Introduction to Evidence-Based Medicine

Dr. Bhisma Murti, MPH, MSc, PhD
Insiitute for Health Economics and Policies (IHEPS, Bagian Ilmu Kesehatan Masyarakat, Fakultas Kedokteran, Universitas Sebelas Maret

” – David L Sackett. R Brian Haynes Evidence Based Medicine-How to Practice and Teach EBM.What is Evidence-Based Medicine? • “The integration of individual clinical expertise with the best available clinical evidence from systematic research. 1996 . William Rosenberg. W Scott Richardson.

The Elements of EBM Patient Concerns. Values and Expectation EBM Best research evidence Clinical Expertise .

Six Steps in EBM 1. 2. 5. 6. 3. 4. The Patient The Question The Resource The Evaluation The Application The Self-Evaluation .

The Patient • Start from a clinical problem or question arising out of the patient’s concern and the care of the patient • It is the patient’s problem that matters. not the disease • So focus on the patient’s problem! .

Matters .Oriented E – Evidence that E.Evidence M. DOE’s D.Oriented vs.Patient O.Disease O.POEM’s P.

extrasystole PSA test= prostate specific antigen test . DOE’s Example Antiarrhythmic Therapy Patient-Oriented Evidence that Matters Comment POEM study contradicts DOE study Drug X  PVCs Drug X increases on ECG mortality POEM agrees Antihypertensive Antihypertensive Antihypertensive therapy  BP therapy  mortality with DOE therapy PSA screening detects prostate cancer early ? whether PSA screening  mortality DOE exists.POEM’s DiseaseOriented Evidence vs. but the important POEM is unknown Prostate Screening PVC = premature ventricular contraction. also known as ectopic heartbeat.

The Question • Construct a well built clinical question derived from the case. i. the patient’s problem .e.

Types of Questions • Therapy/ prevention Question • Prognosis Question • Diagnosis Question • Harm Question • Etc. .

Questions: PICO .

The Resource • Select the appropriate resource(s) and conduct a search .

external validity .The Evaluation • Appraise that evidence for: – Validity (closeness to the truth) --.internal validity – Importance (clinical significance in magnitude and length) – Applicability (applicable to your patient) --.

Suggested Best Type of Study Type of Question Therapy Diagnosis Etiology/Harm Prognosis Prevention Clinical Exam Cost Suggested best type of Study RCT>cohort > case control > case series Prospective. blind comparison to gold standard Economic analysis . blind comparison to a gold standard RCT > cohort > case control > case series Cohort study > case control > case series RCT>cohort study > case control > case series Prospective.

Evidence Pyramid for Therapy Question Meta-Analysis Systematic Review Randomized Controlled Trial Cohort studies Case Control studies Case Series/Case Reports Animal research .

integrate that evidence with clinical expertise.The Application • Return to the patient -. patient preferences and apply it to practice .

The Self-Evaluation • Evaluate your performance with this patient .

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