Uma Devalapalli Evidence Based Medicine Process - An Introduction Aims & Objectives To know about What is Evidence Based Medicine (EBM)? Why is EBM Important? The steps in EBM process Learning Outcomes By the end of this session you will be able to Formulate a clinical question
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Evidence Based Medicine Process - An Introduction
To know about
By the end of this session you will be able to
“EBM is theConscientious, explicit and judicious use ofcurrent best evidencein making decisions about the care of the individual patient.
-Sackett D. et al., 1996
Thus, the practice of EBM means :
Integrating individual clinical expertise with the
best available external clinical evidence from systematic research.”
“Evidence Based Clinical practice is an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best”
-Muir Gray JA., 1997
When actually observed:
by the medical record or hospital information system.
(Osheroff JA. Forsythe DE. Buchanan BG. Bankowitz RA. Blumenfeld BH.
Miller RA. Physicians' information needs: analysis of questions posed during
clinical teaching. Annals of Internal Medicine 114(7):576-81, 1991 Apr 1.)
When Clinicians have access to information,
it changes their patient caremanagement decisions.
(Sackett D, 1998 & Crowley S, 2003)
a clinical problem/ question arises out of the care of the patient.
You are assessing a 65-year-old man who is due to have coronary grafting.
Anaesthetist suggests ‘thoracic epidural’, where as Surgeon says that ‘epidurals can be dangerous with full heparinisation’
Now the the team wants to know whether the thoracic epidural prior to induction reduce the post -operative complications…
Does epidural anesthesia reduce post
operative complications ?
Ask focussed and answerable questions !!!
In elderly male patient undergoing cardiac surgery, does epidural anaesthesia reduce the post operative complications?
P - Patient, Problem or Population
I - Intervention
C - Comparison (not always relevant)
O - Outcome
I: Intervention or Exposure
(not always relevant)
What patient group, population or problem are you interested in?
elderly coronary patient
What intervention or exposure are you examining?
Do you want to make a comparison?
What outcome were you looking for?
reduce the post operative complicationsPICO - Finding the evidence
P – In elderly coronary artery graft patients
I – does epidural anaesthesia
C – compared with general anaesthesia
O – reduce postoperative complications?
and conduct a search
- (reports, statistics, guidelines)
Appraise the evidence for its
validity (closeness to the truth) and
applicability (usefulness in clinical practice)
A review in which all available evidence on a particular subject is systematically identified, appraised and summarised.
A group of patients are randomly allocated to receive different interventions. Outcomes are then compared.
Groups of people are selected on the basis of their exposure to a particular agent and followed up.
Survey or interview of a sample of the population of interest at one point in time.
Cross Sectional Survey
A report based on a single subject or patient.
A consensus of experience amongst professionals.
Something a bloke told you after a meeting or in the bar.
Return to the patient
- integrate the evidence with clinical expertise, patient preferences
- apply it to practice
Identify & Define the problem
Formulate a focused clinical question
Identify the appropriate resources
Search for valid and relevant information
Critically appraise/review this information
Implement in practice
Clinical audit ...