EVIDENCE-BASED MEDICINE

• THE INTEGRATION OF BEST RESEARCH EVIDENCE

WITH CLINICAL EXPERTISE AND PATIENT VALUES
• GOAL: OPTIMIZES CLINICAL OUTCOMES AND
QUALITY OF LIFE
 Clinical expertise
• Ability to use clinical skills and past
experience to rapidly identify each
patient’s unique health state and
diagnosis
• To identify their individual risks and
benefits of potential interventions
• To identify their personal values and
expectations
 How do we practice ebm

• Converting the need for information

into an answerable question
• Tracking down the best evidence
• Critically appraising that evidence for
its validity and applicability
WELL-BUILT CLINICAL QUESTIONS

• BACKGROUND QUESTIONS
* Ask for general knowledge about a disorder
**Have two essential components:
1. a question root with a verb
(who,what,where,when,how,why)
2. a disorder or an aspect of a disorder

• When do complications of acute pancreatitis usually occur?

 Central issues in clinical work
where clinical questions often
arise
• Clinical findings
• Etiology
• Clinical manifestations of disease
• Differential diagnosis
• Diagnostic tests
• Prognosis
• Therapy
• Prevention
• Experience and meaning
• Self improvement
 CLINICAL QUESTION
• IN INFANTS WITH PROJECTILE VOMITING
IN WHOM THERE IS NO PALPABLE
TUMOUR, DOES ULTRASOUND AID IN
DIAGNOSIS (RULE IN OR OUT) OF
PYLORIC STENOSIS ?
 READ AN ARTICLE AND DECIDE

• ARE THE RESULTS OF THIS DIANOSTIC

ARTICLE VALID ?
• ARE THE VALID RESULTS OF THIS STUDY
IMPORTANT ?
• CAN YOU APPLY THIS VALID IMORTANT
EVIDENCE ABOUT A DIAGNOSTIC TEST IN
CARING FOR YOUR PATIENTS ?
•A 27 WEEK GESTATION INFANT,BW 900 GRAMS
•CRANIAL ULTRASOUND: BLOOD IN BOTH
VENTRICLES ()
•1 MONTH LATER: HEMORHAGE NEG. BUT THE LEFT
LATERAL
VENTRICEL IS DILATED BEYOND THE 97TH CENTILE
FOR
POSTCONCEPTUAL AGE
*THE INFANT REMAINS WELL/NO ABNORMAL
NEUROLOGICAL
SYMPTOMS AND SIGNS
*PARENTS ASK: WHETHER THEIR CHILD WILL HAVE
ANY
LONG TERM DISABILITY
FORMULATE THE QUESTION:

“In a premature infant with very low

birth weight
who is expected to survive, and who
has post-
hemorarhagic Ventriculography, what
is the risk
of future neurological disability?”
PUBMED SEARCH :
Choose the right word

** INFANT, NEWBORN (MeSH)

** VENTRICULOGRAPHY (TEXT WORD)
** DISABILITY
 ebm
PERFECT MATCH: RECENT, POPULATION-BASED

Aziz K, Vickar DB, Sauve RS, et al.

PROVINCE-BASED STUDY OF NEUROLOGIC

DISABILITY CHILDREN WEIGHING 500
THROUGH 1249 GRAM AT BIRTH IN RELATION TO
NEONATAL CEREBRAL ULTRASOUND FINDINGS.
PEDIATRICS 1995;95:837-844

MAKE A CRITICAL APPRAISAL OF PROGNOSIS

 SUMMARY :
THE STUDY PATIENTS: PROVINCIAL COHORT
OF
646 PRETERM INFANTS WITH BIRTH
WEIGHTS
500 GM TO 1249 GM WHO SURVIVED BEYOND
THE FIRST YEAR OF AGE.

PROGNOSTIC FACTOR: CRANIAL

ULTRASOUNDS
TO DETECT INTRAVENTRICULAR
HEMORRHAGE
(IVH) OR CEREBRAL VENTRICULOMEGALY (CV)
SUMMARY :
FOLLOW UP ASSESSMENTS WERE
PERFORMED
AT 2-3 YEARS OF AGE, INCLUDED
PHYSICAL,
SENSORY AND PSYCHOLOGICAL
ASSESSMENT.

THE OUTCOME:DISABILITY (WHICH

INCLUDED
CP, VISUAL LOSS, MENTAL
RETARDATION,EPI
LEPSY, AND NEUROSENSORY HEARING
LOSS.
SUMMARY :
** WELL DEFINED SAMPLE
** AT UNIFORM STAGE OF ILLNESS
** FOLLOW UP SUFFICIENTLY LONG AND
COMPLETE
** OBJECTIVE OUTCOME CRITERIA
(BLINDED ??)
** NO ADJUSTMENT FOR OTHER
PROGNOSTIC
FACTORS
** NO VALIDATION IN AN INDEPENDENT
TEST
SET OF PATIENTS
PLEASE READ OTHER SOURCES FOR YOUR SELF !