Evidence Based Medicine. DARWIN AMIR Bgn Penyakit Saraf RS DR. M. Djamil / Fakultas Kedokteran Universitas Andalas PADANG. Evidence Based Medicine. A new paradigm for the health care system Using the current evidence in the medical literature to provide the best care to patients
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Bgn Penyakit Saraf
RS DR. M. Djamil / Fakultas Kedokteran
probabilities using two dice
of probability by noting that it was natural
Englishman John Graunt (1660) wrote on
norms of statistic including the relation of
personal choice and judgement to statistical
Table : Probability of survival, 1660 and 1993
Percentage survival to each age
Clinician helps patients by
- Diagnosing what is wrong with them
- Administering treatment that does more
good than harm
- Giving them an indication of what the
future is likely to hold (prognosis)
N e e d s
Effects of care
MAKING POLICIES AND
Professional and providers
Service users and purchasers
researchers and funders
- judicious use
1. define the problem;
2. track down the information sources you need;
3. critically appraise the information;
4. apply the information with your patients;
5. evaluate how effective this application of information is
- Cochrane library (a database of high quality systematic
review of health care)
- AGP Journal Club.
- BMJ and Lancet.
The relevant clinical questions in your patients must contain 4 element:
1). The patients problem.
2). Intervention, which by research methodology, diagnostic test and the treatment
3). If needed with intervention comparable.
4). Clinical outcome or outcome of interest.
The 4 element to form the terminology i.e. PICO P= Patient, I = Intervention, C= Comparison, O= Outcome.
Use of theophylline in asthma
Following the publication for the management of asthma in adults,
dr. A noted the statement that thephylline might have a role in
patients whose asthma was not controlled with high dose inhaled
steroid, but even then alternative treatment might have fewer side
effects. He decided it was time to review his prescribing of
theophylline and used the practice computer to produce a list of all
his asthmatic patients and their recent medication. He found 86
patients, three of whom were taking theophylline. He was reassured
that his use of theophylline was limited, but made an entry in the
records of each of these patients to remind him to review their
medication when the patient next attended. Ultimately, he was able
to persuade two of these patients to discontinue theophylline, and
after 6 months the prescribing data were checked again to confirm
that these changes had persisted.
Prognosis- What are the consequences of having the disease
Is it dangerous ?
Could I die of it
How long will I be able to continue my present actives ?
Will it ever go away altogether?
The prognosis question
A qualitative aspect
(which outcomes could happen?)
A quantitative aspect
(how likely are they to happen ?)
A temporal aspect
(over what time period ?)
Natural history of diseases (no medical intervention)
Biologic onset Clinical
Diagnosis Outcome Recovery
Disease specific variables
The strategy for making a prognosis
consulting the appropriate specialist
looking it up in a text book
Cohort studySurvival analysisCase control studyCase Series
◊ Will make the GP an even more rewarding
discipline within which to practice.
◊ Will support shared decision making with
users. It is the ideal model of making
decisions within the medical encounter.
◊ EBM / EBP will help maintain the central role
of general practice in health care.
for Your Good Attention