1 / 84

What is Evidence-Based Medicine?

This article explores the increasing amount of information in the medical field and the challenge of staying updated. It discusses the half-time and doubling time of clinical medical science, as well as the importance of keeping current in an ever-changing profession. The article also highlights the need for clinicians to critically appraise new research and discusses the hierarchy of studies in evidence-based medicine.

swall
Download Presentation

What is Evidence-Based Medicine?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What is Evidence-Based Medicine?

  2. Today I put forward an idea Tomorrow I doubt it The day after I refute it And each day I can be wrong’ Voltaire 1745

  3. Volume of new information a major barrier 5,000? per day 1,360 per day 55 per day

  4. Knowledge Gap The Problem Amount of Information is rising Amount of Information Time to meet information needs decreasing Time The Knowledge Gap

  5. Half-time or Half-life of Clinical Medical Science is now about 6 Month

  6. Doubling time of biomedical science was about 19 years in 1991

  7. Doubling time of biomedical science was about 20 months in 2001

  8. So you work in a job which: Its half-time (half-life) is 6 months, & Its doubling-time is 20 month You works in a ever-changing & ever-growing profession ! So you should keep updating !

  9. The Slippery Slope r = -0.54 p<0.001 . .. . . .... . Knowledge of best current HTN care ... ... ... ... .. .... .... Years since Med School graduation Shin,et al: CMAJ;1993: 969-976

  10. For General Physicians to keep current: Read 19 new articles per day which appear in medical journals 19 x 2 hrs (Critical Appraisal) = 38 hrs per day Davidoff F et al. (1995) EBM; A new journal to help doctors identify the information they need. BMJ 310:1085-86.

  11. "Kill as Few Patients as Possible" - Oscar LondonRule 31- Review the world literature fortnightly 555 feet A Year of MEDLINE indexed journals Washington Monument

  12. Can’t I trust the editors? Percent of articles meeting quality criteria NEJM 12.6% Ann Int Med 7.6% JAMA 7.2% Lancet 6.2% BMJ 4.4% Arch Int Med 2.4%

  13. Medical Publishing Annually: • 20,000 journals • 17,000 new books MEDLINE: • 4,000 journals • 6 Million references • 400,000 new entries yearly

  14. Types of Medical articles • Original Article • Review Article • Case Reports

  15. Hierarchy of studies

  16. EBM History • G. Guyatt from McMaster University in 90s • Sackett in 1995 defined EBM • “Our clinical decesion malking should be based on the best scientific avaiabe evidence”

  17. What is Evidence? Evidence is anything used to determine or demonstrate the truth of an assertion. Scientific evidence is evidence which serves to either support or counter a scientific theory or hypothesis. In scientific research evidence is accumulated through observations of phenomena occur in the natural world, or created as experiments in a laboratory

  18. What is ‘level of evidence’? • The extent to which one can be confident that an estimate of effect or association is correct(unbiased).

  19. Levels of Evidence Adapted from: Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed. Churchill Livingstone; 2000.

  20. EBM: Original “Official” Definition The explicit, conscientious, and judicious use of the current best evidence in making decisions about the care of individual patients (and populations) Evidence-Based Medicine Working Group Sackett et al circa 1996 Evidence Based Medicine D.J. Van Durme, MD

  21. The best research Clinical expertise Patient value What is EBM?

  22. Better – EBM definition

  23. Clinical Expertise Research Evidence Patient Preferences EBM - What is it?

  24. Traditional medicine Experiences Pathophysiology, references,… Patient value

  25. By best research evidence • clinically relevant research • Unbiased research • Reproducible research • often from the basic sciences of medicine • especially from patient centered clinical research

  26. By clinical expertise • We mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.

  27. By patient values • We mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.

  28. When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life

  29. Lu-Yao: JAMA, Volume 269(20). May 26, 1993.

More Related