med.fsu.edu/index.cfm?page=medicalinformatics.ebmTutorial • Evidence Based Medicine • conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient
Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 9 https://phpartners.org/tutorial/04-ebph/2-keyConcepts/4.2.2.html • Evidence Based Public Health • development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models
Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 10 EB Public Health EB Medicine Primary Focus Populations Individuals Emphasis Prevention, Health Promotion, Whole Community Diagnosis, Treatment, Whole Patient Paradigm Interventions aimed at Environment, Human Behavior and Lifestyle, and Medical Care Medical Care Organizational Lines of Specialization Analytical (Epidemiology), Setting and Population (Occupational Health), Substantive Health Problem (Nutrition), Skills in Assessment, Policy Development, and Assurance Organ (Cardiology), Patient Group (Pediatrics), Etiology, Pathophysiology (Oncology, Infectious Disease), Technical Skill (Radiology)
Section 2: Hierarchy of evidence Critical appraisal of health literature SBCM, Joint Program – Riyadh
Levels of evidence – generic Critical appraisal of health literature SBCM, Joint Program – Riyadh 12
Levels of evidence – oxford CEBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 13 http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford , http://mulicia.pixnet.net/blog/post/20902397-%E8%AD%89%E6%93%9A%E5%BC%B7%E5%BA%A6-strength-of-evidence
Levels of evidence - AHA Critical appraisal of health literature SBCM, Joint Program – Riyadh 14
Quality of evidence Critical appraisal of health literature SBCM, Joint Program – Riyadh 15 • From Papers to Patients • http://guides.library.upenn.edu/c.php?g=475172 &p=3254090#5244526 • http://hsl.mcmaster.libguides.com/ebm
Evidence in context Critical appraisal of health literature SBCM, Joint Program – Riyadh 16
Section 3: Domains, sources & steps of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh
Domains of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh • A systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values 18
Sources of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 19 • EBM Databases • Cochrane Collaboration • ACP Journal Club • Evidence-Based Practice (Jr) • InfoPOEMS • National Guideline Clearinghouse • US Preventative Services Task Force
Sources of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 20 • EBM Hunting Tools • Essential Evidence Plus • DynaMed • Unappraised – MEDLINE • Meta-search engines • TRIP (Turning Research Into Practice) • SUMSearch
Steps of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 21
Step 1: Ask Critical appraisal of health literature SBCM, Joint Program – Riyadh • Convert information needs into answerable questions 22
Step 2: Acquire Critical appraisal of health literature SBCM, Joint Program – Riyadh 23 • Track down with maximum efficiency the best evidence with which to answer them
Step 3: Appraise Critical appraisal of health literature SBCM, Joint Program – Riyadh 24 • Critically appraise that evidence for its validity and usefulness
Step 4: Apply Critical appraisal of health literature SBCM, Joint Program – Riyadh 25 • Apply the results of this appraisal in your practice
Step 5: Assess Critical appraisal of health literature SBCM, Joint Program – Riyadh 26 • Evaluate your performance
Section 4: Examples Critical appraisal of health literature SBCM, Joint Program – Riyadh
Example of EBM application Critical appraisal of health literature SBCM, Joint Program – Riyadh 28 • http://guides.mclibrary.duke.edu/c.php?g=158201&p=1035584
Take home messages Critical appraisal of health literature SBCM, Joint Program – Riyadh 29 • This is the age of EBP • EBP combines clinical expertise with scientifically sound research and patient expectations • Mastering EBP takes time & effort • Medical science is not perfect but it is the best alternative
Thank you! Email your queries to sarizwan1986@outlook.com

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Evidence Based Medicine Guide

  • 1. Evidence based medicine/practice Dr. S. A. Rizwan, M.D. Public Health Specialist SBCM, Joint Program – Riyadh Ministry of Health, Kingdom of Saudi Arabia
  • 2. Learning objectives Critical appraisal of health literature SBCM, Joint Program – Riyadh • Define evidence based medicine/practice • Define evidence based public health practice • Describe the evolution of EBM • Describe the hierarchy of evidence • Describe the sources for EBM • Describe the domains & steps of EBM • Application of EBM to some case scenarios 2
  • 3. Section 1: Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh
  • 4. Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 4 • Experiences and personal preferences of individual treating doctors • Experiences handed down from teachers to students
