bahan kuliah ebm1.pptx

7/25/2019 bahan kuliah EBM1.pptx

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EVIDENCE-BASEDMEDICINE

Zwasta Pribadi M



A quick question to hel!ou "row

# is a se$uall! trans%itted disease &ith re'alence o( )*+,

atal in . in / eole 0reat%ent re'ents death Sensiti'it! o( a test to detect # is 11, Seci2cit! o( a test to detect # is 11, . in +3 eole dia"nosed with # co%%it suicide Will screening prevent more deaths than it

causes?

Discuss this question with your neighbour

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End



A dile%%a

8ou are 'er! ill 9



&hich doctor do !ou want:

&illia% ;sler< .1)) S%art !oun" doctor



&hich doctor do !ou want:

&ise = e$erienced s%art !oun" doctor



&hat is e'idence-based%edicine: E'idence-based %edicine is the

inte"ration o( best researchevidence with clinical expertise

and patient values>Patient

Concerns

ClinicalE$ertise

Best researche'idence

EBM



&hat is EBM :

By best research evidence we %ean clinicall!rele'ant research< o(ten (ro% the basic sciences o(%edicine< but eseciall! (ro% atient centeredclinical research into the accurac! and recision o(

dia"nostic tests ?includin" the clinical e$a%ination@<the ower o( ro"nostic %arkers< and the ecac!and sa(et! o( theraeutic< rehabilitati'e< andre'enti'e re"i%ens*

New e'idence (ro% clinical research both in'alidatesre'iousl! acceted dia"nostic tests and treat%entsand relaces the% with new ones that are %oreower(ul< %ore accurate< %ore ecacious< and sa(er



&hat is EBM :

B! clinical expertise we %ean theabilit! to use our clinical skills and aste$erience to raidl! identi(! each

atients unique health state anddia"nosis< their indi'idual risks andbene2ts o( otential inter'entions< andtheir ersonal 'alues and e$ectations



&hat is EBM :

b! patient values we %ean the uniquere(erences< concerns and e$ectationseach atient brin"s to a clinical

encounter and which %ust be inte"ratedinto clinical decisions i( the! are to ser'ethe atient



Why the sudden interestin EBM?our dail! need (or 'alid in(or%ation about dia"nosis<

ro"nosis< thera! and re'ention ?u to 3 ti%es er in-atient and twice (or e'er! 4 out-atients@*

the inadequac! o( traditional sources (or this in(or%ation

because the! are out-o(-date ?te$tbooks@< (requentl! wron"?e$erts@< ineecti'e ?didactic continuin" %edicaleducation@ or too o'erwhel%in" in their 'olu%e and too'ariable in their 'alidit! (or ractical clinical use ?%edical

ournals@*

the disarit! between our dia"nostic skills and clinical ud"e%ent< which increase with e$erience< and our u-to-date knowled"e and clinical er(or%ance< which decline*

our inabilit! to aord %ore than a (ew seconds er atient(or 2ndin" and assi%ilatin" this e'idence< or to set aside

%ore than hal( an hour er week (or "eneral readin" andstud!



ule 4. F e'iew the &orld Giteratureortni"htl!H HJill as ew Patients as Possible - ;scar Gondon

5,000?

per day

1,500

per day95 per

day M e d i c a l A

r t i c l e s P e r 8 e a

r



The Need for EBM

In the !ears a(ter !ou "raduate< two thin"swill haenK

.* 8our %e%or! o( what !ou learned in

%edical school will lose its (reshness*+* New treat%ent %ethods will be (ound

that the! ne'er tau"ht !ou about inschool because the! didnt e$ist*



The Need for EBM

I( !ou are to re%ain a "ood doctor< orbeco%e a better one< !ou need to sta!on to o( new de'elo%ents as the!

occur* E'idence Based Medicine ro'ides !ou

with the tools !ou need to 2nd i%ortantnew %edical research quickl! and easil!<and to work out its i%lications (or !ourractice*



Is keein" u to date MissionI%ossible:

Bluegreenblog 2006



How do we actually practice EBM?

