EBM Lecture1 PDF

Mahmoud E.Elrggal, PharmD Evidence Based Medicine Course Introduction to Evidence Based Practice Mahmoud E. Elrggal After this lecture you should Know • Overview of the whole syllabus • Stages of development of EBP • The need for EBP Once Upon a time ...... In 1972, Archie Cochrane highlighte...

Mahmoud E.Elrggal, PharmD Evidence Based Medicine Course Introduction to Evidence Based Practice Mahmoud E. Elrggal After this lecture you should Know • Overview of the whole syllabus • Stages of development of EBP • The need for EBP Once Upon a time ...... In 1972, Archie Cochrane highlighted the fact that most treatment-related decisions were not based on a systematic review of clinical research. Remember this Name Once Upon a time ...... Rather, they were based on × Random selection of information from the vast and variable quality scientific literature × Expert opinion × or, worst of all, on trial and error. Once Upon a time ……… • Cochrane proposed that researchers and practitioners should collaborate internationally to systematically review all the best clinical trials, specialty by specialty. Once Upon a time ……… Cochrane ideas were taken up during the 1980s by Iain Chalmers who persuaded colleagues to join him and make care during pregnancy and childbirth the first area of clinical practice to be reviewed in this way. Once Upon a time ……… • Systematic Reviews highlighted the gaps that existed between research and clinical practice and started to convince some doctors of the benefits of an evidence-based approach to bridge this gap. Back to sleep • Physicians in western countries traditionally recommended that babies sleep on their stomachs. It was thought that by sleeping on their backs infants were at risk for regurgitation and aspiration, leading to sudden infant death syndrome (SIDS). Back to sleep • In the 1980's, some physicians asked the question, "Is there any evidence to support the practice of sleeping babies on their stomachs?" As it turned out, case-control studies found a dramatic decrease in SIDS deaths among children sleeping on their backs, leading to the national "Back to Sleep" program. Steroids in prematurity • In 1973, a small study demonstrated that steroids given to women expected to deliver prematurely reduced the likelihood of death in their infants. Six further studies in the next 10 years had mixed results, primarily because they were all quite small. • Had a meta-analysis been done in 1983, it would have shown that the overall results of all the trials combined supported a beneficial effect of steroids , it might have changed practice much sooner and saved thousands of lives. However, it took another decade before these results were accepted and began to change practice. • The results of the first seven studies of steroids in prematurity, and the summary results (the diamond at the bottom of the diagram) are memorialized in the logo of the Cochrane Collaboration, shown at right. Lines completely to the left of the vertical bar represent a statistically significant benefit of steroids in preventing death. Once Upon a time ...... • In the early 1990s, David Sackett and his colleagues at McMaster University in Ontario, Canada, introduced the term “Evidence-based medicine” What is Evidence Based Medicine ? Remember…... Medicine is the science of uncertainty and the art of probabilities What is Evidence Based Medicine ? The integration of the best research evidence with clinical expertise and patient values. “best research evidence” What does “best” mean? clinically relevant research. Patient centered clinical research The accuracy and precision of diagnostic tests The power of prognostic markers The efficacy and safety of therapeutic, rehabilitative, and preventive regimens “clinical expertise” EBM does not eliminate the need for: Noting signs and symptoms Taking a good history Interpreting results of tests Thinking analytically “patient values” • • • • • • Risk aversion Time preference Living arrangements Working arrangements Medical care vs. other goods and services Income? Evidence Based Medicine Vs Evidence Based Practice üMore inclusive of different areas of health care practice. Why Evidence Based Practice ? (Cont.) • EBM launched as a process by which advances in medical research may come into practical use so as to yield safer, better and more cost-effective health care. Why Evidence Based Practice ? (Cont.) • More than 15 million medical papers have been published. • The number of medical journals is in excess of 5000. Why Evidence Based Practice ? (Cont.) Half of what you are taught as medical students will have been shown in ten years to be wrong. And the trouble is none of our teacher know which half. Charles Sidney Burwell Ex-Dean ,Harvard Medical School (1935-1949) Why Evidence Based Practice ? (Cont.) • It has been estimated that only some 10–15% of what is published today will be of lasting scientific value. • It has been estimated that half of today’s medical knowledge base will be out-of-date, erroneous or irrelevant in 10 years. Important Requirements! • Fundamental elements should be present in all studies, including: Appropriate qualifications of the researchers. Valid investigational methods & Proper research techniques. Appropriate analysis plus interpretation of the results.