Dr. Nisreen A. Jastaniah

Assist Prof KSAU-HS

Consultant Geriatric Medicine KAMC-J

Problem solving methods

other …

• Hani ( 47 years) software programmer

Thinking about early retirement …. (retirement and

health) Discussion

Problem solving methods

Scientific…( searching for evidence)

• HANI ( 47 years) software programmer

Thinking about early retirement ….

Discussion , retirement and health

Problem solving methods

Scientific…( searching for evidence)

Problem solving methods

Scientific…( searching for evidence)

Problem solving methods

Scientific…( searching for evidence)

Problem solving methods

Scientific…

Needs

• We need evidence (about the accuracy of diagnostic tests, the power of prognostic markers, the comparative efficacy and safety of interventions, etc.)

• about 5 times for every in-patient (and twice for every 3 out-patients).

• We get less than a third of it

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Why Evidence Based Health Care?

• Too many patients

• Too many problems

• Too many journals

• Information overload

• No time to read

• Read what I am familiar with

• Avoid difficult issues

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EBM; IS IT NEW?

865)الرازي أول من دعا إليه في االقرن التاسع الميالدي حين قال ( 915 –

إنه ما أجمع عليه األطباء وشهد عليه القياس وأيدته “ “التجربة

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April 2006 12

والتحفظ في , مع انتقاد المقدمات..

و نتحرى في جميع ما , النتائج

نميزه و ننتقده طلب الحق ال

......الميل مع اآلراء

Requirements of new treatment

• The drug must have a defined mode of action

• It must be tested on a well defined disease

• The time of action must be observed

• The effect of the drug must be seen to occur constantly in many cases

• The experimentation must be done with the human body for testing a drug on a lion or a horse might not prove anything about its effect on man

Ibn Sina 981-1037

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When did EBM begin ?

• Dr. Archie Cochrane

(British epidemiologist and a leading EBM

theoretician, estimated a decade ago

that only 15-20% of all medical practice is

based on scientific, statistically sound

research.

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Evidence-based medicine

Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values.

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Steps of evidence based

medicine

1)Ask a question

2)Acquire some articles

3)Appraise the evidence

4)Apply the findings

5)Assess our performance

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Steps of evidence based medicine

Step 1: formulating an answerable question

Patient or Problem

Intervention

Comparison Intervention

Outcome.

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Steps of evidence based medicine

Step 2: Tracking down the best available evidence

Tracking down the best evidence with which to

answer that question.( diagnosis, therapy

,prognosis…)

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Steps of evidence based medicine

Step 2: Tracking down the best available evidence

study design

Primary studies (therapy ,diagnosis ,harm &prognosis ).

Integrative studies (overview ,practice guidelines..).

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.

Steps of evidence based medicine

Step3: Critically appraising that evidence

validity (closeness to the truth),

impact (size of the effect) the results, and

applicability.

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Steps of evidence based medicine

Step4: Integrating of the best available

evidence to our patients

our patient's unique biology, values and

circumstances.

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Steps of evidence based medicine

Step 4: Integrating of the best available

evidence to our patients

The evidence

Clinical experience Patient values

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Steps of evidence based medicine

Step5: Evaluating our effectiveness

in executing Steps 1-4 and seeking ways to improve

them both for next time.

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Steps of evidence based medicine

• Do We need always carry out all 5 steps to provide E-B Care ?

Searching & appraising”

o provides E B care, but is expensive in time and resources

“Searching only”

o much, quicker, and if carried out among E B resources, can provide E B care.

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POEMs & DOEs POEM

Patient

Oriented

Evidence that

Matters

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DOE

Disease

Oriented

Evidence

HRQL (Health Related Quality of life) for example, mobility, self-care, and physical, emotional, and social function).

Relevance: Type of Evidence

• DOE: Disease-oriented evidence

o pathophysiology, pharmacology, etiology

• POE: Patient-oriented evidence

o mortality, morbidity, quality of life, satisfaction

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Study design & Evidence based

clinical practice Different questions study design

• Prevalence or frequency of factor Cross sectional study

•Hypotheses about possible Harm (or causes) Case-control

• Harm or Causes or risk factors Cohort

• Experience of illness Qualitative

• Effectiveness Randomized controlled trial

Original Study

Longitudinal Descriptive

Cross sectional

Case report

Case series

interventional observational

Case-control

cohort

Integrative Studies

SR

Evidence

Study design & Evidence based

clinical practice

Study design & Evidence based

clinical practice

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1)Ask a question

2)Acquire some articles

3)Appraise the evidence OR use appraised evidence

4)Apply the findings

5)Assess our performance

?

Steps of evidence based medicine

Types of health care professional

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Evidence Finders

Evidence Users

Evidence generator

Evidence Ignorer

Questions?

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1)Ask a question

2)Acquire some articles

3)Appraise the evidence OR use appraised evidence

4)Apply the findings

5)Assess our performance

?

Steps of evidence based medicine

THANK YOU

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