This document discusses evidence-based medicine (EBM) and addresses some common misconceptions. It outlines the benefits of EBM, including that it is a rigorous, problem-solving approach that leads to better patient outcomes when the best available evidence is incorporated into clinical decision making. Some myths are addressed, such as the idea that experience is better evidence than clinical trials, or that EBM is too time consuming. The document emphasizes that EBM helps improve quality of care when combined with clinical expertise and patient preferences.

1. Prof. Aboubakr Elnashar
Benha university, Egypt
Email: elnashar53@hotmail.com

2.  Benefits of EBM
 Misconceptions
 Myths
 Conclusion

3. Yes

4. EBM:
Way of critical thinking
Appropriate tool for sound clinical decisions
Problem solving approach
Life-long self-directed learning

6. Use:
more effective intervention
proven therapies and diagnostic tests
only
Result in:
Better management of patients
Better patient outcomes.
Less harm or side-effects
Better communication with patients about the
rationale behind the management decisions.

7. More efficient use of resources
Improve resource utilization
Reduced cost per patient.

8. Using the best available evidence :
Appropriate funding decisions.
More effective and efficient care

9. Upgrade knowledge routinely.
Up-to-date, Keeping up knowledge
explosion &med literature based on valid
evidence.
Improve clinicians’ understanding of research
methods & make them more critical in using
data.
Improves confidence in management
decisions. Relieve anxiety about uncertainty
Improves reading habits.

10. Gives team a framework for group
problem solving & for teaching
Enables juniors to contribute fully to
the team.
VI. The graduates:
EBM curricula
Self-directed
Problem-based

11. •There is a significant gap between
EBM & application of this to clinical
practices

12. Clinical
Practice
Research
Haynes calls this the “evidence transfer gap”. EBM seeks to close the gap
between completed research activity and the practice of medicine.
The “Evidence Transfer Gap”
EBM

13. •A mistaken thought, idea, or notion; a misunderstanding.
•Can happen anywhere, in any situation: not understanding a
topic; not knowing the full story; hearing the wrong story… there’s
many reasons how one can misunderstand something.

14. The clinically-important knowledge of
physicians deteriorates rapidly after we
complete our training.

15. 2. Expert opinion is the best evidence.
•Experience: “I always did it this way”
 Clinical experience is crucial.
 Clinical guideline should be based on
critical appraisal of medical literature

16. Traditional CME is completely ineffective in
changing our behavior.
A great deal of research reported in journals
is poorly done, poorly analyzed: not valid &
irrelevant to our patients and practices.
Only 20% of health care is EB (Kerr White, 2002)

17. Setting Type I Type II No Evid.
Cancer center (USA) 24% 21% 55%
Tertiary surgical center (USA) 14% 64% 22%
Primary care centers (Spain) 38% 4% 58%
General medicine hospital (UK) 53% 29% 18%
General psychiatric ward (UK) 65% 35%
Anesthesia (Australia) 32% 65% 3%

18. Decision based on pathophysiologic
principles may be incorrect

19. Certain rules of evidence are
necessary.
Systematic unbiased observation
increases the confidence of the
physician knowledge.

20. CAT = Critical appraisal of topic is
necessary
Critical appraisal: assessment of evidence
by systematically reviewing its relevance,
validity, results and applicability (RVRA)

21. 1. Relevance:
Common to our practice &
patient-oriented outcome (POEM) not DOE
2. Validity: Free from bias (Truth)
 Randomization.
 Follow up complete.
 Intention to treat.
 Blindness.
 Similar groups at start.
 Both groups treated equally.
3. Results:
Clinically important (magnitude and precession)
4. Applicability:
Applicable at my setting &
useful for my patients

22. •Derived from the Greek word mythos, which means "word of mouth."
•Something that is widely thought to be false
•Holy story

23. EBM focus on:
patient preference
clinical judgment of the
practitioner
best available evidence to
produce the best patient
outcomes
EBM takes into account the
circumstances of the patient

