evidence based medicines

8/9/2019 Evidence Based Medicines

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EVIDENCE - BASED MEDICINE

- DR. DEEPANKAR SRIGYAN



Evidence-based medicine (EBM)

The practice of medicine in which the

physician finds, assesses, and implements

methods of diagnosis and treatment on thebasis of the best available current research,

their clinical expertise, and the needs and

preferences of the patient.



Classification

Two types of evidence-based medicine have been proposed.

Evidence-based guidelines

Evidence-based guidelines (EBG) is the practice of evidence-

based medicine at the organizational or institutional level. Thisincludes the production of guidelines, policy, and regulations.

This approach has also been called evidence based

healthcare.

Evidence-based individual decision making

Evidence-based individual decision (EBID) making is

evidence-based medicine as practiced by the individual health

care provider. There is concern that current evidence-based

medicine focuses excessively on EBID.



Categories of recommendations (1)

The U.S. Preventive Services Task Force uses:

Level A: Good scientific evidence suggests that the benefits of

the clinical service substantially outweighs the potential risks.

Clinicians should discuss the service with eligible patients. Level B: At least fair scientific evidence suggests that the

benefits of the clinical service outweighs the potential risks.

Clinicians should discuss the service with eligible patients.

Level C: At least fair scientific evidence suggests that there

are benefits provided by the clinical service, but the balancebetween benefits and risks are too close for making general

recommendations. Clinicians need not offer it unless there are

individual considerations.



Categories of recommendations (2)

Level D: At least fair scientific evidence suggests that the

risks of the clinical service outweighs potential benefits.

Clinicians should not routinely offer the service to

asymptomatic patients. Level I: Scientific evidence is lacking, of poor quality, or

conflicting, such that the risk versus benefit balance cannot

be assessed. Clinicians should help patients understand

the uncertainty surrounding the clinical service.



Categories of drugs for pregnant

woman (according to FDA)

The Food and Drug Administration (FD A) has developed a rating

system to provide therapeutic guidance based on potential

benefits and fetal risks.

Drugs have been classified into categories A, B, C, D and Xbased on this system of classification.

Drugs like multivitamins that have demonstrated no fetal risks

after controlled studies in humans are classified as Category

A.

On the other hand drugs like thalidomide with proven fetal

risks that outweigh all benefits are classified as Category X.



Classification of a few important

drugs/vaccines (1)

Antibacterial agents

Category B : Penicillin, metronidazole, nitrofurantoin,

cephalosporins, erythromycin

Category C : Aminoglycosides, chlooquine, quinolones,mebendazole, fluconazole

Category D : Tetracyclines

Cardiovascular drugs

Category B : Heparin (LMW) Category C : Heparin (conventional), beta-blockers, calcium

antagonists, furosemide, digoxin, methyldopa

Category D : ACE inhibitors, coumarins, thiazide



Classification of a few

important drugs/vaccines (2)Central nervous system drugs

Category B : Acetaminophen, caffeine

Category C : Aspirin, clonidine, rofecoxib

Category D : Carbamezapine, valproic acid, diazepam,

lithium

Vaccines

Category C : Tetanus toxoid, polio vaccine , BCG vaccine,

hepatitis A vaccine, hepatitis B vaccine and rabies vaccine.



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