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L8 Evidence based medicine :tropical_fish: (:hourglass: Basic steps ofâĶ
L8
Evidence based medicine
:tropical_fish:
Intro
:pencil2:
:<3:
āļŦāļąāļ§āđāļāļāļąāļāļāļĢāļēāļāļāđ
: āļŠāļļ āļāļī āļāļļ āļĨāļī
āļāļī = āļāļīāļāļāļ° = āļāļđāđāļĢāļđāđāđāļāđāļāđāļ§āļĒāļāļ§āļēāļĄāļāļīāļ āļāļīāļāļāļāļēāļāļēāļĢ āļŠāļĢāđāļēāļāļŠāļĢāļĢāļāđ
(āļāļāļāļąāļ&āļāđāļēāļāđāļĨāđāļ§-> āļāļģāļĄāļēāļāļīāļ āđāļāļ·āđāļāļĄāđāļĒāļrelation, comparing âāļāļīāļāđāļāļāļĄāļĩāļ§āļīāļāļēāļĢāļāļāļēāļ)
āļāļļ = āļāļļāļāļāļē = āļāļđāđāļĢāļđāđāđāļāđāļāđāļ§āļĒāļāļēāļĢāļŠāļāļāļāļēāļĄ, āļāđāļāļāļ§āđāļē seach knowledge āđāļāļ·āđāļāļŦāļē correct info
āļĨāļī = āļĨāļīāļāļīāļ = āļāļđāđāļĢāļđāđāđāļāđāļāđāļ§āļĒāļāļēāļĢāđāļāļĩāļĒāļ
(āļāļāļāļąāļāļāļķāļāļāļ§āļēāļĄāļĢāļđāđ with understanding fr āļāļąāļ,āļāļīāļ,āļāļēāļĄ -> āļāļēāļĢāđāļāļĩāļĒāļ āļāļķāļāđāļāđāļ
āļāļāļŠāļĢāļļāļāļāļāļāļŦāļąāļ§āđāļāļāļąāđāļāļŦāļĄāļāļāļāļāļāļąāļāļāļĢāļēāļāļāđ
)
āļŠāļļ = āļŠāļļāļāļ° = āļāļđāđāļĢāļđāđāđāļāļĢāļēāļ°āļāļąāļ āļĄāļĩāļŠāļĄāļēāļāļī āļāļ§āļāļāļđāđāļāļ°āļāļēāļĢāļāđāļēāļāļĄāļēāļāļāđāļ§āļĒ
Communication skills
Get new information: by
Listening
,
Reading
(repeating chance is higher > Listening)
Express for knowledge: by
Speaking
(āđāļ§āļāļ§āđāļēāđāļāļĩāļĒāļ),
Writing
(āđāļāļāļēāļŠāļāļīāļ> Speaking)
Listening continuum
(:five: levels)
āļāļēāļĨāļēāļĄāļŠāļđāļāļĢ 10 āļāļĢāļ°āļāļēāļĢ
Dr. David Sackett â âFather of EBMâ :man::skin-tone-4:
Outline
:hourglass_flowing_sand:
Definition & Purpose of EBM
Basic steps
Trials, Studies, & Reports (TBC)
Pros, Cons & Limitations (TBC)
:hourglass:
Def & Purpose
Def: Conscientious, Explicit, and Judicious use of
current best Evidence
in making decisions abt
care of individual pts
Purpose: For pt care, public health, research
improving Quality of pt lives
Q. Why do we need to know EBM?
At the present is the era of
Information explosion
(so many new researches, textbook knowledge is old) -> so we need to search data & evaluate bringing best evidence to improvise â use to take care pt
So much info, so little time
:hourglass:
Basic steps
of EBM
(
5Aâs of EBM
)
:one:
Ask
question
Using
PICO*
in āļāļąāđāļāļāļģāļāļēāļĄ
Category
of Q
Major
categories
Etiology, Risk
Dx
Prognosis
Therapy, Rx
Harm (Iatrogenic, Other)
Miscellaneous
Quality of care
Health economics
Office Mx
Etc.
Pt-focused, problem-oriented
:two:
Acquire
evidence (search evidence)
āļāļģāļŦāļāļ
Keywords
fr Question āļāļĩāđāļāļąāđāļāđāļ§āđ
Domain
that needed to be search
: Etio, Dx, Prog, Therapy, Prevention
Type
of study
: cohort, case-control, RCT...
Literary resources
find the best evidence!
Textbooks :warning:
most obsolete, outdate!
traditional
Evidence based
Journals (mayb outdated)
Review articles (summaries, abstracts)
Systematic reviews (prepared in systematic, rigorous manner)
eg. Cochrane collection
Meta-analysis
Clinical practice guidelines
(summarized &easily-digestible information)
Pros & Cons of each resources
Best evidence is
External
- from outside resources (researchers, expert)
Current
- not out of date, most recent
High quality
- accurate, precise, effective, safe
Patient focused
- applicable, appropriate for Your Individual pt
Literal search
:three:
Appraise
evidence (āļāļĢāļ°āđāļĄāļīāļ evidence)
:rabbit2: evaluate evidence abt
Causes of ds/harmful of factor
Valids
āļāļēāļĢāļĻāļķāļāļĐāļē āđāļĄāđāļāļāļĢāļāļŦāļĢāļ·āļāđāļĄāđ??
