Evidence Based Medicine From Clinical trials to Clinical Practice. Mohamed Meshref M.D, DES( Lyon) Faculty of Medicine Cairo University
|
|
- Horatio Hood
- 6 years ago
- Views:
Transcription
1 Evidence Based Medicine From Clinical trials to Clinical Practice Mohamed Meshref M.D, DES( Lyon) Faculty of Medicine Cairo University
2 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
3 What is EBM? Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
4 What is evidence-based medicine? Evidence-based medicine (EBM) Patient Values Clinical expertise Best Research Evidence
5 What is evidence-based medicine? By Best Research Evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research.
6 What is evidence-based medicine? By Clinical Expertise: we mean the ability to use our clinical skills and past experience to rapidly identify each patient s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.
7 What is evidence-based medicine? By Patient Values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient
8 What is evidence-based medicine? EBM takes systematic approach to looking at medical evidence. It requires the physician to: Assess your patient Ask Clinical Questions Acquire the best Evidence Appraise the evidence Apply the evidence to patient care
9
10 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
11 Evidence Based Medicine Levels - Level I: Adequately powered, high quality randomized trial, or meta-analysis of randomized trials showing statistically consistent results - Level II: Randomized trials inadequately powered, possibly biased, or showing statistically inconsistent results
12 Evidence Based Medicine Levels - Level III: Non-randomized studies with concurrent controls - Level IV: Non-randomized studies with historical controls (i.e. typical single-arm phase II studies) - Level V: Expert committee review, case reports, retrospective studies
13 Evidence Based Medicine Meta-Analysis of Phase III Trials/ Systematic reviews Randomized Phase III Trial Phase II Clinical Trial (s) Phase I Clinical Trial (s) In Vitro/Vivo Data Anecdotes
14 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
15 Step I: Formulating the clinical question Start with the patient: a clinical problem/ question arises out of the care of the patient. The Question: Construct a well-built question derived from the case.
16 Step I: Formulating the clinical question Anatomy of a good clinical question (PICO) 1. Patient or problem How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? (This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease). 2. Intervention, prognostic factor, or exposure Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? 3. Comparison What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? 4. Outcomes What can you hope to accomplish, measure, improve or affect? (What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores? )
17 Step I: Formulating the clinical question Clinical Case: Mr. Hussein is a 70 years old male who was diagnosed to have a stage IV NSCLC 8 months ago and was treated with platinum doublet for 4 cycles. He tolerated first line chemotherapy with difficulty. Now he relapsed, his ECOG PS is 1, he is symptomatic, he has no co morbidities. He wants to be treated but doesn t want to suffer from the side effects of treatment as he lives alone. What would be the right question to ask?
18 Step I: Formulating the clinical question Problem Relapsed NSCLC, elderly Intervention Chemotherapy Comparison (if any) Chemo type, TKIs? Outcome Primary : reduce symptoms, improve survival Secondry: Reduce toxicity Our question may be: For elderly patients with relapsed NSCLC what is the most effective therapy with least toxicity? Key words : NSCLC, second line, chemotherapy, TKI
19 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
20
21 Secondary Sources A secondary research is an attempt to synthesize the results and conclusions of two or more publications on a given topic Can I trust this secondary source: (Only if you say yes to the following) No conflict of interest Clearly states the question it addresses There is a clear evidence based methodology behind finding, producing and checking the information The source is reviewed and updated regularly
22 Useful resources
23 Is a review addressing a specific research question using explicit methodology of collecting, selecting and appraising studies Systematic reviews
24
25 Primary Sources Needed when there is no collective secondary source data Search strategies for MEDLINE are Thesaurus and text word search We might need to do the search using the 2 methods so as not to miss important articles which might have been indexed in a different way.
26 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
27 Evaluate the evidence Appraise the evidence for: Its validity ( closeness to the truth) Applicability ( usefulness in clinical practice)
28 Are the results of this therapy study valid? 1. Was the assignment of patients to treatment randomized? 2. Were all the patients who entered the trial properly accounted for at its conclusion? Was follow-up complete? 3.Were patients analyzed in the groups to which they were (originally) randomized? 4. Were the groups similar at the start of the trial? 5. Aside from the experimental intervention, were the groups treated equally?
