1. Dr. Nisreen A. Jastaniah
Assist Prof KSAU-HS
Consultant Geriatric Medicine KAMC-J

2. Problem solving methods
other …
• Hani ( 47 years) software programmer
Thinking about early retirement …. (retirement and
health) Discussion

3. Problem solving methods
Scientific…( searching for evidence)
• HANI ( 47 years) software programmer
Thinking about early retirement ….
Discussion , retirement and health

4. Problem solving methods
Scientific…( searching for evidence)

5. Problem solving methods
Scientific…( searching for evidence)

6. Problem solving methods
Scientific…( searching for evidence)

7. Problem solving methods
Scientific…

9. Needs
• We need evidence (about the accuracy of diagnostic
tests, the power of prognostic markers, the
comparative efficacy and safety of interventions,
etc.)
• about 5 times for every in-patient (and twice for
every 3 out-patients).
• We get less than a third of it
9

10. Why Evidence Based Health Care?
• Too many patients
• Too many problems
• Too many journals
• Information overload
• No time to read
• Read what I am familiar with
• Avoid difficult issues
10

11. EBM; IS IT NEW?
‫الميالدي‬ ‫التاسع‬ ‫االقرن‬ ‫في‬ ‫إليه‬ ‫دعا‬ ‫من‬ ‫أول‬ ‫الرازي‬(865
–915)‫قال‬ ‫حين‬
“‫وأيدته‬ ‫القياس‬ ‫عليه‬ ‫وشهد‬ ‫األطباء‬ ‫عليه‬ ‫أجمع‬ ‫ما‬ ‫إنه‬
‫التجربة‬“
11

12. April 2006 12
..‫المقدمات‬ ‫انتقاد‬ ‫مع‬,‫في‬ ‫والتحفظ‬
‫النتائج‬,‫ما‬ ‫جميع‬ ‫في‬ ‫نتحرى‬ ‫و‬
‫ال‬ ‫الحق‬ ‫طلب‬ ‫ننتقده‬ ‫و‬ ‫نميزه‬
‫اآلراء‬ ‫مع‬ ‫الميل‬......

13. Requirements of new
treatment
• The drug must have a defined mode of action
• It must be tested on a well defined disease
• The time of action must be observed
• The effect of the drug must be seen to occur
constantly in many cases
• The experimentation must be done with the
human body for testing a drug on a lion or a
horse might not prove anything about its effect
on man
Ibn Sina 981-1037
13

14. When did EBM begin ?
• Dr. Archie Cochrane
(British epidemiologist and a leading EBM
theoretician, estimated a decade ago
that only 15-20% of all medical practice is
based on scientific, statistically sound
research.
14

15. Evidence-based
medicine
Evidence-based medicine (EBM) is the
integration of best research evidence with
clinical expertise and patient values.
16

16. Steps of evidence based
medicine
1)Ask a question
2)Acquire some articles
3)Appraise the evidence
4)Apply the findings
5)Assess our performance
17

17. Steps of evidence based medicine
Step 1: formulating an answerable question
 Patient or Problem
 Intervention
 Comparison Intervention
 Outcome.
18

18. Steps of evidence based medicine
Step 2: Tracking down the best available evidence
Tracking down the best evidence with which to
answer that question.( diagnosis, therapy
,prognosis…)
19

19. Steps of evidence based medicine
Step 2: Tracking down the best available evidence
study design
 Primary studies (therapy ,diagnosis ,harm &prognosis
).
 Integrative studies (overview ,practice guidelines..).
20
.

20. Steps of evidence based medicine
Step3: Critically appraising that evidence
 validity (closeness to the truth),
 impact (size of the effect) the results, and
 applicability.
21

21. Steps of evidence based medicine
Step4: Integrating of the best available
evidence to our patients
 our patient's unique biology, values and
circumstances.
22

22. Steps of evidence based medicine
Step 4: Integrating of the best available
evidence to our patients
The evidence
Clinical experiencePatient values
23

23. Steps of evidence based medicine
Step5: Evaluating our effectiveness
in executing Steps 1-4 and seeking ways to improve
them both for next time.
24

24. Steps of evidence based medicine
• Do We need always carry out all 5 steps to provide E-
B Care ?
Searching & appraising”
o provides E B care, but is expensive in time and
resources
“Searching only”
o much, quicker, and if carried out among E B
resources, can provide E B care.
25

25. POEMs & DOEs
POEM
Patient
Oriented
Evidence that
Matters
26
DOE
Disease
Oriented
Evidence
HRQL (Health Related Quality of life) for
example, mobility, self-care, and physical,
emotional, and social function).

26. Relevance: Type of Evidence
• DOE: Disease-oriented evidence
o pathophysiology, pharmacology, etiology
• POE: Patient-oriented evidence
o mortality, morbidity, quality of life, satisfaction
27

27. Study design & Evidence based
clinical practice
Different questions study design
• Prevalence or frequency of factor Cross sectional study
•Hypotheses about possible Harm (or causes) Case-control
• Harm or Causes or risk factors Cohort
• Experience of illness Qualitative
• Effectiveness Randomized controlled trial

28. Original Study
LongitudinalDescriptive
Cross sectional
Case report
Case series
interventionalobservational
Case-control
cohort
Integrative Studies
SR
Evidence
Study design & Evidence based
clinical practice

29. Study design & Evidence based
clinical practice

30. 31
1)Ask a question
2)Acquire some articles
3)Appraise the evidence
OR
use appraised evidence
4)Apply the findings
5)Assess our performance
?
Steps of evidence based medicine

31. Types of health care
professional
32
Evidence
Finders
Evidence Users
Evidence
generator
Evidence Ignorer

32. Questions?

33. 34
1)Ask a question
2)Acquire some articles
3)Appraise the evidence
OR
use appraised evidence
4)Apply the findings
5)Assess our performance
?
Steps of evidence based medicine

35. THANK YOU
36