  • 5. Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 5 • Bloodletting: withdrawing blood to treat disease, common for 2,000 years until 1800s
  • 6. Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 6 • Anecdotal evidence since 1500s for use of lemons and limes to treat scurvy
  • 7. Evolution of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 7 • Does a treatment work? • Antibiotics are successful at treating bacterial infections, but not viral infections • Beta blockers lower the risk of a heart attack
  • 8. Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 8 http://med.fsu.edu/index.cfm?page=medicalinformatics.ebmTutorial • Evidence Based Medicine • conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient
  • 9. Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 9 https://phpartners.org/tutorial/04-ebph/2-keyConcepts/4.2.2.html • Evidence Based Public Health • development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models
  • 10. Introduction Critical appraisal of health literature SBCM, Joint Program – Riyadh 10 EB Public Health EB Medicine Primary Focus Populations Individuals Emphasis Prevention, Health Promotion, Whole Community Diagnosis, Treatment, Whole Patient Paradigm Interventions aimed at Environment, Human Behavior and Lifestyle, and Medical Care Medical Care Organizational Lines of Specialization Analytical (Epidemiology), Setting and Population (Occupational Health), Substantive Health Problem (Nutrition), Skills in Assessment, Policy Development, and Assurance Organ (Cardiology), Patient Group (Pediatrics), Etiology, Pathophysiology (Oncology, Infectious Disease), Technical Skill (Radiology)
  • 11. Section 2: Hierarchy of evidence Critical appraisal of health literature SBCM, Joint Program – Riyadh
  • 12. Levels of evidence – generic Critical appraisal of health literature SBCM, Joint Program – Riyadh 12
  • 13. Levels of evidence – oxford CEBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 13 http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford , http://mulicia.pixnet.net/blog/post/20902397-%E8%AD%89%E6%93%9A%E5%BC%B7%E5%BA%A6-strength-of-evidence
  • 14. Levels of evidence - AHA Critical appraisal of health literature SBCM, Joint Program – Riyadh 14
  • 15. Quality of evidence Critical appraisal of health literature SBCM, Joint Program – Riyadh 15 • From Papers to Patients • http://guides.library.upenn.edu/c.php?g=475172 &p=3254090#5244526 • http://hsl.mcmaster.libguides.com/ebm
  • 16. Evidence in context Critical appraisal of health literature SBCM, Joint Program – Riyadh 16
  • 17. Section 3: Domains, sources & steps of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh
  • 18. Domains of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh • A systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values 18
  • 19. Sources of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 19 • EBM Databases • Cochrane Collaboration • ACP Journal Club • Evidence-Based Practice (Jr) • InfoPOEMS • National Guideline Clearinghouse • US Preventative Services Task Force
  • 20. Sources of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 20 • EBM Hunting Tools • Essential Evidence Plus • DynaMed • Unappraised – MEDLINE • Meta-search engines • TRIP (Turning Research Into Practice) • SUMSearch
  • 21. Steps of EBM Critical appraisal of health literature SBCM, Joint Program – Riyadh 21
  • 22. Step 1: Ask Critical appraisal of health literature SBCM, Joint Program – Riyadh • Convert information needs into answerable questions 22
  • 23. Step 2: Acquire Critical appraisal of health literature SBCM, Joint Program – Riyadh 23 • Track down with maximum efficiency the best evidence with which to answer them
  • 24. Step 3: Appraise Critical appraisal of health literature SBCM, Joint Program – Riyadh 24 • Critically appraise that evidence for its validity and usefulness
  • 25. Step 4: Apply Critical appraisal of health literature SBCM, Joint Program – Riyadh 25 • Apply the results of this appraisal in your practice
  • 26. Step 5: Assess Critical appraisal of health literature SBCM, Joint Program – Riyadh 26 • Evaluate your performance
  • 27. Section 4: Examples Critical appraisal of health literature SBCM, Joint Program – Riyadh
  • 28. Example of EBM application Critical appraisal of health literature SBCM, Joint Program – Riyadh 28 • http://guides.mclibrary.duke.edu/c.php?g=158201&p=1035584
  • 29. Take home messages Critical appraisal of health literature SBCM, Joint Program – Riyadh 29 • This is the age of EBP • EBP combines clinical expertise with scientifically sound research and patient expectations • Mastering EBP takes time & effort • Medical science is not perfect but it is the best alternative
  • 30. Thank you! Email your queries to sarizwan1986@outlook.com