EVIDENCE BASED MEDICINE Definition: integrating best research evidence with clinical expertise % patient values to achieve best

possible patient management. Component: 1. Evidence: relevant, valid & easy to obtain (information mastery) for diagnosis & therapy 2. Experience 3. Expectation Important: 1. Stay up-to-date with current literature 2. Communication effectively with each other 3. Make best use of different sources of information: infor mastery Usefulness of medical info = 4. 5. Take sound clinical decision based in valid research evidence Reducing variation in practice Steps EBM process 1. Formulate answerable clinical question PICO 1. Population/ Problem Descript grp patient belong Age Gender Race Ethnicity Stage of disease diagnostic test Prognostic marker Exposure factor Treatment Alternative Usually conversion Sometimes no comparison Improve fx Relieve symptoms Increase survival Improve quality of life
Most sensitive: 1. Systemic review & meta analyses 2. RCT 3. Cohort 4. Case control 5. Case series 6. Case report 7. Ideas, editorials, opinion 8. Animal research 9. In vitro research

2. Intervention

3. Comparison 4. Outcome

Type of studies 1ry (original research) 1. Experimental- randomized control trial 2. Observational cohort, case control, cross- sectional Type of question Therapy Diagnosis Etiology / harm Prognosis Prevention Clinical exam Cost 1. MEDLINE 2. PUDMED 1. 2. 3. 2ry 1. Review original research (systemic preview) 2. Meta analysis 3. Practice guidelines

Suggested best type of study RCT > Cohort > Case control > case series Prospective. Blind comparison to gold standard RCT > Cohort > Case control > case series Cohort > Case control > case series RCT > Cohort > Case control > case series Prospective. Blind comparison to gold standard Economic analysis

2. Literature search select appropriate resources conduct a search 3. Appraise evidence for its validity (closeness to truth) & applicability (usefulness in clinical

Randomization Patient follow up Blinding

Was the assignment of patient to treatment randomized? Were all patients who enter trial properly accounted & attributed for at its conclusion? Were patients, health workers & study personnel

practice) 4. 5. Baseline characteristic of patients Treatment

blind to treatment? Were grps similar at starting of trial? Aside from experimental intervention, were grps treated equally?

4. Apply evidence: Return to patient, integrate with clinical expertise, patient preference & apply it to practice 5. Asses outcome: evaluate performance

Result of validity: 1. Magnitude 2. Relative risk reduction 3. No need to treat (NNT): No of patient who need to be treats in order to prevent 1 additional bad outcome Absolute Risk Reduction (AAR) = control grp event rate (CER) experimental grp event rate (EER) NNT = 4. Confidence intervals 1. INTERNAL: Is valid result important? 2. EXTERNAL: are valid & important result applicable RR = 1 NO RISK RELATION <1 NO >1 HARMFUL