29 Are the results applicable to your patient?
30 EBM: Topics to discuss Introduction to EBM Levels of evidence The process of EBM: Step I: Formulate the clinical question Step II: Finding the evidence (The literature search) Step III: Evaluate the evidence Conclusion
31 Conclusion
32 Conclusion Remember that: Prestigious journals and authors are never a seal of guarantee of quality Research needs to be filtered Research of poor methodology harms our practice and need to excluded Controversial results of studies needs to be summarized
33 Conclusion Because randomized trials and systematic review of randomized trials is much more likely to inform us and much more likely to mislead us, it has become the gold standard for judging whether a treatment does more good than harm. However, some questions about therapy do not require randomized trials or cannot wait for the trials to be conducted. And if no randomized trials have been carried out, we must follow the trail to the next best external evidence and work from there David L Sackett BMJ 1996
34
Finding the Evidence: a review. Kerry O Rourke & Cathy Weglarz UMDNJ-RWJ Library of the Health Sciences
Finding the Evidence: a review Kerry O Rourke & Cathy Weglarz UMDNJ-RWJ Library of the Health Sciences Evidence Based Medicine Evidence-based medicine is the conscientious, explicit and judicious use of
More informationEvidence Based Medicine
Hamadan University of medical sciences School of Public Health Department of Epidemiology Evidence Based Medicine Amin Doosti-Irani, PhD in Epidemiology 10 March 2017 a_doostiirani@yahoo.com 1 Outlines
More informationEvidence-based Laboratory Medicine: Finding and Assessing the Evidence
Find Assess Decide Evidence-based Laboratory Medicine: Finding and Assessing the Evidence Pieter Vermeersch, M.D. Ph.D. Laboratory Medicine, UZ Leuven November 18th 2008 Introduction Archie Cochrane (1908-1988)
More informationAPPLYING EVIDENCE-BASED METHODS IN PSYCHIATRY JOURNAL CLUB: HOW TO READ & CRITIQUE ARTICLES
University of Miami Scholarly Repository Faculty Research, Publications, and Presentations Department of Health Informatics 7-26-2017 APPLYING EVIDENCE-BASED METHODS IN PSYCHIATRY JOURNAL CLUB: HOW TO
More informationEVIDENCE-BASED HEALTH CARE
EVIDENCE-BASED HEALTH CARE AND OTHER MYTHS OF A MODERN AGE Peggy Mancuso, PhD, CNM, RN. 1 An Overview of EBM 2 Evidence-Based Health Care Definition Conscientious, explicit, judicious use Current best
More informationDefinition of Evidence-Based Medicine
Converting Experience into Evidence-Orienting the Clinician for Scientific Validation Practical Approach Dr. Rangesh Paramesh Senior Medical Advisor, Himalaya Healthcare, Bangalore Evidence in medicine,
More informationEvidence-based Laboratory Medicine. Prof AE Zemlin Chemical Pathology Tygerberg Hospital
Evidence-based Laboratory Medicine Prof AE Zemlin Chemical Pathology Tygerberg Hospital Content Definition History Challenges Steps Appraising evidence Tools Criticism Barriers although the laboratory
More informationImproving Return on Public Health Investments in Disasters with Evidence Synthesis
Improving Return on Public Health Investments in Disasters with Evidence Synthesis Karen A. Robinson Johns Hopkins University Evidence Aid 17 Nov 2016 Evidence Synthesis Formal methods for summarizing
More informationCritical point learning
Critical point learning Reflection as a method of continuing professional development and life long learning EBM Day to day clinical practice involves solving questions in a peer supported environment
More informationGrading the Evidence Developing the Typhoid Statement. Manitoba 10 th Annual Travel Conference April 26, 2012
Grading the Evidence Developing the Typhoid Statement Manitoba 10 th Annual Travel Conference April 26, 2012 Disclosure of Potential Conflict of Interest Alexandra Henteleff MEd, BN, RN Certificate in
More informationEvidence-based medicine: Too much evidence?
