Professional Documents
Culture Documents
Medicine Informtion
Evidence Based Medicine
Antonius Nugraha Widhi Pratama, Apt.
Bag Farmasi Klinik dan Komunitas
Fakultas Farmasi
Universitas Jember
Reference
• Glasziou, P., Del Mar, C., 2003, Evidence‐based Medicine Workbook
Finding and applying the best evidence to improve patient care,
London: BMJ Publishing Group
• Some BMJ articles
What is EBM?
• “The conscientious, explicit, and
judicious use of current best evidence
in making decisions about the care of
individual patients.”
• The practice of EBM means integrating
individual clinical expertise with the
best available external clinical
evidence from systematic research.
• Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B.,
Richardson, W.S., 1996. Evidence based medicine: what it is
and what it isn’t. BMJ 312, 71 ‐72.
EBM ...
• Replaced the older term ‘clinical epidemiology’ and synonimous with
‘evidence‐based practice’.
• The ‘evidence’: empirical evidence about what actually works or
doesn’t work in practice.
• EBM is about actual clinical outcomes.
Why Do We Need EBM?
• Large info gap: research and clinical
practice
• Overloaded research information
• Not easily accessible for busy
practitioner
•
Why Do We Need EBM?
• Bridge of the gap: systematic reviews
• Speciality by speciality
Farmasis Klinik dan EBM
• Untuk membantu dokter (tim) dalam memberikan keputusan klinis
• Untuk layanan informasi obat dan pengobatan kepada pasien
ataupun tenaga kesehatan lain
Steps in EBM
1. Formulate an answerable question
2. Track down the best evidence of outcomes available
3. Critically appraise the evidence (ie find out how good it is)
4. Apply the evidence (integrate the results with clinical expertise and
patient values)
5. Evaluate the effectiveness and efficiency of the process (to improve
next time)
Steps in EBM
1. Formulate an answerable question
Steps in EBM
1. Formulate an answerable question
• A 28‐year‐old male
presents with
recurrent furunculosis
for past 8 months;
these episodes have
been treated with
drainage and several
courses of antibiotics
but keep recurring. He
asks if recurrences can
be prevented.
Steps in EBM
1. Formulate an answerable question
• George has come in to
your surgery to discuss
the possibility of getting
a vasectomy.
• He says he has heard
something about
vasectomy causing an
increase in testicular
cancer later in life.
• You know that the risk of
this is low but want to
give him a more precise
answer.
Steps in EBM
1. Formulate an answerable question
• Jeff , a smoker of more than
30 years, has come to see • Population/patient? ...................
you about something • Intervention/indicator ? ..............
unrelated.
• You ask him if he is • Comparator/control ? ...................
interested in stopping • Outcome ? ...........................
smoking. He tells you he has
tried to quit smoking
unsuccessfully in the past.
• A friend of his, however,
successfully quit with
accupuncture. Should he try
it?
• Other interventions you
know about are nicotine
replacement therapy and
antidepressants.
Steps in EBM
1. Formulate an answerable question
• Susan is expecting her first • Population/patient? ...................
baby in two months. She • Intervention/indicator ?
has been reading about ..............
the potential benefits and
harms of giving newborn • Comparator/control ?
babies vitamin K ...................
injections. • Outcome ? ...........................
• She is alarmed by reports
that vitamin K injections in
newborn babies may
cause childhood
leukaemia.
• She asks you if this is true
and, if so, what the risk for
her baby will be.
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
[smoking patient] AND [acupuncture OR
nicotine replacement therapy] AND [success]
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Acupuncture and related therapies do not
appear to help smokers who are trying to quit.
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in
EBM
2. Track down the best
evidence of outcomes
available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
Steps in EBM
2. Track down the best evidence of outcomes available
• Dipiro, JT;2007 ; 7th Ed.,
Infectious Disease
Steps in EBM
3. Critically appraise the evidence (ie find out how good it is)
• Were the groups of subjects representative and comparable?
• Was the outcome measurement accurate?
• Was a placebo used?
• Could the results have been due to chance?
• Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature
Evaluation Skills, American Journal of Pharmaceutical Education, 71 (4)
Article 63
Berlatih EBM Secara Mandiri
• Apakah zinc dapat memperpendek durasi diare?
• Apakah probiotik baik untuk digunakan pada diare akibat antibiotik
pada anak?
• Apakah beta‐blocker baik untuk hipertensi?
• Apakah barbiturat baik untuk digunakan pada pasien geriatrik?
Internet Sources of EBM
• http://www.cochrane.org
• http://www.evidence‐basedmedicine.com
• http://www.clinicalevidence.com
• http://www.bestbets.org
• http://sumsearch.uthscsa.edu/searchform45.htm
• http://www.urmc.rochester.edu/miner/educ/ebnfi
lt.htm
• http://www.cchs.usyd.edu.au/pedro
• http://www.jr2.ox.ac.uk/bandolier/whatnew.html
• http://www.tripdatabase.com
Medicine Information
Referensi
• Lee, A, 2004. Medicines Information. in Winfield, AJ, Richards, RME
(Eds.) Pharmaceutical Practice. Edinburgh: Churchill Livingstone
Outline
• Medicines (Drug) information services
• Sources of drug information
• Answering enquiries about medicines
Medicines (Drug) Information Services
• Essential part of pharmacy practice
• Important in last decades and increasingly important
in this age of EBM and patient empowerment
• Formalized center in general, but can be informalized
Medicines (Drug) Information Services
• Active drug information: giving response to questions
that may patient specific
• Proactive drug information: preparing newsletter,
bulletins, websites, etc. increasing awareness of
key therapeutic issues
Medicines (Drug) Information Services
• Information explosion
• Clinical governance
• All health professionals working in primary care and
secondary care need to address the quality of the services
they provide
• Doctor’s information needs
• Pharmaceutical industry representatives
• “When doctors see patients they usually generate at least
one question (Smith, 1996). Most about treatment, a
quarter about drug therapy.
Medicines (Drug) Information Services
• Activities requiring drug information skills
• Solving patient‐specific clinical problems
• Critical evaluation/appraisal of the literature
• Effective provision of verbal and written information to the
public
• Clinical guideline development
• Drug policy management (e.g. Formulary management,
drug use evaluation or audit)
• Preparation of bulletins and newsletters
• Managing the entry of new drugs into health care
• Adverse drug reaction/event management
• Continuing professional development
Medicines (Drug) Information Services
• Categories of drug information enquiry
• Choice of therapy (also indications, contraindications)
• Adverse effects
• Administration and dosage
• Product information, availability
• Drug interactions
• Drugs in pregnancy
• Drugs in breastfeeding
• Complementary medicine
• Identification of tablets and other dosage forms
• Pharmaceutical (stability, compatibility, formulations)
• Pharmacology (including pharmacokinetics)
Sources of Drug
Information
Sources of Drug Information
Tertiary drug information sources
Sources of Drug Information
Tertiary drug information sources
Sources of Drug Information
Tertiary drug information sources
Sources of Drug Information
Secondary drug information sources
Sources of Drug Information
Primary drug information sources
Answering Enquiries About
Medicines
Answering Enquiries About Medicines
• Gathering all relevant information
• Analysing and evaluating it
• Applying it to the question or clinical problem
• Delivering or communicating an answer or response
Answering Enquiries About Medicines
• Useful background information
• Patient age, sex, weight
• Medication (incl dose, duration of tx)
• Diagnosis and relevant medical history
• Liver and renal function
• History of ADR
• Pregnant, breastfeeding
• PICO search
Answering Enquiries About Medicines
Answering Enquiries About Medicines
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