Dr.

SUHAEMI, SpPD, FINASIM

 Gelang Magnet
 TCM ( Traditional Chinese Medicine )
 Susu Mandala 55
 Jamu Jamtangin
 Temulawak
 Daun Sirsak
 Buah Mengkudu
 Ginseng
Dulu Saya Sering Masuk Angin, Tapi Setelah 3x Berobat Ke Klinik
TongFang, Saya Malah Jadi Pengendali Angin, Terima Kasih Tong
Fang
Evidence-based medicine is the
integration of best research evidence
with clinical expertise and patient values
Sackett DL, Straus SE, Richardson WS, Rosenberg W, and Haynes RB.
Evidence-Based Medicine: How to Practice and Teach EBM, 2nd Ed, Churchill
Livingstone, London, 2000
 Adalah cara pendekatan untuk
mengambil keputusan dalam
penatalaksanaan pasien secara eksplisit
dan sistematis berdasarkan bukti
penelilitian terakhir yang sahih ( valid )
dan bermanfaat.
 “The conscientious, explicit, and judicious
use of current best evidence in making
decisions about the care of individual
patients”
 “Pemanfaatan bukti mutakhir yang sahih
dalam tata laksana pasien”
 Integration of (1) physician’s competence
(2) valid evidence from
studies (3) patient’s preference
Dr Carl Heneghan
Director CEBM
Clinical Reader, University of Oxford
“Evidence-based medicine is the integration of best
research evidence with clinical expertise and patient
values”
- Dave Sackett

Patient
Concerns

EBM
Best research Clinical
evidence Expertise
Some variants of Evidence-Based Practice

Brian Haynes, Bob Phillips,

physician McMaster Oncology, Leeds
ACP journal club Patients in Trials

Kevin Mackway Jones Yaser Faden,

A&E Manchester Neonatology,
BestBets Jeddeh
“PICO” rounds
 From librarians (hands-on training)
 From experts in medical informatics
 Courses/ Tutorials
Best

Worst
Ideal, still theoretical, links EMR to best
research evidence, always updated, drills down

Provide enough information to support a clinical

action

More details, summaries based on exhaustive

search for evidence, explicit scientific reviews,
and systematic assembly of evidence

When all above fails, more recent or not

reviewed topics
 Clinical Evidence (BMJ)
• URL: http://www.clinicalevidence.com
• Contains limited range of clinical questions
 PIER (the Physician’s Information and Education
Resource) by ACP
• URL: http://pier.acponline.org
• Only for members
 UpToDate®
• URL: http://www.uptodate.com
• Updated quarterly
• Extensively referenced
 ACP Medicine (Formerly Scientific American
Medicine)
• URL: http://www.acpmedicine.com
 Harrison’s Principles of Internal Medicine
• URL: http://www.harrisonsmed.com
• Only updated every 3 years
 Evidence Based on Call
• URL: http://www.eboncall.org/content.jsp.htm
 Evidence-Based Pediatrics and Child Health
• URL: http://www.evidbasedpediatrics.com
 Evidence Based Cardiology
• URL: http://www.evidencebasedcardiology.com/

OVID includes and links EBMR (Cochrane, ACP Journal Club, the
Database of Abstracts of Reviews of Evidence (DARE), and Medline
 Specialized
 ACP Journal Club:
www.acpjc.org
 Evidence Based
Medicine:
www.ebm.bmjjournals.com
 Evidence Based Nursing:
www.ebn.bmjjournals.com
 Evidence Based Mental
Health:
www.ebmh.bmjjournals.co
m http://askmedline.nlm.
General
 Cochrane Central
Register of Controlled
Trials (Therapy)
 MEDLINE:
http://www.ncbi.nlm.ni
h.gov/PubMed/
• Using the Clinical
Queries Search
 ASK MEDLINE
nih.gov/ask/ask.php

Make use of your Library and Institutional subscriptions

 EBM Home page (McMaster):
www.hiru.hirunet.mcmaster.ca/ebm/
 Users' guide to the literature:
www.hiru.mcmaster.ca/ebm/userguid/1_map.htm
 USA Cochrane Collaboration Home Page: www.cochrane.org
 Journal of Family Practice Journal Club: www.infopoems.com/
 Center for Evidence Based Medicine: www.cebm.jr2.ox.ac.uk/
 University of Michigan Pediatric EBM site:
www.ped.med.umich.edu/ebm
 Evidence Based Medicine Review (EBMR): www.ovid.com
 Clinical Evidence:
www.clinicalevidence.org/IpBinCE/Ipext.dll?f=templates&fn=ma
in-h.htm&2.0
 DARE: Database of Abstracts of Reviews of Effectiveness:
nhscrd.york.ac.uk/darehp.htm
 EBM online: http://ebm.bmjjournals.com/misc/about/shtml
Patient’s Name Learner:

3-part Clinical
Target Disorder: Question

Intervention (+/- comparison):

Outcome:

Date and place to be filled:

Presentations will cover:

1. search strategy;
2. search results;
3. the validity of this evidence;
4. the importance of this valid evidence;
5. can this valid, important evidence be applied to your patient;
6. your evaluation of this process.
William Osler, 1900 Smart young doctor
Wise & experienced smart young doctor
The hardest conviction to get into the mind of a
beginner is that the education upon which he is
engaged is not … a medical course, but a life
course, for which the work of a few years under
teachers is but a preparation.

• Sir William Osler (1849-1919), from: The Student of

Medicine
1. Formulate an answerable question
2. Track down the best evidence
3. Critically appraise the evidence
4. Individualise, based clinical expertise and patient
concerns
A 35 year old man says
his brother recently
died of a ruptured
cerebral aneurysm.
He is worried about
whether he might have
one and what the
chances are that it
would rupture.
-> PICO Table
 Risk Factors Frequency Prognosis
Cohort Study Inception Cohort Study
Survey

CT Scan
Treatments
Treatment Effect
Randomised Trial
Symptoms
Cause(s) Signs, Tests
Cross Sectional Study
Past current future
It’s peer-reviewed, therefore it must be OK?
How it happens in practice?
 Rec
Weight of
Scientific Meta-analysis of RCT Level 1
Scrutiny A
Large RCT
Small RCT Level 2

B
Non-Randomized trials
Observational studies Level 3

Case series / reports

C
Level 4
Anecdotes, expert, consensus
For complete description see www.cebm.net
 End result
Self directed, life-long learning attitude
for high quality patient care