DISCLAIMER: The content of this presentation may not accurately reflect current legal or regulatory requirements, industry standards, or professional best practices. ISMPP is providing access to this presentation
More informationIntroduction to Evidence Based Medicine
Introduction to Evidence Based Medicine Outline 1. Introduction: what is EBM 2. The steps in evidence based practice 3.An example 4. Reflection and further information Chaisiri Angkurawaranon Department
More informationPET-CT in Oncology: an evidence based approach
Sarajavo (Bosnia & Hercegovina) Monday, June 16 2014 10:15-10:45 a.m PET-CT in Oncology: an evidence based approach Helle Westergren Hendel MD, PhD, assistant professor Bachelor in Leadership & Health
More informationA general treatment approach
Chapter 2 A general treatment approach Using the rubric of evidence-based medicine Evidence-based medicine (EBM) is not just about the evidence, but how to use it in a meaningful way [1]; practicing EBM
More informationOutline. What is Evidence-Based Practice? EVIDENCE-BASED PRACTICE. What EBP is Not:
Evidence Based Practice Primer Outline Evidence Based Practice (EBP) EBP overview and process Formulating clinical questions (PICO) Searching for EB answers Trial design Critical appraisal Assessing the
More informationMeta-analyses: analyses:
Meta-analyses: analyses: how do they help, and when can they not? Lee Hooper Senior Lecturer in research synthesis & nutrition l.hooper@uea.ac.uk 01603 591268 Aims Systematic Reviews Discuss the scientific
More informationEvidence based dentistry and bibliometry Asbjørn Jokstad Departments of Prosthetics and Oral Function Dental Faculty University of Oslo
Evidence based dentistry and bibliometry Asbjørn Jokstad Departments of Prosthetics and Oral Function Dental Faculty University of Oslo Information Explosion in Dentistry Tremendous growth in scientific
More informationEvidence-based medicine and guidelines: development and implementation into practice
Evidence-based medicine and guidelines: development and implementation into practice PD Dr D. Aujesky, MSc MER Médecin-adjoint Service de Médecine Interne CHUV 1 Goals To discuss the basics of evidence-based
More informationEvidence-Based Medicine
Evidence-Based Medicine Is EBM just a pack of lies, damned lies, and statistics? Oregon Rural Heart Attack Care Project Webinar February 5, 2008 What the Experts Say About This Webinar 2 The long-range
More informationEvidenced-Based Medicine: Where Does it Fit in Foot and Ankle Surgery?
Sean T. Grambart, DPM, FACFAS Ankle and Foot Surgery Carle Clinic Association Evidenced-Based Medicine: Where Does it Fit in Foot and Ankle Surgery? MODULE: Calcaneal Fracture Evidence-Based Medicine The
More informationIntro to Evidence Based Medicine
Intro to Evidence Based Medicine Dr Hasan Nugud Consultant Paediatric Surgeon 4/18/2015 EBM Resources 1 Outline What is EBM? Why do we need it? How to use EBM in daily practice The five steps Formulating
More informationGRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2018
GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2018 Previous grading system Level of evidence Strength of recommendation Level of evidence
More informationGuidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates
Guidelines for Writing and Reviewing an Informed Consent Manuscript From the Editors of Clinical Research in Practice: The Journal of Team Hippocrates 1. Title a. Emphasize the clinical utility of the
More informationSystematic Reviews and Meta- Analysis in Kidney Transplantation
Systematic Reviews and Meta- Analysis in Kidney Transplantation Greg Knoll MD MSc Associate Professor of Medicine Medical Director, Kidney Transplantation University of Ottawa and The Ottawa Hospital KRESCENT
More informationSkillBuilder Shortcut: Levels of Evidence
SkillBuilder Shortcut: Levels of Evidence This shortcut sheet was developed by Research Advocacy Network to assist advocates in understanding Levels of Evidence and how these concepts apply to clinical
More informationThe Evidence Is So Clear. The Evidence Is So Clear
The Evidence Is So Clear 1 Evidence-Based Medicine is at the Heart of DynaMed Plus As described by Izet Masic, Milan Miokovic and Belma Muhamedagic, evidence-based medicine (EBM) is, the conscientious,
More informationCare Pathways for Enabling Recovery from Common Traffic Injuries: A Focus on the Injured Person
Care Pathways for Enabling Recovery from Common Traffic Injuries: A Focus on the Injured Person Jessica J. Wong, DC, MPH, FCCSC Research Associate, UOIT-CMCC Centre for Disability Prevention and Rehabilitation
More informationISPOR Task Force Report: ITC & NMA Study Questionnaire
INDIRECT TREATMENT COMPARISON / NETWORK META-ANALYSIS STUDY QUESTIONNAIRE TO ASSESS RELEVANCE AND CREDIBILITY TO INFORM HEALTHCARE DECISION-MAKING: AN ISPOR-AMCP-NPC GOOD PRACTICE TASK FORCE REPORT DRAFT
More informationWhat is evidence-based dentistry? Evidence-based Dentistry. Is there a down side? Why learn EBD? What is the process of EBD?
