Professional Documents
Culture Documents
Medicine (EBM)
Tim FOME
Fakultas Kedokteran Universitas Andalas
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Introductory Lecture: Objectives
1. What
What is evidence-based medicine?
What does it look like in practice?
2. How
Formulate Clinical Questions
1. Search for Evidence
2. Appraisal of research
3. Apply to clinical problem
What is evidence-based medicine?
Patient
Concerns
EBM
Best research Clinical
evidence Expertise
What is “EBM” NOT?
What we have always done
“Cookbook medicine”
Only a cost-cutting trick
Only randomized trials
Meta-Analysis
Randomized Controlled Trial
Uncontrolled Trial
Case Series
Anecdote
Meta-Analysis
Randomized Controlled Trial
Uncontrolled Trial
Case Series
Anecdote
Apply Clinical
Evidence Question
Critical Literature
Appraisal Search
The EBM Cycle
1. Assess the patient: A clinical question arises from caring for a
patient.
2. Ask the question: Construct a well-built foreground question derived
from the case.
3. Acquire the evidence: Find the answer from the evidence presented
in the medical literature and identify the best resource from among
the many.
4. Appraise the evidence: Appraisal includes validity (closeness to
truth) and applicability (usefulness in clinical practice).
5. Apply: Communicate the evidence to your patient and integrate the
evidence with clinical expertise, patient preference and apply.
6. Self-evaluation: Evaluate the process and outcome.
Clinical Questions
– Ask the question: Construct a well-built
foreground question derived from the
case.
Two Types of Questions are
Generated in the EBM Cycle
Background Questions ask about general knowledge
relating to a condition, diagnostic test or treatment.
• They typically start with who, what, where, when, how, or why.
Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995 Nov-
Dec;123(3):A12-3.
Formulating the Foreground Question
Primary Literature
III
Apply Evidence
– Apply: Communicate the evidence to your
patient and integrate the evidence with
clinical expertise, patient preference and
apply.
Applying to the individual
• What do the results mean
on average?
• What do they mean for
this individual?
Evaluate Application
• Self-evaluation: Evaluate the process
and outcome.
In short…
EBM is the conscientious, explicit, and judicious
use of current best evidence in making decisions
about the care of individual patients.
Review the World Literature Fortnightly*
*"Kill as Few Patients as Possible" - Oscar London
2500000 5,000?
per day
Year per Year
2000000
Articles
1500000
1,500
MedicalPer
1000000
per day
Medical Articles
500000 95 per
day
0
Biomedical MEDLINE Trials Diagnostic?
Coping with the overload:
three possible things you might try
A. Read an evidence-based
abstraction journal
(and cancel other journals)
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Clinical Question
• In person who have high risk to type 2 DM,
will life style intervention or take
metformin, is better for reduced incidence
of diabetes?
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