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EBM

EBM. Dr. Nada AlYousefi April 25, 2012. Motivation: EBM “Successes”. Theophylline and asthma We were doing the wrong thing Littenberg, 1988 Beta blockers and MIs We weren’t doing the right thing Yusuf, 1987. Uses of “EBM”. Use of empirically-verified treatments in the care of patients

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EBM

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  1. EBM Dr. Nada AlYousefi April 25, 2012

  2. Motivation: EBM “Successes” • Theophylline and asthma • We were doing the wrong thing • Littenberg, 1988 • Beta blockers and MIs • We weren’t doing the right thing • Yusuf, 1987

  3. Uses of “EBM” • Use of empirically-verified treatments in the care of patients • Incorporation of research results into the process of care • Ability to critically appraise research results

  4. What is Evidence-Based Medicine? • “Theintegration of individual clinical expertise with the bestavailable clinical evidence from systematic research.” • David L Sackett, W Scott Richardson, William Rosenberg, R BrianHaynes Evidence Based Medicine--How to Practice and Teach EBM, 1996 • Various definitions

  5. About 10% of published evidence is worth reading About 1/3 of worthwhile evidence is eventually refuted or attenuated About 1/2 of relevant evidence is not implemented

  6. Steps of ebm 5A’s

  7. Critical: careful, exact evaluation and judgment Critically Appraise: To evaluate, & estimate the quality, amount of validity, results and applicability Appraised Topic Topic: A subject of discussion or conversation

  8. “Best Available Clinical Evidence” • Therapy • Double-blind, placebo-controlled, randomized clinical trial • Diagnosis • Independent, blind comparison with a reference standard • Prognosis • Representative and well-defined prospective cohort of patients at a similar point in the course of disease • See Centre for Health Evidence

  9. Levels of Evidences • (I-1) a well done systematic review of 2 or more RCTs • (I-2) a RCT • (II-1) a cohort study • (II-2) a case-control study • (II-3) a dramatic uncontrolled experiment • (III) respected authorities, expert committees, etc.. • (IV) ...someone once told me.... • http://www.phru.org/casp/ • See also AAFP

  10. “Systematic Research” • “Meta-analysis” • “Literature synthesis” • From Michael Scriven

  11. Questions ARIF

  12. Questions: PICO Centre for EBM: http://163.1.212.5/docs/focusquest.html

  13. Should a 30-year-old woman with recurrent uncomplicated lower UTIs be advised to drink cranberry juice to prevent reinfection? For a 63 year old woman with Type 2 diabetes, is gabapentin superior to amitriptyline as first-line therapy for painful peripheral neuropathy? Problems

  14. Presentation will cover: • Relavance • PICO • search strategy • search results • the validity of this evidence • the importance of this valid evidence • can this valid, important evidence be applied to your patient

  15. Task • Well formulated question? • Formulate the query • Report back to us on your success • The whole group reports back in a week

  16. Search for the Best Evidence • Review articles • Community/professional standards • Systematic reviews • Original results

  17. What are the Sources of Good Evidence? www.welch.jhu.edu

  18. http://ksu.edu.sa/Deanships/library/Pages/Home.aspx

  19. http://saudi.digitallibraryplus.com

  20. National Guideline Clearinghouse Website www.guideline.gov

  21. Cochrane Website

  22. TRIP Database Website (75 resources…) www.tripdatabase.com

  23. UpToDate Website

  24. Getting to PubMed

  25. PubMed Response

  26. PubMed Clinical Query www4.ncbi.nlm.nih.gov/PubMed/

  27. Question Context Subject matter PubMed, Clinical Query, cont’d Website

  28. Controlled Vocabulary for Subject Matter

  29. www.ncbi.nlm.nih.gov/pubmed

  30. Key concepts! • Auther

  31. Stopwords

  32. MeSH(The Medical Subject Headings )

  33. Exercise • Use the MeSH Database to build a strategy that will find citations to references discussing the economics of community-acquired pneumonia.

  34. Exercise • Use the NLM Catalog Journal search page to see if PubMed includes the journal, Molecular Microbiology. If so, retrieve all PubMed citations from this journal.

  35. Exercise • Use the Clinical Queries to find systematic reviews for accidents caused by sleep deprivation.

  36. Search • What role does pain have in sleep disorders?

  37. Search • To search for citations to articles written by Bonnie W. Ramsey about gene therapy for cystic fibrosis

  38. Search • To search for citations to articles about drosophila in the journal Molecular Biology of the Cell

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