Evidence-based Dentistry OS 512 Research Design October 20,2003 What is evidence-based dentistry? The conscientious, explicit, and judicious use of the current best evidence in making decisions about the
More informationHow do we identify a good healthcare provider? - Patient Characteristics - Clinical Expertise - Current best research evidence
BSC206: INTRODUCTION TO RESEARCH METHODOLOGY AND EVIDENCE BASED PRACTICE LECTURE 1: INTRODUCTION TO EVIDENCE- BASED MEDICINE List 5 critical thinking skills. - Reasoning - Evaluating - Problem solving
More informationContent. Evidence-based Geriatric Medicine. Evidence-based Medicine is: Why is EBM Needed? 10/8/2008. Evidence-based Medicine (EBM)
Content Evidence-based Geriatric Medicine Patricia P. Barry, MD, MPH Review of evidence-based medicine (EBM) and evidence-based practice (EBP) Use of guidelines in evidence-based practice Relevance of
More informationLearning objectives. Examining the reliability of published research findings
Examining the reliability of published research findings Roger Chou, MD Associate Professor of Medicine Department of Medicine and Department of Medical Informatics and Clinical Epidemiology Scientific
More informationCritical Appraisal of Research Reports
Critical Appraisal of Research Reports Dr Lale Say Department of Reproductive Health and Research Postgraduate Training Course in Reproductive Health/Chronic Disease Geneva 2004 PVL_COUNTRY_DATE00/1 What
More informationSystematic reviews: From evidence to recommendation. Marcel Dijkers, PhD, FACRM Icahn School of Medicine at Mount Sinai
Systematic reviews: From evidence to recommendation Session 2 - June 18, 2014 Going beyond design, going beyond intervention: The American Academy of Neurology (AAN) Clinical Practice Guideline process
More informationEvidence-Based Reproductive Health Care Professor E. Oluwole Akande WHO Consultant
Evidence-Based Reproductive Health Care By Professor E. Oluwole Akande WHO Consultant At The Regional workshop on the Training of Core Group of RH Experts and sharing of RH best practices. Johannesburg,
More informationIntroduzione al metodo GRADE
Introduzione al metodo GRADE Atto Billio MD, MSc EBHC Ematologia e TMO-Bolzano Gruppo linee guida SIE Critique of EBM De-emphasizes patient values Doesn t account for individual variation Devalues clinical
More informationClinical Epidemiology for the uninitiated
Clinical epidemiologist have one foot in clinical care and the other in clinical practice research. As clinical epidemiologists we apply a wide array of scientific principles, strategies and tactics to
More informationCRITICAL EVALUATION OF BIOMEDICAL LITERATURE
Chapter 9 CRITICAL EVALUATION OF BIOMEDICAL LITERATURE M.G.Rajanandh, Department of Pharmacy Practice, SRM College of Pharmacy, SRM University. INTRODUCTION Reviewing the Biomedical Literature poses a
More informationPrinciples of meta-analysis
Principles of meta-analysis 1 The popularity of meta-analyses Search on 22 October 2015 10000 9000 8156 8875 8000 7000 6554 6000 5000 4852 4000 3000 2000 1000 0 1 1 1 272 334 371 323 386 429 482 596 639
More informationHow to prepare the perfect CPC
How to prepare the perfect CPC Presented by: Linda Suk-Ling Murphy, MLIS Steve Clancy, MLS UCI Science Library January 10, 2010 Distinguish the difference between evidencebased information and expert opinion.
