Search and Review Literature MK KIE Antonius NW Pratama Bagian Farmasi Klinik dan Komunitas, Fakultas Farmasi Universitas Jember

Reference Glasziou, P., Del Mar, C., 2003, Evidence-based Medicine Workbook Finding and applying the best evidence to improve patient care, London: BMJ Publishing Group Some BMJ articles

A common daily life situation A friend or relative asks about particular drugs. – Which one from this, this, and this is better? – What drug should I take? I don’t want to go to a doctor? It’s expensive. Our health professional colleagues A patient, someone we don’t know WHAT SHOULD WE DO?

Recall Evidence-Based Medicine? Types of epidemiology study? Types of literature? Level of evidence?

How can we do EBM? Five steps: 1.Formulate an answerable question 2.Track down the best evidence of outcomes available 3.Critically appraise the evidence (ie find out how good it is) 4.Apply the evidence (integrate the results with clinical expertise and patient values) 5.Evaluate the effectiveness and efficiency of the process (to improve next time)

EBM step 1: Formulate an answerable question First principle First, you must admit that you don’t know. Impossible to know everything EBM provides a way to find answers to questions without having any prior knowledge of what you ought to know.

Steps in EBM 1. Formulate an answerable question

A 28-year-old male presents with recurrent furunculosis for past 8 months; these episodes have been treated with drainage and several courses of antibiotics but keep recurring. He asks if recurrences can be prevented.

Steps in EBM 1. Formulate an answerable question George has come in to your surgery to discuss the possibility of getting a vasectomy. He says he has heard something about vasectomy causing an increase in testicular cancer later in life. You know that the risk of this is low but want to give him a more precise answer.

Steps in EBM 1. Formulate an answerable question Jeff, a smoker of more than 30 years, has come to see you about something unrelated. You ask him if he is interested in stopping smoking. He tells you he has tried to quit smoking unsuccessfully in the past. A friend of his, however, successfully quit with accupuncture. Should he try it? Other interventions you know about are nicotine replacement therapy and antidepressants. Population/patient? Intervention/indicator ? Comparator/control ? Outcome ?

Steps in EBM 1. Formulate an answerable question Susan is expecting her first baby in two months. She has been reading about the potential benefits and harms of giving newborn babies vitamin K injections. She is alarmed by reports that vitamin K injections in newborn babies may cause childhood leukaemia. She asks you if this is true and, if so, what the risk for her baby will be. Population/patient? Intervention/indicator ? Comparator/control ? Outcome ?

Steps in EBM 2. Track down the best evidence of outcomes available

[smoking patient] AND [acupuncture OR nicotine replacement therapy] AND [success]

Steps in EBM 2. Track down the best evidence of outcomes available

Acupuncture and related therapies do not appear to help smokers who are trying to quit.

Steps in EBM 3. Critically appraise the evidence (ie find out how good it is) Were the groups of subjects representative and comparable? Was the outcome measurement accurate? Was a placebo used? Could the results have been due to chance? Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of Pharmaceutical Education, 71 (4) Article 63 Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of Pharmaceutical Education, 71 (4) Article 63

Internet Sources of EBM lt.htm lt.htm

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