Evidence Based Practice

HaDSoc Session 2b

Professor
Qayser Sahib Habeeb

Specialist in
Internal and Community Medicine
Department of Family and Community Medicine
College of Medicine / University of Duhok
 Learning outcomes

1- Offer a critical perspective on the rise of the

evidence-based medicine movement.

2- Discuss, using social science theory and

evidence, some of the difficulties of getting
evidence into practice
 What is
? EBM

LO 1
 Traditionally
medical teaching has been based
on
apprenticeship – type system‫لتمهن‬,,‫ا‬

Much of medical practice depends

on
anecdotal‫ئي‬,‫ولياو روا‬,,‫ ق‬evidence & experience
which may be
biased & unreliable
LO 1
 Anecdote - based
Medicine

Levels of Evidence
 Level I : Beardy old gent from royal college
 Level II : Doctor with air of credibility and honest face
 Level III : Academic with mad stare
 Level IV : NHS manager with trust in financial crisis
 Computerized data bases
and
the revolution in information technology
bring forth new concepts.
one of these is

“Evidence Based Medicine”

LO 1
Anecdote Evidence
Based Based
 ?What is evidence-based medicine

the integration of best research evidence with“

” clinical expertise and patient values

patient
concerns
EB
M
best research clinical
evidence expertise

David Sackett
 EBM
was created as a response to a call
by
Archie Cochrane,
Cochrane

a British epidemiologist.

LO 1
 Cochrane's work
was honoured through the naming of

Cochrane Centres
Cochrane Collaboration

The first
Cochrane Centre was opened in
.Oxford in 1992
LO 1
 The Cochrane Collaboration
supports
:collaborative review groups in
preparing, maintaining & promoting
the accessibility of research evidence
 EBM
advocates‫لى‬,,‫دعو إ‬,,‫ ي‬the use of
up - to - date "best" scientific evidence
from
health care research as the basis
for
making medical decisions

LO 1
 Evidence Based Practice

is the integration of
‫ تكامل‬/ ‫ توحيد‬/ ‫دمج‬
clinical expertise,
patient values
&
the best research evidence
in
the decision making process for patient care

( Sackett D, 2002 )
 --- Clinical expertise
refers to the clinician's cumulated experience,
education and clinical skills.

--- The patient

brings to the encounter his or her own personal
and unique concerns, expectations and values.

--- The best evidence

is usually found in clinically relevant research that
has been conducted using sound methodology.
LO 1
 Finding the Evidence

? Type of evidence
? Sources of evidence

LO 2
 ? Type of evidence

LO 2
 Types of Research

.Qualitative R
.Quantitative R )interpretive(

.Primary R. Secondary R
).Integrative R ( ).First Hand R (

Overviews ►
-
- Traditional ( NS)
Descriptive Analytic - Systematic
Meta Analysis -
Observational ► Guidelines -
Experimental ► Decision Analyses -
Economic Analyses ►
17
 The Blind Men and the Elephant
John Godfrey Saxe (1816-1887)
Traditional ◄ REVIEWS ► Systematic
̶ Many questions ̶ One question
– No search methods – Explicit search
– No inclusion criteria – Explicit inclusion criteria
– No combining of studies – Combining study results
(Personal view) (Meta-analysis)
Systematic Review
A systematic review
involves
identification of all the relevant primary papers
in human populations that deal with
a focused question, these papers are then
appraised critically to
.identify their strengths and weaknesses
Finally
.a summary of the evidence is reported
LO 2
 Well done systematic reviews
are increasingly being accepted as
the highest form of evidence
.in the hierarchy of evidence

LO 2
Hierarchy of Evidence LO 2 
 ? Sources of evidence

LO 2
 When
practice guidelines or systematic reviews
are
---- not available,
---- not current,
---- not trustworthy, and/or
---- not relevant,
one can turn to
individual studies
to seek evidence to help make treatment
decisions
LO 2
 The first place to find
individual studies
would be an online bibliographic database.

The best place to start with would be

MEDLINE,
the world's largest online bibliographic database
of health related studies.

MEDLINE
cites millions of articles from more than
4,000 peer-reviewed journals.
 :Strengths of EBM
.Helps clinicians in their decision – making ---

Helps ensure consistency of care offered to ---

patients

.Develops skills in critical appraisal ---

.Helps clinicians keep up to date ---

Helps in the development of evidence based ---

.guide lines
LO 2
 Weaknesses:
--- Development of the evidence base has

been biased.

--- Ignores the benefit of clinical experience.

--- Can be time consuming and requires the

acquisition of basic skills.
Thank You