1. Evidence Based Medicine
Dr. Mansour AlZahrani
SB-FM,ABFM,MRCGP[INT]
Consultant and Associate professor of Family Medicine

2. Objectives Discuss the importance of evidence-based practice
  Define ‘evidence-based practice’
  Discuss the importance of evidence-based practice
   Engage in evidence-based practice (including literature search)

3. Definition
Evidence-based medicine requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.
Patient
Values
Clinical
Expertise
Best
research
evidence
EBM
Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-based medicine: how to practice and teach EBM 3d ed. London: Churchill Livingstone, 2005

4. Why is EBM important? Physician is taking a decision all the time.
Physicians asked 2 questions for every 3 patients.
Only 30% of physicians' information needs were met during the patient visit, usually by a colleague.
EBM can confirm your plan but it can change it totally.
Is EBM a "cook book medicine“ ?!!

5. Steps in Evidence Based Research
Asking answerable questions
Finding the best evidence
Critically appraising the evidence
Applying a decision
Evaluation
Heneghan C, Badenoch D. Evidence-based medicine toolkit. 2d ed. Malden, MA: Blackwell, 2007 5

6. The Answerable Question

7. Background questions It is all about conditions
address normal human physiology and the pathophysiology associated with a medical condition.
answered by standard textbooks
Consist of two parts:
The root question (W5H) + verb, eg. what causes ...? [W5H = who, what, when, where, why, how]
Problem, eg. influenza

8. Examples What is type 2 diabetes mellitus?
Why does this patient have polyuria?
Why does this patient have numbness and pain in his/her legs?
What treatment options are available?

9. Clinical questions
Asking answerable questions – focused, searchable, clinical
PICO
Patient, Problem, Population (subjects)
Intervention or therapy
Comparison, Control
Outcome (results) 9

10. Can You Identify PICO?
In children under 6 months, how does sleeping on back compared to sleeping on the stomach in terms of risk of SIDS?
In children under 6 months (P), how does sleeping on back (I) compared to sleeping on the stomach (C) in terms of risk of SIDS (O)?

11. Formulate PICO question
Does hand washing among healthcare workers reduce hospital acquired infections?

12. Step 2
Finding the best evidence with which to answer the question through structured searches and understanding the literature 12

13. Um Ahmed is a new patient in your clinic
Um Ahmed is a new patient in your clinic. She is 70 year old and has a history of congestive heart failure brought on by several myocardial infarctions.

14. She has been hospitalized twice within the last 6 months for worsening of heart failure. Her medications (enalapril, aspirin and simvastatin).
You think she should also be taking digoxin but you are not certain if this will help keep her out of the hospitalization. You decide to research this question before her next visit.

15. Step 1 PICO designed question.
In elderly patients with congestive heart failure, is digoxin effective in reducing the need for hospitalization?

17. Types of studies

18. Medline Over 5,000 journals indexed, with worldwide coverage
The world’s largest biomedical database
Over 5,000 journals indexed, with worldwide coverage
Covers all aspects of biosciences and healthcare
Database of 19+ million journal citations, 1950 to the present
90% are in English ; 79% have abstracts
The primary component of PubMed

19. So What Is PubMed? PubMed is a tool to search: Produced by NCBI
MEDLINE (1950 to present)
Produced by NCBI
National Center for Biotechnology Information, part of NLM
Accessible worldwide on the Web at no charge

20. Accessing PubMed Directly at: http://pubmed.gov
Or, National Library of Medicine’s homepage:

21. Move to pubmed

22. Assignment

23. Assignment Clinical scenario:
5 yo with asthma now in severe acute asthma exacerbation. Intern gave 2x ventolin and pulmicort with good improvement. Intern asks how good is pulmicort for prevent hospitalization?

24. Question formulate a PICO question
Do a literature review using Pubmed website
Assignment should be submitted next Thursday 26/4/2018 to the module coordinator

25. Thank you