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Information about EBM1

Published on January 12, 2009

Author: aSGuest10189

Source: authorstream.com

Introduction to Evidence Based Medicine : Introduction to Evidence Based Medicine Evidence Based Medicine – What Is It? : Evidence Based Medicine – What Is It? Sackett defines Evidence Based Medicine as: The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients BMJ 1996; 312: 71-72 The Practice of EBM : The Practice of EBM The practice of EBM is the integration of Individual clinical expertise clinical judgment and proficiency gained through experience in clinical practice reflected through improved expertise and efficiency in diagnosis BMJ 1996; 312: 71-72 Slide 4: WITH THE Best available external clinical evidence from systematic research research from basic sciences and patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens it is important but not sufficient to understand pathophysiologic basis of disease BMJ 1996; 312: 71-72 Slide 5: AND Patient’s values and expectations identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care skill involved in application of results of clinical trials to individual patients BMJ 1996; 312: 71-72 Why EBM Should Matter to Clinicians : Why EBM Should Matter to Clinicians Clinical knowledge deteriorates with time Physician’s year of graduation from medical school associated with initiation of appropriate antihypertensive therapy JAMA 1991;266:1103-7 Antibiotic prescribing literature also documents greater inappropriate antibiotic use by older physicians Arch Pediatr Adolesc Med 1998; 152:349-352 Journals watched by Journal Watch Pediatrics : Journals watched by Journal Watch Pediatrics American Journal of Clinical Nutrition American Journal of Human Genetics American Journal of Medicine American Journal of Obstetrics and Gynecology American Journal of Perinatology American Journal of Sports Medicine Archives of Diseases in Childhood Archives of Pediatric and Adolescent Medicine BMJ Clinical Genetics Clinical Infectious Diseases Developmental Medicine and Child Neurology European Journal of Pediatrics European Journal of Human Genetics Journal of Adolescent Health JAMA Journal of the Ambulatory Pediatric Association Journal of the American Academy of Child and Adolescent Psychiatry Journal of Developmental and Behavioral Pediatrics Journal of Infectious Diseases Journal of Pediatric and Adolescent Gynecology Pediatric Infectious Disease Journal Journal of Pediatric Surgery Journal of Pediatrics Lancet MMWR Nature Genetics New England Journal of Medicine Pediatrics Minimum reading to keep up-to-date with pediatrics : Minimum reading to keep up-to-date with pediatrics Pediatrics – 40 articles x 12 months New England Journal of Medicine – 5 articles x 52 weeks Lancet - 6 articles x 52 weeks Journal of Pediatrics – 18 articles x 12 months Pediatric Infectious Disease Journal - 15 articles x 12 months JAMA 8 articles x 12 months BMJ 10 articles x 52 months Archives of Pediatric and Adolescent Medicine – 10 articles x 12 months 1694 article per year= 5 articles per day Why EBM Should Matter to Clinicians : Why EBM Should Matter to Clinicians Certification/recertification will requires physicians to be evaluated on 6 general competencies: Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice PRACTICE-BASED LEARNING AND IMPROVEMENT : PRACTICE-BASED LEARNING AND IMPROVEMENT Residents are expected to: analyze practice experience and perform practice-based improvement activities using a systematic methodology locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems obtain and use information about their own population of patients and the larger population from which their patients are drawn apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness use information technology to manage information, access on-line medical information; and support their own education facilitate the learning of students and other health care professionals How Can EBM Help Us to Keep Up-to-date? : How Can EBM Help Us to Keep Up-to-date? By teaching strategies and skills to track down and appraise new evidence By developing secondary sources of evidence that have been reviewed and appraised such as journals (ACP Journal Club, EBM, Bandolier), or summarized as in databases of systematic reviews (Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-Based On-Call) By taking advantage of information systems that allow rapid access to this information (even during a brief patient encounter) By applying evidence based strategies for changing our clinical behaviour Secondary Journals and Databases : Secondary Journals and Databases Evidence Based Pediatrics (book with updates) ACP Journal Club/Evidence Based Medicine Online (Best Evidence and Ovid EBM reviews) Bandolier Clinical Evidence Evidence-Based On-Call Cochrane Database of Systematic Reviews Cochrane Controlled Clinical Trials Register Best Bets Archives of Disease of Childhood – Archimedes section Archives of Pediatric and Adolescent Medicine – evidence based journal club Journal of Pediatrics – Abstracts from the Literature Common Misperceptions About EBM : Common Misperceptions About EBM EBM denigrates clinical expertise EBM ignores patients’ values and preferences EBM promotes a cookbook approach to medicine EBM is simply a cost-cutting tool EBM is an ivory tower concept EBM is limited to clinical research EBM leads to therapeutic nihilism in the absence of evidence from randomized trials Steps in Practicing EBM : Steps in Practicing EBM Convert information needs into answerable questions Track down best evidence with which to answer questions Critically appraise evidence for validity and importance Integrate appraisal with clinical expertise and patient values to apply results in clinical practice Evaluate performance Physicians’ use of EBM : Physicians’ use of EBM Overall low level of awareness of publications and databases relevant to EBM Fewer than half ever perform literature searches and read primary or secondary sources of evidence from searches Clinical practice guidelines from trusted source considered to be most accessible Favoured sources of information remain clinical experience, opinions of trusted colleagues and specialists Understanding of EBM : Understanding of EBM Many physicians feel they understand conceptually what EBM is Self-rating and responses to specific questions about EBM indicate a relatively low level of knowledge of EBM terms and confidence in performing many aspects of EBM Mixed responses about clinician’s need to understand terms and perform critical appraisal themselves to practice EBM Perceived Limitations to the Practice of EBM : Perceived Limitations to the Practice of EBM Time – need relevant information accessible at the point of care Lack of evidence relative to particular area of practice (primary care) Patient demands for unproven tests and therapies Lack of skills Gray zones of clinical evidence EBM and Pediatrics : EBM and Pediatrics In pediatrics few rigorously designed studies of drugs in children: Previously no financial incentives Many available studies suffer from fatal design flaws (think otitis media studies and other antibiotic studies), especially those funded by pharmaceutical companies Lack of organization of multi-center trial groups

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