Evidence-Based Medicine - Overview - How to be a good doctor - A step in Health promotion - By Ibrahim A. Abdelhaleem - Zagazig Medical Research Society (ZMRS)

1. Evidence Based Medicine
‫العلمى‬ ‫الدليل‬ ‫على‬ ‫القائم‬ ‫الطب‬
BY
Ibrahim Abdelmonaem
ZMRS TEAM

2. Goal of EBM
 Improve the health of people through decisions that will
maximize their health-related quality of life and life span.

3. What
How
Why
When

4. What is EBM ?
current best research evidence
Clinical expertise
patients values, preferences and
circumstances
Evidence
Medicine

5. means most updated and
relevant clinical research
best
research
evidence
means the clinical skills and
past experience to identify each
patient's unique health state
and diagnosis
clinical
expertise
mean the specific preferences,
concerns, personal values, and
expectations of each patient
patient
values

7. When to apply EBM ?
 Find Etiology.
 Diagnose condition.
 Prescribe treatment.
 Predict prognosis.

8. Why we need EBM ?
 In the past, physicians relied on their own experience or that of
other health care workers to take decisions regarding patient's
treatment.
 The inadequacy of traditional sources for this information
because they might be out-of-date (textbooks), potentially
wrong (colleagues), or too overwhelming in their volume -
(medical journals).

9. How to apply EBM ?
 Practicing EBM is primarily based on five well defined steps (5 A's) …
Ask
answerable
question
Acquire
the
evidence(s
)
Appraise
the
evidence(s)
Apply the
best
evidence
Assess your
performanc
e

10. Ask
answerable
question

11. Asking Focused Questions
 Identifying the relevant question is the initial step in practicing EBM
 The question divided into four components, which are called (PICO)
• Indicates for Patients or Population
p
• Indicates for Intervention
I
• Indicates for Comparison
c
• Indicates for Outcome
o

12. Mohamed, 31 years old, was diagnosed with heart failure 3 years old and prescribed a beta-blocker
which dramatically improved his symptoms. Mohamed’s 5-year-old daughter, Sarah, has been
recently diagnosed with chronic symptomatic congestive heart failure. Mohamed asks you, Sarah’s
pediatrician, whether his daughter should also be prescribed a beta-blocker.
Example
• Children with congestive heart failure
Patient
• Carvedilol (beta-blocker)
Intervention
• Other drug group
Comparison
• Improvement of congestive heart failure symptoms
Outcome

13. Can Carvedilol (beta-blocker) improve symptoms in children with heart failure
in comparison to other drug group ???
Questio

14. Acquire the
evidence(s)

15. Acquiring the Evidence
 Systematic retrieval of the best evidence available.
 The particular source used to identify evidence of clinical effectiveness
will depend on the clinical question.
 Sources of information:
 All databases are searched for every clinical question.
 The PICO framework can be used to construct the terms for your
search strategy.
Answerable Question
Search Strategy
Data Base

16. Appraise the
evidence(s)

17. Appraisal of evidence:
 Appraisal of the search results !!!
 Appraisal of evidence depends on the following 4 pillars -RVRA:
I. Relevance: It focuses on the relevance of the literature to the question asked.
II. Validity: Are the results of the study valid?
III. Results: What are the overall results? How precise are they?
IV. Applicability: Are the results Applicable in and useful for my patients?

18. Critical appraisal of the study !!!
 Determine both the internal validity and external validity of the study:
I. External validity: The extent to which the study findings are generalizable beyond the
limits of the study to the study’s target population.
II. Internal validity: Ensuring that the study was run carefully (research design, how
variables were measured, etc.) and the extent to which the observed effect(s) were
produced solely by the intervention being assessed (and not by another factor).

19. Hierarchy of evidence
 Different study designs provide varying levels of evidence.
 The rank of a study in the hierarchy of evidence is based on its potential for bias, i.e. a
systematic review provides the strongest evidence for a causal relationship between an
intervention and outcome.

21. Apply the
best
evidence

22. Application of the best evidence in
practice:
After critical appraisal of the evidence, extraction the most
useful results and determination whether they are important,
you must decide whether this evidence can be applied to your
individual patient or population.

23. Assess your
performanc
e

24. Assessing and evaluating the
performance:
 Evaluating the effectiveness and efficiency in executing Steps 1 - 4 and
seeking ways to improve them both for next time.

25. Limitations of EBM
 EBM is regarded as the best standard of conventional clinical practice
Although….
 there are a number of limitations for its use:
I. Lack of good evidence for many clinical questions
II. Results may not be relevant for all treatment situations
III. Lag in time between when the research studies is conducted, when its results are published when these
are properly applied

26. Finally …
The health care practitioner has to be equipped with both clinical and research
knowledge. More specifically, research knowledge includes understanding of research
process, ethical consideration, study design, statistical analyses, and results
interpretation.

27. Thank you