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Premium member Presentation Transcript Evidence Based Medicine: Dr. Gopalrao Jogdand, M.D. Ph.D. Professor and Head Department of Community Medicine Evidence Based MedicineOn what do we base Our Clinical Decision?: Knowledge of the doctor Vs Evidence On what do we base Our Clinical Decision?What is Evidence-Based Medicine?: “The integration of individual clinical expertise with the best available clinical evidence from systematic research.” David L Sackett, W Scott Richardson, William Rosenberg, R Brian Haynes Evidence Based Medicine--How to Practice and Teach EBM , 1996 Various definitions What is Evidence-Based Medicine?Need for Evidence based Medicine: Archie Cochrane claimed that only a small minority (10-20%) of medical treatments were supported by evidence. An expert committee of the US institute of Medicine commented that only about 4% of all services have strong strength of evidence (1992). Need for Evidence based MedicineWhy sudden interest in EBM?: Our daily need for valid information about diagnosis, therapy, prognosis. The inadequacy of traditional sources for this information. Disparity between clinical practice and up-to-date knowledge. Inability to afford more than a few minutes for finding and assimilating the evidence. Why sudden interest in EBM?PowerPoint Presentation: In clinical practice it is a methodology of acquiring and managing data to determine treatment effectiveness and safety.Where do we get the Knowledge?: Reported % Observed % Print source 62 27 General / Specialty text books 25 3 Pharmaceutical text book 14 9 Journals 18 7 Drug Company Information 1 1 Self made Compendia 4 7 Human sources 33 53 Where do we get the Knowledge?Hierarchy of evidence: Hierarchy of evidence“Best Available Clinical Evidence”: Therapy Double-blind, placebo-controlled, randomized clinical trial Diagnosis Independent, blind comparison with a reference/gold standard Prognosis Representative and well-defined prospective cohort of patients at a similar point in the course of disease “Best Available Clinical Evidence”What are skills needed to practice evidence-based medicine?: What are skills needed to practice evidence-based medicine?How do we actually practice Evidence based Medicine?: A sk an answerable question Find an A rticle (the evidence) Clinically A ppraise the evidence (Validity, impact, applicability) A pply A sses How do we actually practice Evidence based Medicine?Step1 : Ask an answerable question (PICO): Population Intervention Comparison Outcome Step1 : A sk an answerable question (PICO)Clinical Scenario: 60 year old male with an INR (International normalized ratio) of 3.0 scheduled for tooth extraction Clinical ScenarioPICO: Population : patient on warfarin undergoing tooth extraction Intervention : continuing warfarin Comparison : holding warfarin Outcome : major bleeding PICOAn answerable question : A patient on warfarin treatment under going tooth extraction, whether extraction will increase chance of major bleeding? An answerable questionStep2: Find an article?: www.pubmed.org Ovid Up-to-date Step2: Find an article?Step3: Appraise the article: After finding out the appropriate reference from the internet / journal ask your self: Is the study valid? What are the results? Does it apply to my patient? Step3: Appraise the articleStep4: Apply the evidence: Literature search resulted in changes to decision making in 47% of clinical queries Step4: Apply the evidenceStep5: Assess: Assess the outcome in your patient Step5: AssessWhat made it possible?: Information system and electronic databases Identification and application of effective strategies to search, appraise and apply evidence. The creation of systematic reviews, concise summaries and creation of evidence based journals. What made it possible?Conti…….: There was a need to organize the evidence of effectiveness of treatments for the benefit of patients. The term “evidence -based Medicine” introduced by McMaster University, Canada. Conti…….Barriers to EBM: The most frequently reported barrier to implementing EBM in clinical practice is a perceived lack of personal time. Work load on the physician in the institute. 1986: effective literature search, is feasible to be undertaken in less than 10 minutes. Barriers to EBMUses of “EBM”: Use of empirically-verified treatments in the care of patients Incorporation of research results into the process of care Ability to critically appraise research results Uses of “EBM”Details: Therapy/prevention Diagnostic test Prognosis HARM CPG Systematic review Economic analysis Outcomes research Details www.med.ualberta.ca/ebm/ebm.htm WebsiteThank You: Thank You You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
