Block B6

Practical session
Evidence Based Medicine

Faculty of Medicine
Universitas Gadjah Mada
 Learning Objectives
Students are able to:
Practice EBM and use EBM in clinical problem
Assignment

Each group will be work with their own disease

topic (e.q. tuberculosis, malaria, thypoid fever,
dengue fever, etc)

Each group has a clinical scenario on diagnosis or

treatment or prognostic or harm of that disease
topic.

Based on this scenario, students formulate a

clinical question, PICO, search literature,
appraise the article, answer the clinical question.
 Assignment: EBM case report
Based on Scenario, student determine
1. Clinical question
2. The PICO (Population/problem,
Intervention, Comparator/Control,
Outcome)
3. How to get the answer (searching)
4. Apraise the articles
5. Answer the clinical question
EXAMPLE
Disease Topic: Colorectal Cancer (screening)

2. Scenario:

A 50 yr old man, his father died at age 60 of colorectal

cancer. He wonders if he should be screened for
colorectal cancer.
Faecal Occult Blood-testing is available in your setting
for screening colorectal cancer. The patient ask you
as his family physician if the screening could prevent
him from early death due to colorectal cancer.
1. CLINICAL QUESTION

 1. Possible question:
“ In adults screened with faecal
occult blood-testing, compared to
no screening, is there a reduction
in mortality from colorectal
cancer ? “
2. PICO
 2. PICO = Population/patient,
Intervention, Comparison/Control,
Outcome
Question part Question Term
Population/patient Colorectal cancer
Intrevention Screening

Comparison No screening

Outcome Mortality
3. How to get the answer
 Defining the topic:
– What are the key words?
– Are there other words which could be
used, such as synonyms, variations in
spelling?
– Use the keywords from PICO for
searching using boolean logic &
truncation
– use pubmed for searching
3. How to get the answer

 Develop general inclusion/exclusion criteria

for studies you will or will not consider.
– Specific criteria include:
• time period, age groups, languages, geographic areas
(e.g., developing countries), type of published material
(research/original article, clinical trial).
– Some exclusion criteria can be handled in the
search strategies : no free full text)
Assignment
On the report, the student should be able to
formulate a brief description (max 200 words) of:
- search terms,
- search criteria,
- database searched,
- selection of studies based on level of evidence.
- Give a choice of bibliographic references.
- Make flow chart

Please choose one of the article (each student in

the small group should should choose at least one
reference) to do critical appraisal.
4. CRITICAL APPRAISAL
 Each group should choose minimum 2 articles
and divided groups into 2 subgroups. Each
subgroups do appraisal for 1 article.
 Identify which worksheet will be used to
appraise critically the article (worksheet for
diagnosis, therapy, prognosis or harm)
 Make a report appraisal report
 Make table to summarize the studies/articles
Assignment
Answer
Specify the answer for the clinical question based
on the finding on the articles. Make a table for
conclusion of the each reference.

Student will present the answer in their group (in

power point slides) with supervision from their
instructor.
Example studies summary
Study Design Setting Intervention/e Results
and xposure
sample
Scholefi Random- UK, Haemoccult 13% reduction in
eld et al, ised trial 152 850 (FOB) test kit colorectal cancer
2002 subjects mortality (95%
CI 3-22%)
....
....
.....
Assignment
Report

After giving presentation, the report should

be rewritten in Roman 12 font type writer, 1-
1,5 space, A4 paper, minimum 1 page, and
maximum 5 pages. It should be collected to
their supervisor.

Contribution for final grade: 7.5%

Meeting with instructors

Meeting 1: Discussion on Clinical Scenario,

Research Question and PICO, searching
literature and decide which article will be used

Meeting 2: Presenting result of Critical

Appraisal

Meeting 3: Presenting of the results from

clinical question until answer of that question
Coordinator Groups

Contact the instructor to disucss time and

place for meeting

Arrange administrative documents at the

secretariat (attendace list, assignment
form)

Chairman of each meeting

Example scenario

A 16 years old female who live in Sulawesi Island,

came to a clinic with a chief complaint of fever since
4 days ago. The doctor did a laboratory test namely
IgM anti S. Typhi and the result of the test was
positive. What is probability that she really suffer
has the typhoid fever?

The doctor prescribed her Ciprofloxacin 500 mg

twice daily for 5 days. What is probability is that she
can be cured if she suffers from typhoid fever?