24. Three (Es) - EBM Components

25. EBP is a patient-centered approach &
is highly individualized
Begin & end with the patient in mind
Any practice that fails to take into
account of the individual patient is not
EBP
Clinical evidence can never replace
individual clinical expertise because this
expertise decides whether the external
evidence applies to the patient (Sackett,
1998)

26. The traditional medical paradigm is based on
authority.
EBM is dependent on the use of RCT, systematic
reviews & meta-analysis, although it is not restricted
to these.
 RCT is
 the epitome of all research designs because its
design provides the strongest validity
 It provides the best assurance that the result was
due to the intervention

27. RCT:
a group of patients is randomised into
study group & control group. These
groups are followed up for the
variables/outcomes of interest.
If the sample size is large enough, this
study design avoids problems of bias
and confounding variables

28. Randomized Controlled study

29.  SR
A review of a clearly formulated question that
uses systematic & explicit methods to
1. identify, select and critically appraise relevant
research
2. collect & analyse data from the studies that are
included in the review
 Meta-Analysis
The use of statistical techniques in a SR to
integrate the results of included studies.

31. Why SR on the top:
Rigorous methodology
Peer reviewed
Relatively large sample size
Ensures the highest quality evidence

32. There are now many advocates of a more
inclusive approach to evidence:
Qualitative research is as valid a form of
evidence as quantitative research
There are now methodologies to systematic
review both numerical and textual findings of
research
 EBP insists that each client is treated with
the best available evidence, that practitioners
make a genuine effort to find the best solution
given their resources.

33. It is not disputed that practice should be
grounded in theory, however it should be
predicated on the best available evidence
This is addressed by systematic reviews

34. Disease-Oriented
Evidence
DOE (intermediate
outcomes)
▪ Pathophysiology,
pharmacology,
etiology, test result
▪ using drug x
decreases the
level of serum
Lipid
Patient-Oriented
Evidence that Matters
to the Patient
POEM (final outcomes)
 Mortality
Morbidity
quality of life
 using drug x
decreases morbidity
& mortality

35. This indicates a fundamental
misunderstanding of the financial
consequences
Physicians identify & implement the
most efficacious treatments to maximize
the outcomes for patients, this may
increase costs
EBP does not reduce the need for
treatments, it attempts to ensure that
each patient gets the best treatment
appropriate for his/her condition.

36. EBP incorporates the more
extensive processes of
SECONDARY & TERTIARY
RESEARCH
searching,
appraisal,
synthesis and
incorporation of the best available
evidence into practice

38. Refuted by audits from
within clinical care where at
least some inpatient clinical
teams have provided EB
care to patients
Busy clinicians who can
devote their scarce time can
practice EBM

39. EBP critically examines all
clinical procedures, critically
evaluating their appropriateness
for the specific situation.
Text books: Fail to recommend
Rx up to 10 ys after it’s been
shown to be efficacious.
Continue to recommend therapy
up to 10 ys after it’s been shown to
be useless.

40. The use of evidence is only one piece of
the clinical decision-making process.
Patient situations, preferences & values
are a key component in the process.

41. It is impossible for any practitioner
to keep up with the entire health care
literature {2 million articles published
annually, 6000 articles published
daily].
To keep up to date, physician should
read 19 articles/d.
 Lag time from time of “knowing” to
time of implementation:
13 ys for thrombolytic therapy.
10 ys for corticosteroids to enhance
fetal lung maturity.

42. Do not need skills in biomathematics or
statistics
Physicians can gain skills to make
independence decisions & can evaluate
expert opinions.
EBP does not mean continous running to
the library, but that clinicians should
remember to search for evidence to support or
refute their practice methods.
EBM reduces reading by quality filters

44. Search Cascade

45. EBM approach depends on high-quality
literature, which is lacking in many areas of
medicine
There are more RCT each year
There are many other types of evidence to
make good decisions.

46.  Many myths & misconceptions exist in
health care practice
 Myths & misconceptions must be overcome
to implement EBM
 EBM:

48. Life is short &
the evidence is too
hard to find???
Thank you
Questions?