Evidence Based Medicine = An integration of… –The best research evidence –Clinical expertise –Patient values Sacket DL, et. al. Evidence-based medicine: how to Teach and Practice EBM. 2 nd ed. Edinburgh: Churchill Livingston, 2000
Evidence Based Medicine Sackett: Integrating individual expertise with the best available clinical evidence from systematic research. Domino: Basing the care of patients on clinical research whose outcomes are our main priority.
Clinical Trial An intervention is given to half of a study population, and half receive a placebo Outcomes are compared to look for a difference Produces an Absolute Risk for Intervention and Placebo
Cohort Study Prospective analysis of a population believed to be free of a disease, but who vary in exposure This population is followed over time to determine the Incidence in the Exposed group and the Incidence in the Unexposed group Produces a Relative Risk –Incidence of the disease state in the Exposed population divided by the Incidence in the Unexposed population.
Case Control Study Patients are identified, matched to Controls (people with similar demographics but without the disorder), in hopes of finding exposures that may have increased the risk of developing the disease.
Review Articles Summaries of the literature on a certain topic Problems –Many do not include all of the relevant evidence –They may mix the opinions and biases of the authors with the evidence.
Systematic Review A study of studies. Explicit criteria for selecting which studies to review is included (results in less bias) Has a structured format for consistent presentation of information
Abstract Background Objectives Criteria for considering studies for this review Types of participants Types of intervention Types of outcome measures Types of studies Search strategy for identification of studies Methods of the review Description of the studies Methodological qualities of included studies Results Discussion Conclusions Implications for practice Implications for research Internal sources of support to the review External sources of support to the review Potential conflict of interest Acknowledgements Contribution of Reviewer(s) Synopsis Characteristics of included studies Table 01 results References to studies included in this review Additional references Typical Systematic Review “Skeleton”
Meta-Analysis A subclass of systematic reviews Meta-Analyses combine and statistically summarize the results of individual studies
Evidence Pyramid MOST evidence LEAST evidence From SUNY Downstate Medical Research Library http://servers.medlib.hscbklyn.edu/ebm/2100.htm Only a small amount of the medical literature contains best evidence!
Questions? Bring them to your 3 rd year Family Medicine Clerkship EBM session in the Lamar Soutter Library OR Contact: Len Levin 508-856-6028 firstname.lastname@example.org email@example.com Jim Comes 508-856-6810 firstname.lastname@example.org email@example.com