first annual learning to practice and teach evidence based health care n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
(First Annual) Learning to Practice and Teach Evidence-based Health Care PowerPoint Presentation
Download Presentation
(First Annual) Learning to Practice and Teach Evidence-based Health Care

Loading in 2 Seconds...

play fullscreen
1 / 22

(First Annual) Learning to Practice and Teach Evidence-based Health Care - PowerPoint PPT Presentation


  • 117 Views
  • Uploaded on

Welcome!. (First Annual) Learning to Practice and Teach Evidence-based Health Care. An Intensive Workshop. Introductions. Robert Wild & Dave Thompson Susan Hollingsworth Speakers Facilitators Participants. A true story.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about '(First Annual) Learning to Practice and Teach Evidence-based Health Care' - palila


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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
introductions
Introductions
  • Robert Wild & Dave Thompson
  • Susan Hollingsworth
  • Speakers
  • Facilitators
  • Participants
a true story
A true story
  • A randomized trial of treating high blood pressure on the jobsite (a steel mill) vs. referral for treatment to primary care doctor
  • Primary outcome: treatment compliance
  • No difference in compliance between the groups
  • Some patients who were referred with documented hypertension did not get treated
slide4
Determinants of the clinical decision to treat some, but not other, high blood pressure patients:
  • The level of diastolic blood pressure.
  • The patient’s age.
  • _
  • The amount of target-organ damage.
slide5
Determinants of the clinical decision to treat some, but not other, hypertensive patients:
  • The level of diastolic blood pressure.
  • The patient’s age.
  • The physician’s year of graduation from medical school.
  • The amount of target-organ damage.
how we know
How we “know”
  • observations in the world
  • clinical experience
    • open to bias
      • specious causal connections
      • vividness and immediacy
      • small samples
  • laboratory and physiological research
    • systematic but generalization dangerous
  • observational studies
    • non-comparable groups
what we did know that ain t so
What we (did) know that ain’t so:
  • HRT to decrease cardiovascular risk
    • observational studies consistently suggest decreased risk
    • RCTs show increased risk
  • High flow oxygen for RDS
    • My 6th grade pen-pal was in the “gifted children” class at the Ohio state school for the blind
  • Anti-arrythmics post-MI
contrasting reasoning
Patho-physiologic reasoning

Depends on logic and knowledge of pathophysiology

This leads to a decision to prescribe flecainide to patients after heart attack

Evidence from systematic studies in human subjects:

Randomized trial of flecainide after MI:

7.7% dead on flecainide

3.0% dead on placebo

Leads to a decision NOT to prescribe flecainide after MI

Contrasting Reasoning
hierarchy of evidence
Hierarchy of Evidence

Meta-analysis of RCTs

systematic review of RCTs

Individual RCT

Observational studies

patient-important outcomes

Basic research

test tube, animal, human physiology

Clinical experience

why don t we practice ebm
Why don’t we practice EBM?
  • Exploding information supply
  • Textbooks are out of date
  • No time to read
  • Traditional CME doesn’t work
asking questions
Asking questions
  • Practice identifying information needs:
    • Routinely question decisions
    • Question routine decisions
  • Identify the specific issue at hand
  • Do you need background or foreground information?
identify the type of information that is needed
Identify the type of information that is needed
  • Background information: What IS myelomonocytic leukemia?? Best source of information for background questions is recent textbooks or recent general review articles.
  • Foreground information: Should patients with myelomonocytic leukemia be treated with methotrexate? The best information for foreground questions comes from original research in human subjects.
asking questions1
Asking Questions
  • Design a focused clinical question that addresses the information need
    • Patient/population
    • Intervention
    • Comparison if relevant
    • Outcome
  • The “PICO question”
  • PCOS
why bother with ebm
Why bother with EBM?
  • without EBM we are helpless in the face of
    • misguided experts
    • overenthusiastic experts
    • drug company hype
  • without EBM our ability is limited
    • to understand difficult tradeoffs
    • to help our patients make difficult decisions
  • with EBM comes
    • understanding and power
    • greater effectiveness in helping our patients
seven alternatives to evidence based medicine
Seven Alternatives to Evidence Based Medicine
  • Eminence Based Medicine (marked by radiance of white hair)
  • Vehemence Based Medicine
  • Eloquence Based Medicine
  • Providence Based Medicine
  • Diffidence Based Medicine
  • Nervousness Based Medicine
  • Confidence Based Medicine
    • (Isaacs and Fitzgerald, BMJ 1999;319:1618)
structure of the workshop
Structure of the Workshop
  • Breakfast at 8:00am both days
  • First plenary at 9:15 am on Friday and 9:00am Saturday
  • Small group sessions
    • 10:15-11:40 am Friday, 1:30-3:30 pm Friday
    • Saturday 10:15-11:30 adjourn Sat 11:30 am
  • Box Lunches Friday and Saturday
  • Lunchtime registrants hands - on searching session today
    • Sign up at registration table, limited space -
  • facilitators go to room 251 Provost Conference PM
  • Reception this afternoon after last plenary 4:45PM
  • Please turn in your evaluations. CME can be obtained for an additional $25 , slide presentations, and the library resource guide with links to many, many helpful websites will be posted on URL http://moon.ouhsc.edu/dthompso/cdm/ebhc1/ … in your packet
goals of the workshop
Goals of the workshop
  • To learn and practice skills of critical appraisal of the research literature
  • To learn techniques for teaching EBM
your own goals
Your own goals
  • You will have come with your own objectives for the workshop
    • Please share them with your group
ground rules
Ground Rules
  • Facilitators are there to facilitate and demonstrate
  • Please arrive on time and prepared for each session
  • Have a good time!