Clear
research question?
Pt group āļāļģāļŦāļāļāđāļ§āđāļāļąāļāđāļāļāđāļĨāļ°āļāļĨāđāļēāļĒāļāļĨāļķāļāļāļąāļāļŦāļĢāļ·āļāđāļĄāđ?
āļ§āļąāļ āļāļąāļāļāļąāļĒāļŦāļĢāļ·āļāļŠāļēāđāļŦāļāļļāļāļąāļāļāļĨāļāļĩāđāđāļāļīāļāļāļķāđāļāđāļāđāļāđāļāđāļ āļĨāļąāļāļĐāļāļ°āļŦāļĢāļ·āļāļ§āļīāļāļĩāļāļēāļĢāđāļāļĩāļĒāļ§āļāļąāļ
āļāļēāļĢāļāļīāļāļāļēāļĄāļāļ. āļāļĢāļāļāđāļ§āļāđāļĨāļ° āļāļēāļāļāļāļāļĩāđāļāļ°āđāļāļīāļāđāļĢāļāļāļēāļĄāļāļĢāļĢāļĄāļāļēāļāļīāļāļāļāđāļĢāļ
Is Factor or Cause of study āļĄāļĩāļāļ§āļēāļĄāđāļāļ·āđāļāļĄāđāļĒāļāļāļĩāđāđāļŦāļĄāļēāļ°āļŠāļĄ??
Importance
āļāļĨāļāļēāļĢāļĻāļķāļāļĐāļēāļĄāļĩāļāļ§āļēāļĄāļŠāļģāļāļąāļāļŦāļĢāļ·āļāđāļĄāđ??
Consider fr
Calculated
risk that got from study includes
relative risk(RR)
fr Cohort study
Odds ratio (OR)
from Case-control study by looking at Confidence interval (C.I) āļ§āđāļē
āļāļĢāļāļāļāļĨāļļāļĄ 1 āļŦāļĢāļ·āļāđāļĄāđ??
āđāļĄāđ
āļāļĢāļāļāļāļĨāļļāļĄ 1 ->
āļĄāļĩāļāļąāļĒāļŠāļģāļāļąāļāļāļēāļāļŠāļāļīāļāļī
āļāļąāļāļāļąāļĒāļāđāļēāļāļ°āđāļāđāļāļŠāļēāđāļŦāļāļļāļāļāļāđāļĢāļ
āļāļĢāļāļāļāļĨāļļāļĄ 1 -> āđāļĄāđāļĄāļĩāļāļąāļĒāļŠāļģāļāļąāļāļāļēāļāļŠāļāļīāļāļī āļāļąāļāļāļąāļĒāđāļĄāđāļāđāļēāļāļ°āđāļāđāļāļŠāļēāđāļŦāļāļļāļāļāļāđāļĢāļ
:rabbit2:
Critical appraisal
:carrot:
Interpreting the evidence
:small_orange_diamond:How to do math? :grapes:
:small_orange_diamond:How to read a
paper
?
Evaluate written evidence
for
Quality
&
Usefulness
by assessing
Validity, Reliability, Relevance & Clinical importance
:chestnut:
Validity
How was the info gathered & process?
Was the study completed?
Did the study account for all test subjects?
Include subject lost to F/U?
Were ALL pts analyzed in their allocated group ?
Eg. Intention to treat â
not complete treatment
analysis
Information
Results
Comprehensiveness
: size, thoroughness, duration
:chestnut:
Reliability
Trust
info & result?
Appropriate type of study
eg. āļ§āļīāļāļąāļĒāļĒāļē should do Prospective study
Questuins on Rx should do RCT
Reproduceability
(āļāļģāđāļāđāļĨāļ°āļāļĢāļąāđāļ āđāļāđāļāļĨāļāđāļēāļ?)
3 more items...
Interpretation of results
2 more items...
Bias
dangerous pitfall
:warning:
3 more items...
:chestnut:
Relevance
Question. Is the report applicable to our...
problem?
patient?
practice?
:chestnut:
Clinical importance
Info can be true & interesting in theory yet
useless in clinical practice
Q. Is the info clinically important?
Yes -> How important it is?
study design
weight of results
Evaluation of RCT
:grapes:
Evaluate evidence for quality & usefulness
:four:
Apply
evidence (āļāļĢāļ°āļĒāļļāļāļāđāđāļāđāļŦāļĨāļąāļāļāļēāļ)
Implement useful findings in clinical practice
Key points :key:
âParadigm shiftâ
new: Current best evidence leds medical practice but it MUST be individually applied
âIndividual patientâ
peach pt is different, treat ur pr & not others
:five:
Assess outcome
(āļāļĢāļ°āđāļĄāļīāļāļāļĨāļāļēāļĢāđāļāđāļŦāļĨāļąāļāļāļēāļ)
for Information, intervention & EBM process