More informationHOW TO DEVELOP A RESEARCH PROTOCOL
Research and Evidence Based Medicine Committee 2010-2011 HOW TO DEVELOP A RESEARCH PROTOCOL Evidence-Based Medicine The conscientious, explicit, and judicious use of current best evidence in making decisions
More informationRisk Study. Section for Clinical Epidemiology and Biostatistics. Definition
Risk Study Section for Clinical Epidemiology and Biostatistics What is Risk? Definition The probability of some untoward event The likelihood that people who are exposed to certain factors (risk factors)
More informationLess is more: Guidelines
ESIM Summer School June 20 Friday, 2014 Less is more: Guidelines Primiano Iannone, MD Head of Emergency Department Ospedali del Tigullio, Lavagna (GE) Italy layout What is a clinical guideline Why do we
More informationEvidence based practice. Dr. Rehab Gwada
Evidence based practice Dr. Rehab Gwada Objectives Define the ABP Identify the steps of the EBP process Recognize hierarchy of evidence and types of study design Explain how to build focused clinical questions
More informationDr. Sonia Oveisi Assistant Professor of Qazvin University of Medical Science RESOURCES FOR EBM 6/2/2014 1
Dr. Sonia Oveisi Assistant Professor of Qazvin University of Medical Science RESOURCES FOR EBM 6/2/2014 1 Definitions of EBM EBM is the conscientious, explicit, and judicious use of current best evidence
More informationMeta-analysis: Critical appraisal
Format Meta-analysis: Critical appraisal Prathap Tharyan Director, South Asian Cochrane Network & Centre Prof BV Moses & ICMR Centre for Advanced Research & Training in Evidence-Informed Healthcare, Christian
More informationEBM in action: "Does ovulation induction increase the risk of ovarian cancer?"
Middle East Fertility Society Journal Vol. 11, No. 2, 2006 Copyright Middle East Fertility Society EVIDENCE-BASED MEDICINE CORNER EBM in action: "Does ovulation induction increase the risk of ovarian cancer?"
More informationEBP STEP 2. APPRAISING THE EVIDENCE : So how do I know that this article is any good? (Quantitative Articles) Alison Hoens
EBP STEP 2 APPRAISING THE EVIDENCE : So how do I know that this article is any good? (Quantitative Articles) Alison Hoens Clinical Assistant Prof, UBC Clinical Coordinator, PHC Maggie McIlwaine Clinical
More informationWhat is the Cochrane Collaboration? What is a systematic review?
1 What is the Cochrane Collaboration? What is a systematic review? Archie Cochrane (1909-1988) It is surely a great criticism of our profession that we have not organised a critical summary, by specialty
More informationEvidence Based Medicine
THE ROYAL AUSTRALIAN COLLEGE OF GENERAL PRACTITIONERS Evidence Based Medicine Summary Statement Aim Background Position of the RACGP Recommended Role for Individual GPs Strategies References Notes Summary
More informationIs therapy a realistic option at the present time? Felipe Fregni LEASE DO NOT COPY. Spauding Neuromodulation Center Harvard Medical School
Is therapy a realistic option at the present time? Felipe Fregni Spauding Neuromodulation Center Harvard Medical School Arguments supporting therapeutic use of tdcs Questions to be answered: Is there a
More informationMethodology for Non-Randomized Clinical Trials: Propensity Score Analysis Dan Conroy, Ph.D., inventiv Health, Burlington, MA
PharmaSUG 2014 - Paper SP08 Methodology for Non-Randomized Clinical Trials: Propensity Score Analysis Dan Conroy, Ph.D., inventiv Health, Burlington, MA ABSTRACT Randomized clinical trials serve as the
More informationMCQ Course in Pediatrics Al Yamamah Hospital June Dr M A Maleque Molla, FRCP, FRCPCH
MCQ Course in Pediatrics Al Yamamah Hospital 10-11 June Dr M A Maleque Molla, FRCP, FRCPCH Q1. Following statements are true in the steps of evidence based medicine except ; a) Convert the need for information
More informationCancer Screening: Evidence, Opinion and Fact Dialogue on Cancer April Ruth Etzioni Fred Hutchinson Cancer Research Center
Cancer Screening: Evidence, Opinion and Fact Dialogue on Cancer April 2018? Ruth Etzioni Fred Hutchinson Cancer Research Center Three thoughts to begin 1. Cancer screening is a good idea in principle Detect
More informationSurvival analysis. EPIB Clinical Epidemiology. Date: May 9 to June 3 8:35 11:40. Session 9: Evidence-Based Medicine. Dr. J.