tep !Con'ertin" the need (or in(or%ation?about re'ention< dia"nosis< ro"nosis< thera!<causation< etc@ into an answerable question*

tep " 0rackin" down the best e'idence withwhich to answer that question*

tep # Criticall! araisin" that e'idence (or its'alidit! ?closeness to the truth@< i%act ?sie o(the eect@< and alicabilit! ?use(ulness in our

clinical ractice@* tep $ Inte"ratin" the critical araisal with our

clinical e$ertise and with our atients uniquebiolo"!< 'alues and circu%stances*

tep % E'aluatin" our eecti'eness and



EBM ractice requiresK

Asking Acquiring

Appraising Applying

Assessing



&s'

&c(uire

&ppraise

&pply

&ct ) &ssess

*atientdilemma

*rinciples of

evidence+basedpractice

Evidence alone does notdecide – combine with other

knowledge and values

Hierarchyof evidence

*rocess of EB*



0he 2'e As o( the E'idenceC!cle

&,- .linical /uestion 0evelopment 0he clinician %ust draw (ro% this

e'aluation and ASJ a clear< answerable

question to be ursued*




&./123E- earching for the Evidence 0he ne$t ste is to ecientl! ACOIE

the e'idence (ro% an aroriate

source* Potential sources includeori"inal research studies< s!ste%aticre'iews< e'idence-based ournalabstracts< te$tbooks and co%uterieddecision suort s!ste%s




&**3&2E- .ritical &ppraisal of theEvidence

&ith a otential source in hand< the

clinician %ust APPAISE the e'idence to(urther e$a%ine its worth and reliabilit!




&**45- &pplying Evidence to the*atient

inall!< the rocess %ust conclude b!

returnin" to the indi'idual atient< as theclinician has to decide whether it isaroriate to APPG8 the e'idence to thearticular atient and their unique'alues and circu%stances*




&E- .linical Evaluation 0he clinician %ust ASSESS the atient

and the roble% to deter%ine the

ertinent issues< which %a! include adierential dia"nosis< treat%entdecisions< or ro"nosis

h li i l



&hat are !our clinicalquestions: A 43 !ear old %an sa!s

his brother recentl! diedo( a rutured cerebral

aneur!s%*Qe is worried aboutwhether he %i"ht ha'eone and what the

chances are that itwould ruture*

-R PIC 0able



Risk Factors

Cause(s

!y"pto"s

!igns, #ests

$rognosis

#reat"ent %&&ect

$ast current &uture

0!es o( questionK stroke

Fre'uency

.ohort tudy urvey2nception .ohort tudy

0reat%ents

3andomised Trial

.T can

.ross ectional tudy



Bac'ground67oreground /uestions

&here !ou look (or in(or%ation isdeter%ined b! what kind o( question !ouare askin"* ;ne wa! o( classi(!in" !our

question is to ask whether !ou areseekin" back"round in(or%ation or(ore"round in(or%ation*



Bac'ground information

is sou"ht when a learner has "eneralclinical questions re"ardin" a toic suchas what is the disorder what causes it

how does it resent what are so%etreat%ent otions*

0hese questions can be answered b!usin" back"round resources such aste$tbooks ?both in rint and electronic@and narrati'e re'iews in ournals which"i'e a "eneral o'er'iew o( the toic*



7oreground information

answers seci2c questions a clinicianhas re"ardin" a seci2c atient*

ore"round resources can be di'ided

into ri%ar! sources such as ori"inalresearch articles ublished in ournalsand secondar! sources such ass!ste%atic re'iews o( the toic< ands!noses and re'iews o( indi'idualstudies*



The Bene8ts of EBM

0he total a%ount o( knowled"e out there is (ar"reater and o(ten %ore reliable than the clinicale$erience o( one h!sician or e'en a "rou o(e$erts*

8ou no lon"er need to read throu"h %asses o( ournals in order to take ad'anta"e o( it*

It is no lon"er !our ob to know e'er!thin"< e'en in!our chosen secialt!*

It IS !our ob to be able to 2nd the in(or%ation as andwhen !ou and !our atients need it*



The Bene8ts of EBM

A detailed and e$act knowled"e o( theoutco%es o( dierent inter'entions<deri'ed (ro% the research< can o(ten

sa'e li'es*



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