1. Introduction To Evidence Based Medicine Mohamed M. Elgayar 5th year student at Faculty of Medicine-Menoufiya University.dr.elgayar@yahoo.com

2. What is Evidence-Based Medicine? • Evidence-based medicine is the integration of the best available research evidence with clinical expertise and patient values. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t.

3. Three interacting Principles of EBM

5. Which doctor do you want? Wise & experienced smart young doctor

6. How to practice EBM (5 steps)? • Step1 (Asking) • Step 2 (Accessing) • Step 3 (Appraising) • Step 4 (Applying) • Step 5 (Assessing) Adapted slightly from Straus, Richardson, Glasziou, Haynes. “Evidence-Based Medicine: How to practice and teach EBM”, 3rd Edition

7. Step1 (Asking) • Converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc) into an answerable question.

8. Types of Clinical Questions • “Background” • General information about a disorder: Anatomy ,Physiology...Books might be best • Foreground” • Specific knowledge about a disorder:Detailed informationArticles usually best i.e., the type of clinical question determines the best resource to use

9. Convert a clinical situation into a searchable, (and hopefully answerable) question using • PICO • PATIENT • INTERVENTION • COMPARISON • OUTCOME

10. Example: Specific Well-Built Clinical ?’s • “Can Aspirin decrease the risk of stroke?” • PICO • Patient or problem being addressed: • 65 ys with past stroke and moderate carotid stenosis • Intervention or exposure being considered: • Aspirin • Comparison intervention or exposure: • Placebo • Clinical Outcome of Interest: • Future stroke • “In a 65 ys man with history of past stroke and with moderate carotid stenosis, can ASA decrease risk of recurrent stroke compared to placebo?”

11. Step 2 (Accessing) Tracking down the best evidence with which to answer that question.-Pub-med-Cochrane-Journals-Other databases

12. Step 3 (Appraising) Clinically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in clinical practice).

13. validity • Exclude Chance • Exclude Bias • Exclude Confounding

14. The Evidence Pyramid Validity/Strength of Inference Time Spent in Critical Appraisal pyramid modified from: Navigating the Maze, University of Virginia, Health Sciences Library

15. Step 4 (Applying) Integrating the clinical appraisal with our clinical expertise and with our patient's unique biology, values and circumstances

16. Step 5 (Assessing) Evaluating our effective and efficiency in executing steps 1-4 and seeking ways to improve them both for next time.

17. Thank You