Course: EPIB 679-001 Clinical Epidemiology Survival analysis Date: May 9 to June 3 8:35 11:40 Session 9: Evidence-Based Medicine Dr. J. Brophy Log Rank Test Log Rank Test Log Rank Test Cox PH Model Cox
More informationEvidenced-Based Medicine: Where Does it Fit in Foot and Ankle Surgery?
Jeffrey R. Baker, DPM, AACFAS Weil Foot & Ankle Institute Des Plaines, IL Evidenced-Based Medicine: Where Does it Fit in Foot and Ankle Surgery? MODULE: Bimalleolar Equivalent Ankle Fracture Evidence-Based
More informationQuick Literature Searches
Quick Literature Searches National Pediatric Nighttime Curriculum Written by Leticia Shanley, MD, FAAP Institution: University of Texas Southwestern Medical Center Case 1 It s 1:00am and you have just
More informationMeta-analysis of diagnostic research. Karen R Steingart, MD, MPH Chennai, 15 December Overview
Meta-analysis of diagnostic research Karen R Steingart, MD, MPH karenst@uw.edu Chennai, 15 December 2010 Overview Describe key steps in a systematic review/ meta-analysis of diagnostic test accuracy studies
More informationIntroduction to Evidence-Based Medicine
Introduction to Evidence-Based Medicine Atiporn Ingsathit, M.D., Ph.D. (Clin. Epid.) กล มสาขาว ชาระบาดว ทยาคล น กและช วสถ ต คณะแพทยศาสตร โรงพยาบาลรามาธ บด มหาว ทยาล ยมห ดล Tel 02-201-1284 email: atiporn.ing@mahidol.ac.th
More informationDr. Engle has received an unrestricted educational grant for the MD Anderson Pain Medicine Fellowship.
Mitchell Engle, MD, PhD Dr. Mitchell Engle earned his medical degree and a Ph.D. in Pharmacology from the University Of Iowa Carver College Of Medicine. His Ph.D. research examined the role of the spinal
More informationEvidence-based practice
CHAPTER 1 Evidence-based practice 1.1 Why evidence-based practice? We all like to think we are practicing medicine based on the best evidence available. However, we sometimes do things in medicine for
More informationClinical problems and choice of study designs
Evidence Based Dentistry Clinical problems and choice of study designs Asbjørn Jokstad University of Oslo, Norway Nov 21 2001 1 Manipulation with intervention Yes Experimental study No Non-experimental
More informationGRADE. Grading of Recommendations Assessment, Development and Evaluation. British Association of Dermatologists April 2014
GRADE Grading of Recommendations Assessment, Development and Evaluation British Association of Dermatologists April 2014 Previous grading system Level of evidence Strength of recommendation Level of evidence
More informationCanadian Journal of Anesthesia/Journal canadien d anesthésie. Evidence-Based Clinical Updates (EBCU s) in Anesthesia
Canadian Journal of Anesthesia/Journal canadien d anesthésie Evidence-Based Clinical Updates (EBCU s) in Anesthesia INSTRUCTIONS FOR AUTHORS The Canadian Journal of Anesthesia considers for publication
More informationWelcome to the Louis Calder Memorial Library NW 10 Ave., Miami, FL 33136
Welcome to the Louis Calder Memorial Library 1601 NW 10 Ave., Miami, FL 33136 Objectives: Participants will be able to: 0 Use usearch to find electronic and print resources from all UM libraries 0 Navigate
More informationAsking answerable clinical questions
Asking answerable clinical questions The key to evidence-based decision making Asbjørn Jokstad University of Oslo, Norway 15/07/2004 1 What Questions Arise? At least x 1 question / consultation Most of
More informationOverview of Study Designs in Clinical Research
Overview of Study Designs in Clinical Research Systematic Reviews (SR), Meta-Analysis Best Evidence / Evidence Guidelines + Evidence Summaries Randomized, controlled trials (RCT) Clinical trials, Cohort
More informationTranslating the Clinical scenario into a Searchable Question: Dr : Jarir Alabdelwahab Damascus 3/12/2010
Translating the Clinical scenario into a Searchable Question: Dr : Jarir Alabdelwahab Damascus 3/12/2010 By the year 2020, 90% of clinical decisions will be supported by accurate, timely, and up-to-date
More informationResearch 101: Developing Critical Evaluation Skills
R E S E A R C H Research 101: Developing Critical Evaluation Skills BY M. Gail Woodbury M. Gail Woodbury, BScPT, MSc, PhD, is an Investigator, Program in Rehabilitation and Geriatric Care, Lawson Health
