1. AN Introduction to EBM

2. The Need for Evidence-Based Medicine

6. Evidence: سند، مدرک، گواه Evidence Based Medicine: پزشکی مبتنی بر شواهد

7. در بسیاری اوقات خرد انسان در دریای دانش گم میشود و مواقع بسیاری دانش انسان در دریایی از اطلاعات فراموش می گردد. “The Rock” T.S. Elliot

8. The Life is Short and The Evidence is Too Hard to Find

9. هدف : چرا طبابت مبتني بر شواهد ؟؟؟ اگر فراموش کنیم که چه باید گفته می شد، بسیار آسان فریب آنچه را که گفته می شود خواهیم خورد.

10. Limitations of Current Clinical Practice There is good evidence that the quality of care we give our patients could be better

11. clinical examples, in which lack of good evidence has led to harm for our patients common patterns of thinking that introduce bias ("heuristics") the wide variation in current clinical practice among physicians the difficulty of managing medical information, when results conflict and thousands of articles are published every month our knowledge declines over time, as we get further from medical school, and unfortunately traditional CME doesn't work

13. Annual death rates in USA AIDS: 16,516 Breast cancer: 42,297 Highway accidents: 43,458 Between 44,000 and 98,000 deaths due to medical errors

15. From these calculations, Doctors are approximately 9,000 times more dangerous than gun owners. Number of physicians in the US ----- 700,000 Accidental deaths caused by physicians per year --- 120,000 Average accidental death per physician per year -----0.171 Number of gun owners in the US ---- 80,000,000 Number of accidental gun death per year --- -- 1,500 Average deaths per gun owner per year -- ----- 0.0000188

16. Variation in current practice As new tests and therapies are developed, how do physicians decide which to adopt?

17. Managing medical information

18. Why Is It So Hard to Be Up-to-date? Annually – 3 million articles – 30,000 journals – Creates a stack 750 meters tall After removing the ads Mulrow CD. BMJ 1994;309:599

19. Why Is It So Hard to Be Up-to-date? Doubling time of biomedical science is about 20 months in 2001

20. Web Growth Approximately 1.5 million web pages are being added daily, and overall doubling time of web documents is about 8 months