Information resources for evidence based medicine
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Information Resources for Evidence-Based Medicine. A Review 3 rd Year Family Medicine Clerkship - EBM. What is Evidence Based Medicine?. Evidence Based Medicine =. An integration of… The best research evidence Clinical expertise Patient values.

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Information resources for evidence based medicine

Information Resources for Evidence-Based Medicine

A Review

3rd Year Family Medicine Clerkship - EBM


What is evidence based medicine

What is

Evidence Based Medicine?


Evidence based medicine

Evidence Based Medicine =

  • An integration of…

    • The best research evidence

    • Clinical expertise

    • Patient values

Sacket DL, et. al. Evidence-based medicine: how to Teach and Practice EBM. 2nd ed. Edinburgh: Churchill Livingston, 2000


Evidence based medicine1

Evidence Based Medicine

Sackett: Integrating individual expertise with the best available clinical evidence from systematic research.

Domino: Basing the care of patients on clinical research whose outcomes are our main priority.


Review of study types

Review of Study Types


Clinical trial

Clinical Trial

An intervention is given to half of a study population, and half receive a placebo

Outcomes are compared to look for a difference

Produces an Absolute Risk for Intervention and Placebo


Cohort study

Cohort Study

  • Prospective analysis of a population believed to be free of a disease, but who vary in exposure

  • This population is followed over time to determine the Incidence in the Exposed group and the Incidence in the Unexposed group

  • Produces a Relative Risk

    • Incidence of the disease state in the Exposed population divided by the Incidence in the Unexposed population.


Case control study

Case Control Study

  • Patients are identified, matched to Controls (people with similar demographics but without the disorder), in hopes of finding exposures that may have increased the risk of developing the disease.


Review of ebm literature

Review of EBM Literature

Jim


Review articles

Review Articles

  • Summaries of the literature on a certain topic

  • Problems

    • Many do not include all of the relevant evidence

    • They may mix the opinions and biases of the authors with the evidence.


Systematic review

Systematic Review

  • A study of studies.

  • Explicit criteria for selecting which studies to review is included (results in less bias)

  • Has a structured format for consistent presentation of information


Information resources for evidence based medicine

Typical Systematic Review “Skeleton”

AbstractBackgroundObjectivesCriteria for considering studies for this reviewTypes of participantsTypes of interventionTypes of outcome measuresTypes of studiesSearch strategy for identification of studiesMethods of the reviewDescription of the studiesMethodological qualities of included studiesResultsDiscussionConclusionsImplications for practiceImplications for researchInternal sources of support to the reviewExternal sources of support to the reviewPotential conflict of interestAcknowledgementsContribution of Reviewer(s)SynopsisCharacteristics of included studiesTable 01 resultsReferences to studies included in this reviewAdditional references


Meta analysis

Meta-Analysis

  • A subclass of systematic reviews

  • Meta-Analyses combine and statistically summarize the results of individual studies


Information resources for evidence based medicine

Evidence Pyramid

MOST evidence

Only a small amount of the medical literature contains best evidence!

LEAST evidence

From SUNY Downstate Medical Research Library http://servers.medlib.hscbklyn.edu/ebm/2100.htm


Questions

Questions?

  • Bring them to your 3rd year Family Medicine Clerkship EBM session in the Lamar Soutter Library OR

  • Contact:

    • Len Levin 508-856-6028 [email protected]

    • Jim Comes 508-856-6810 [email protected]


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