Evidence based medicine

EBM Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.

1. EVIDENCE BASED MEDICINE Dr. Dalia El- Shafei Assistant Professor, Community Medicine Department, Zagazig University

2. Learning Objectives : 1 ) Define evidence based medicine (EBM). 2) To list its importance and limitations. 3) To describe how to apply EBM on any problem.

3. Evidence based medicine (EBM) Is the ability to access, asses and apply the best evidence from systematic research information to daily clinical problems after integrating them with the physician's experience and patient's value.

4. Application of EBM into clinical decisions enhances the opportunity for optimal clinical outcomes & quality of life .

5. The best available clinical evidence

6. Physician's clinical expertise R efers to the clinician’s cumulated experience, education and clinical skills.

7. The practice of EBM is to answer questions about:

8. Potential pitfalls “The clinician must always keep in mind that”:

9. So , EBM require new skills of the clinicians, including efficient literature-searching , and the application of formal rules of evidence in evaluating the clinical literature. Instead of routinely reviewing the contents of dozen of journals for interesting articles.

10. EBM process “the 6 As”

11. The patient Start with the patient-a clinical problem or question arises about the care of the patient. The question Construct a well-built clinical question derived from the case. The process Select the appropriate resource(s) and conduct a search. The evaluation Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice). The patient Return to the patient- integrate that evidence with clinical expertise, patient references and apply it to practice. Self -evaluation Evaluate your performance with this patient. EBM always begins & ends with the patient

12. Example for EBM application Mrs . Mona is a new patient who recently moved to the area to be closer to her son and his family. She is 67 years old and has a history of congestive heart failure following several myocardial infarctions . She has been hospitalized twice within the last 6 months for worsening of heart failure. At the present time she remains in normal sinus rhythm. She is extremely diligent about taking her medications ( enalapril , aspirin and simvastatin) and wants to stay out of the hospital. She lives alone . You think she should take digoxin but this will make her under medical supervision in the hospital. You decide to research this question before her next visit.

13. Properties of a good clinical question(PICO)

14. The structure of the question might look like this: Patient/problem Congestive heart failure, elderly Intervention Digoxin Comparison, if any None, placebo Outcome Primary: reduce need for hospitalization. Secondary: reduce mortality.

15. For our patient, the clinical question might be: In elderly patients with congestive heart failure, is digoxin effective in reducing the need for hospitalization? It is a therapy question and the best evidence would be a randomized controlled clinical trial .

16. For this question: We have chosen MEDLINE as our resource. MEDLINE is the most comprehensive resource for health–related literature searches and is accessible to everyone through PubMed . After writing your question you will obtain thousands of research studies. You must filter the obtained research studies by reviewing the type of study ( methodology ). The different types of methodology are arranged in a pyramid called “ evidence pyramid ”.