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INTRODUCTION
Half of what you are taught will in 10 years have been shown to be wrong. And the trouble is, none of your teachers knows which half (Sydney Burwell, MD. Dean of Harvard Medical School, 1956) Keeping up to date with current best evidence for the care of our patients is challenging
INTRODUCTION
Best evidence resources are built according to an explicit process that values research according to its scientific merit and clinical relevance Search engine : electronic or pocket notebook Easy navigation from clinical question to evidence-based answers.
Textbook to be dependable in the modern era : Revised frequently (at least once a year) Heavily referenced (at least about diagnosis and management) Evidence in support Citation or web-linked textbooks is encouraging, but none of these provides systematically critically appraised evidence.
Internal Medicine www.annals.org http://www.acponline.org Pediatric http://pedsccm.wustl.edu/EBJournal_cl ub.html Family Practice http://www.jfponline.com
Trade in your (traditional journal subscription Invest in evidence-based journals and online services ACP Journal Club summarize the best evidence from high-quality studies selected from all the journals of relevance to our clinical interest (general) Applicable clinical decision
O
(M)
: Outcome
: Methods
Therapy/Prevention Double blind randomized controlled trial Systematic review with meta-analysis; Prospective controlled study.
1.
2. Etiology/Cause/Harm RCTs or systematic reviews are the best study designs; Case-control studies are usually the best available; but sometimes a case study is the only evidence available.
3. Diagnosis Prospective cohort studies, with blind comparison to the gold standard
4. Prognosis Systematic review of homogeneous cohort studies Cohort study
Levels of Evidence
1. Systematic
review with meta-analysis of high quality randomized controlled trials with low heterogeneity. 2. Well-designed Randomized Controlled Trial (preferably double-blind) 3. Systematic review of observational studies. 4. Well-designed observational studies (prospective are considered to be stronger or less potentially biased than retrospective) 5. Unsystematic clinical reports: case study, case series 6. Authority, population studies, bench studies
Cases
Urinary Tract Disorders
A 35-year old woman sees you for a second episode of dysuria and fever. For the first episode 3 months ago, she was seen and treated by another GP with a course of co-trimoxazole for 7 days. She was well after that until the day before when the symptoms returned.
Cases
Hepatitis B Carrier Mr Tan is a 35-year-old engineer married with a 6 year-old son. He has been diagnosed as a Hepatitis B carrier 2 months ago while trying to donate blood. His son has had hepatitis immunization at birth. He has come to see you for advice.
Clinical problem
SUMMARY
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