More informationEvidence Based Medicine. Feb 18, 2009 Dr Ayham Moty
Evidence Based Medicine Feb 18, 2009 Dr Ayham Moty The new paradigm, probabilistic thinking current paradigm: the biomedical model the body can be approached as an engineering problem. the new paradigm:
More informationreceive adjuvant chemotherapy
Women with high h risk early stage endometrial cancer should receive adjuvant chemotherapy Michael Friedlander The Prince of Wales Cancer Centre and Royal Hospital for Women The Prince of Wales Cancer
More informationA Cochrane systematic review of interventions to improve hearing aid use
A Cochrane systematic review of interventions to improve hearing aid use Fiona Barker f.barker@surrey.ac.uk Department of Healthcare Management and Policy The context Hearing loss is a common long term
More informationControlled Trials. Spyros Kitsiou, PhD
Assessing Risk of Bias in Randomized Controlled Trials Spyros Kitsiou, PhD Assistant Professor Department of Biomedical and Health Information Sciences College of Applied Health Sciences University of
More informationClinical Evidence: Asking the Question and Understanding the Answer. Keeping Up to Date. Keeping Up to Date
Clinical Evidence: Asking the Question and Understanding the Answer Keeping Up to Date 5,000? per day 1,500 per day 95 per day Keeping Up to Date 5,000? per day 1,500 per day 95 per day 1 Bias Bias refers
More informationTrials and Tribulations of Systematic Reviews and Meta-Analyses
Trials and Tribulations of Systematic Reviews and Meta-Analyses Mark A. Crowther and Deborah J. Cook St. Joseph s Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada Systematic
More informationHow to use research to lead your clinical decision
] 6 How to use research to lead your clinical decision ASK ACQUIRE ANALYZE ANSWER APPLY ASSESS making.] Phil Page PhD, PT, ATC, CSCS, FACSM 1) ASK What is your question? Be very specific in what you want
More informationEvidence Based Practice (EBP) Five Step Process EBM. A Definition of EBP 10/13/2009. Fall
What is EBP? Classic Definition of Evidence Based Medicine (EBM) By Aaron Eakman PTOT 413/513 OT Profession Fall 2009 the explicit, judicious and conscientious use of current best evidence from health
More informationCritical Appraisal. Einas Al-Eisa, MSc, PhD King Saud University
Critical Appraisal Einas Al-Eisa, MSc, PhD King Saud University Critical Appraisal = assessment of evidence by systematically reviewing its: Relevance Validity Applicability of its results to specific
More informationDynaMed Plus Evidence-based Methodology
Table of contents: Step 1: Identifying the Evidence...3 Step 2: Selecting the Best Available Evidence...4 Step 3: Critical Appraisal...6 Step 4: Objectively Reporting the Evidence...8 Step 5: Synthesizing
More informationWhat is indirect comparison?
...? series New title Statistics Supported by sanofi-aventis What is indirect comparison? Fujian Song BMed MMed PhD Reader in Research Synthesis, Faculty of Health, University of East Anglia Indirect comparison
More informationLung Cancer Non-small Cell Local, Regional, Small Cell, Other Thoracic Cancers: The Question Isn t Can We, but Should We
Lung Cancer Non-small Cell Local, Regional, Small Cell, Other Thoracic Cancers: The Question Isn t Can We, but Should We Edward Garon, MD, MS Associate Professor Director- Thoracic Oncology Program David
More informationCritical Appraisal of Research Reports
Critical Appraisal of Research Reports Dr Lale Say Department of Reproductive Health and Research Training Course in Reproductive Health/ Sexual Health Research Geneva 2006 05_XXX_MM1 Objective At the
More informationIssues regarding non-inferiority within the anti-bacterials area. Jon Armstrong, AstraZeneca Pharmaceuticals
Issues regarding non-inferiority within the anti-bacterials area Jon Armstrong, AstraZeneca Pharmaceuticals Topics Covered Disease area background The need for non-inferiority studies for anti-bacterials
More informationWhat were the 10 path-breaking discoveries in medicine in the last 500 years?
