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Introduction to Evidence Based Medicine
Dr. Tina Dewi Judistiani, dr. SpOG
Dept Epidemiology and Biostatistics
School of Medicine – Universitas Padjadjaran
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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-the-uninitiated/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.
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I am here to learn EBM because ….
1. I have no idea 2. I will be a practicing doctor 3. I will be working on researches 4. I will help others use evidence5. I plan to teach EBM
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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 MedicinePaul Glasziou , Centre for Evidence-Based Medicine University of Oxford
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What kind of doctor would you become ?
William Osler, 1900 Smart young doctor
Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford
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Do you want to get there ?
Wise & experienced smart young doctor
Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford
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How is the construction building of Learning EBM like ?
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EBM learning
1. What is Evidence-based practice?2. Asking well-formulated Questions3. Searching for evidence 4. Critical Appraisal 5. Diagnostic studies 6. Intervention studies7. Prognostic studies
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Introductory Lecture: Objectives
1. What What is evidence-based medicine? What does it look like in practice?
2. How Formulate Clinical Questions1. Search for Evidence2. Appraisal of research3. Apply to clinical problem
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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
Clinical Expertise
Best research evidence
EBM
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Rule 31 – Review the World Literature Fortnightly*
*"Kill as Few Patients as Possible" - Oscar London
5,000?per day
1,500 per day
95 per day
Medic
al A
rtic
les
Per
Year
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Is keeping up to date Mission Impossible?
Bluegreenblog 2006
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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
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Reminding : The 4 steps of “pull” EBM
1. Formulate an answerable question2. Track down the best evidence 3. Critically appraise the evidence4. Individualise, based clinical expertise and
patient concerns
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Step 1Formulate an answerable clinical question
Structure of researchable questions – PICO-T
Population/Patients
Intervention
Comparison
Outcome
Time
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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
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Risk Factors
Cause(s)
SymptomsSigns, Tests
Prognosis
Treatment Effect
Past current future
Types of question: stroke
Frequency
Cohort Study Survey
Inception Cohort Study
Treatments
Randomised Trial
Cross Sectional Study
Degenerative process in the Coronary artery
ECG Angiography MRI
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2. Searching: finding good answers?
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Searching made easy
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3. Rapid Critical Appraisal
It’s peer-reviewed, therefore it must be OK?
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USE THE TOOLS
WORKSHEET FOR EACH STUDY TYPES
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Step 4: Applying to the individual
What do the results mean on average?
What do they mean for this individual?