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EVIDENCE-BASED MEDICINE

EVIDENCE-BASED MEDICINE. CAN WE PRACTICE EFFECTIVELY WITHOUT IT ?. Hassan Ba’aqeel MBBS, FRCSC, FRCOG Chairman Depart. of Obs&Gyn, King Khalid National Guards Hosp., Jeddah – Saudi Arabia. Readings.

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EVIDENCE-BASED MEDICINE

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  1. EVIDENCE-BASED MEDICINE CAN WE PRACTICE EFFECTIVELY WITHOUT IT? Hassan Ba’aqeelMBBS, FRCSC, FRCOG Chairman Depart. of Obs&Gyn, King Khalid National Guards Hosp., Jeddah – Saudi Arabia. Readings

  2. As a researcher, knowing the importance of translating research results into practice and the fact that over the last 2 decades an ever increasing number of Randomized Controlled Trials evaluating traditional concepts being published and the evolution of formal system of evaluation of evidence, I became interested in Evidence-Based Medicine (EBM). Having been chairman of obstetrics and gynecology departments at various institutions, I'm excited about EBM that provided me with a scientific tool that helped me to induce positive changes in clinical practice.

  3. THE HISTORIC PARADIGM • Authoritarian education and practice • Experts • Textbooks • Consensus statements • The assumption : “Professional authorities represent infallible and comprehensive knowledge”

  4. THE HISTORIC PARADIGM (Cont’d) • A number of prestigious authority figures. • Sometimes the advice lacked scientific proof. Delayed true progress in optimizing maternal fetal outcome.

  5. THE HISTORIC PARADIGM (Cont’d) • Prominent examples of “The advice” • Bloodletting for eclamptic fits. • Diuretics for preeclampsia. • Routine episiotomy. • “Once a section always a section”. • Ventrosuspension for infertility. • Removal of epsilateral ovary in EP.

  6. THE EVIDENCE-BASED PARADIGM • Recognition of the need to encourage patterns of care that do more good than harm. • Taking greater account of systematically collated EVIDENCE. • Responding to the teaching of Archie Cochrane (1972)! • “RCT” as the gold standard. Drug Vs None drug type of interventions

  7. Individual clinical experience is the foundation. Pathophysiology provide the foundation. Personal/collective experience used to evaluate new tests. Mastery of the subject areas dictate practice guidelines. ASSUMPTIONS OF AUTHORITARIAN PARADIGM

  8. ASSUMPTIONS OF EVIDENCE BASED PARADIGM • Systematic, reproducible attempts to record outcome (RCT). • Knowledge of pathophysiology alone is insufficient. • Formal rules of evidence are prerequisites to understanding the literature.

  9. New types of evidence are being generated Pathophysiology Vs “RCT” Metaanalysis EBM - WHY BOTHER ? (1) Major changes in patient care

  10. EBM - WHY BOTHER ? (2) • In spite of clear need for the evidence WE FAIL TO GET IT

  11. EBM - WHY BOTHER ? (3) • Because 1&2, up to date knowledge and clinical performance DETERIORATE WITH TIME

  12. 10 20 30 40 50 Years since graduation, Range (3-42)

  13. EBM - WHY BOTHER ? (4) • TRADITIONAL CME HAS BEEN SHOWN THROUGH RCT’s NOT TO IMPROVE OUR CLINICAL PERFORMANCE !

  14. EBM - WHY BOTHER ? (5) • A different approach to clinical learning utilizing “EBM” approach has been shown to keep its practitioner up to date

  15. 80 70 60 50 40 30 20 10 0 0 5 10 15 20 HYPERTENSION – KEEPING UP TO DATE USING EBM Mean total score Years in practice

  16. PRACTICING EBM, THE NEEDS Evidence-based approach to patient care create the NEED for Clinically Important Information about DIAGNOSIS PROGNOSIS THERAPY

  17. PRACTICING EBM, THE STEPS • Transform information needs into answerable questions. • Track down the best evidence to answer them. • Critically appraise the Validityand usefulness of the evidence. • Apply result of appraisal to clinical practice. • Evaluate your performance.

  18. O U T P U T Printed reviews CD ROM Diskettes Internet version Databases of abstracts of reviews of effectiveness THE COCHRANE LIBRARY The Cochrane Database of Systematic Reviews The Cochrane Controlled Trials Register The Cochrane Review Methodology Database INPUT FROM CC Collaborative Review Groups Methods Working Groups The Cochrane Centers / Cochrane Fields

  19. “ IT AIN’T SO MUCH WHAT WE DON’T KNOW THAT GETS US INTO TROUBLE AS WHAT WE DO KNOW THAT AIN’T SO “ • Will Rogers • “An American cowboy philosopher”

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