Professional Documents
Culture Documents
Clinical
Expertise
Research Patient
Evidence Preferences
• Skills
• Judgement
– which individual health care workers acquire
through
– clinical experience and clinical practice
out-of-date textbooks
the disorganization of the up-to-date journals
23 January 2015 Evidence Based Medicine 20
Importance of EBM for practicing
clinicians?
5,000?
2500000
per day
perYear
Year
2000000
Per
1500000
Articles
2,000
Articles
75 per
500000
day
0
Biomedical MEDLINE Trials Diagnostic?
Al-Rhazi
For I once saved one group Alvan
by it, while I intentionally Pierre Louis Feinstein
neglected another group. publishes his book
Develops his “numerical
By doing that, I wished to Clinical Judgement
method” and changes blood
reach a conclusion .
letting practice in France
David Sackett
23 January 2015 Evidence Based Medicine 28
Prof Archibald Cochrane, CBE
(1909 - 1988)
Etiology/Harm RCT > cohort > case control > case series
Disease
laparotomy
Ectopic
pregnancy
•23 January
Step20155 – Evaluating the Process
Evidence Based Medicine 50
EBM Method
Apply
evidence to
23 January 2015 Evidence Based Medicine patient care 51
Answerable questions
EFFECTIVENESS
A description of the populations P
An identified intervention I
An explicit comparison C
Relevant outcomes O
Patient/ Intervention/
Population Comparison Outcome
Exposure
Source: Brownson, R.C. et al, Evidence-based public health, Oxford University Press, 2003.
Public health
Clinical
• Populations and
• Individuals communities
• Single interventions • Combinations of strategies
• Outcomes only (generally) • Processes as well as
• Often limited consumer input outcomes
• Quantitative approaches to • Involve community members
research and evaluation in design and evaluation
• Qualitative and quantitative
• Health promotion theories
and beliefs
Diffusion
/Adoption
Information overload
Service level
National policy level
Implement
Re- tool
Develop
Program or Develop an
policy action plan
options