EBM drgsj Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 54 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: January 05, 2012 This Presentation is Public Favorites: 0 Presentation Description details about Evidence-Based Medicine Comments Posting comment... Premium member Presentation Transcript Evidence Based Medicine: Dr. Gopalrao Jogdand, M.D. Ph.D. Professor and Head Department of Community Medicine Evidence Based MedicineOn what do we base Our Clinical Decision?: Knowledge of the doctor Vs Evidence On what do we base Our Clinical Decision?What is Evidence-Based Medicine?: “The integration of individual clinical expertise with the best available clinical evidence from systematic research.” David L Sackett, W Scott Richardson, William Rosenberg, R Brian Haynes Evidence Based Medicine--How to Practice and Teach EBM , 1996 Various definitions What is Evidence-Based Medicine?Need for Evidence based Medicine: Archie Cochrane claimed that only a small minority (10-20%) of medical treatments were supported by evidence. An expert committee of the US institute of Medicine commented that only about 4% of all services have strong strength of evidence (1992). Need for Evidence based MedicineWhy sudden interest in EBM?: Our daily need for valid information about diagnosis, therapy, prognosis. The inadequacy of traditional sources for this information. Disparity between clinical practice and up-to-date knowledge. Inability to afford more than a few minutes for finding and assimilating the evidence. Why sudden interest in EBM?PowerPoint Presentation: In clinical practice it is a methodology of acquiring and managing data to determine treatment effectiveness and safety.Where do we get the Knowledge?: Reported % Observed % Print source 62 27 General / Specialty text books 25 3 Pharmaceutical text book 14 9 Journals 18 7 Drug Company Information 1 1 Self made Compendia 4 7 Human sources 33 53 Where do we get the Knowledge?Hierarchy of evidence: Hierarchy of evidence“Best Available Clinical Evidence”: Therapy Double-blind, placebo-controlled, randomized clinical trial Diagnosis Independent, blind comparison with a reference/gold standard Prognosis Representative and well-defined prospective cohort of patients at a similar point in the course of disease “Best Available Clinical Evidence”What are skills needed to practice evidence-based medicine?: What are skills needed to practice evidence-based medicine?How do we actually practice Evidence based Medicine?: A sk an answerable question Find an A rticle (the evidence) Clinically A ppraise the evidence (Validity, impact, applicability) A pply A sses How do we actually practice Evidence based Medicine?Step1 : Ask an answerable question (PICO): Population Intervention Comparison Outcome Step1 : A sk an answerable question (PICO)Clinical Scenario: 60 year old male with an INR (International normalized ratio) of 3.0 scheduled for tooth extraction Clinical ScenarioPICO: Population : patient on warfarin undergoing tooth extraction Intervention : continuing warfarin Comparison : holding warfarin Outcome : major bleeding PICOAn answerable question : A patient on warfarin treatment under going tooth extraction, whether extraction will increase chance of major bleeding? An answerable questionStep2: Find an article?: www.pubmed.org Ovid Up-to-date Step2: Find an article?Step3: Appraise the article: After finding out the appropriate reference from the internet / journal ask your self: Is the study valid? What are the results? Does it apply to my patient? Step3: Appraise the articleStep4: Apply the evidence: Literature search resulted in changes to decision making in 47% of clinical queries Step4: Apply the evidenceStep5: Assess: Assess the outcome in your patient Step5: AssessWhat made it possible?: Information system and electronic databases Identification and application of effective strategies to search, appraise and apply evidence. The creation of systematic reviews, concise summaries and creation of evidence based journals. What made it possible?Conti…….: There was a need to organize the evidence of effectiveness of treatments for the benefit of patients. The term “evidence -based Medicine” introduced by McMaster University, Canada. Conti…….Barriers to EBM: The most frequently reported barrier to implementing EBM in clinical practice is a perceived lack of personal time. Work load on the physician in the institute. 1986: effective literature search, is feasible to be undertaken in less than 10 minutes. Barriers to EBMUses of “EBM”: Use of empirically-verified treatments in the care of patients Incorporation of research results into the process of care Ability to critically appraise research results Uses of “EBM”Details: Therapy/prevention Diagnostic test Prognosis HARM CPG Systematic review Economic analysis Outcomes research Details www.med.ualberta.ca/ebm/ebm.htm WebsiteThank You: Thank You