What were the 10 path-breaking discoveries in medicine in the last 500 years? Top 10 discoveries in medicine in the last 500 years 1. Human Anatomy: Andreas Vesalius 1538 2. Blood circulation: William
More informationRACE611 CLINICAL EPIDEMIOLOGY AND EVIDENCE-BASED MEDICINE Prognostic study
RACE611 CLINICAL EPIDEMIOLOGY AND EVIDENCE-BASED MEDICINE Prognostic study Assoc.Prof.Dr.Atiporn Ingsathit Master of Science Program in Medical Epidemiology and Doctor of Philosophy Program in Clinical
More informationHow to do a quick search for evidence
bs_bs_banner doi:10.1111/jpc.12514 VIEWPOINT David Isaacs Department of Infectious Diseases & Microbiology, Children s Hospital at Westmead, Sydney, New South Wales, Australia Abstract: Doctors quote lack
More informationRecent developments for combining evidence within evidence streams: bias-adjusted meta-analysis
EFSA/EBTC Colloquium, 25 October 2017 Recent developments for combining evidence within evidence streams: bias-adjusted meta-analysis Julian Higgins University of Bristol 1 Introduction to concepts Standard
More informationEvidence-Based Medicine
Evidence-Based Medicine A State-of-the-Art Report Alime Öztürk Vienna University of Technology Institute of Software Technology & Interactive Systems Asgaard-TR-2006-2 October 2006 Authors: Alime Öztürk
More informationCRITICAL APPRAISAL WORKSHEET 1
For Residents CRITICAL APPRAISAL WORKSHEET 1 AN ARTICLE ON THERAPY This worksheet should be submitted along with the completed Submission Form to your supervisor. It is based on the articles on therapy
More informationEvidence-Based Integrative Therapies for Common Problems in Family Medicine. Pamela Wiseman MD Associate Professor of Family Medicine
Evidence-Based Integrative Therapies for Common Problems in Family Medicine Pamela Wiseman MD Associate Professor of Family Medicine Learning Objectives As a result of this session, the participant will
More informationImproving reporting for observational studies: STROBE statement
Improving reporting for observational studies: STROBE statement Technical meeting on the reporting of human studies submitted for the scientific substantiation of health claims EFSA Parma 20 November 2013
More informationTechnology appraisal guidance Published: 29 June 2011 nice.org.uk/guidance/ta227
Erlotinib monotherapy for maintenance treatment of non-small-cell lung cancer Technology appraisal guidance Published: 29 June 2011 nice.org.uk/guidance/ta227 NICE 2018. All rights reserved. Subject to
More informationPROGRAMMA DELLA GIORNATA
PROGRAMMA DELLA GIORNATA si riprendono i concetti della volta precedente compiti dati da fare a casa si richiama il programma del corso 1.1.1. Studi integrativi 1.1.2. Revisioni sistematiche 1.1.4.1. TEST
More informationThe True Meaning of Evidence-Based Practice. Written by Pathways Authors Friday, 01 December :00 - Last Updated Monday, 26 March :30
Chiropractors that run evidence-based practices are able to provide patients with adjusting techniques, recommendations, and advice for wellness and health management that reflect knowledge and experience
More informationEvidence-Based Medicine for clinical years Sep 13 th 2016
Evidence-Based Medicine for clinical years Sep 13 th 2016 Professor Carl Heneghan University of Oxford Director CEBM What is Evidence-Based Medicine? Evidence-based medicine is the integration of best
More informationQuality & Quantity of life in oncology What the CT doesn t tell us. Baby boomers have gone grey!
Quality & Quantity of life in oncology What the CT doesn t tell us Peter Harper Guys Hospital, London UK Baby boomers have gone grey! 57 % of patients with cancer are over 65 Number of people over 65 yrs
More informationTwo Cycles of Chemoradiation: 2 Cycles is Enough. Concurrent Chemotherapy / RT Regimens
1 Two Cycles of Chemoradiation: 2 Cycles is Enough Heather Wakelee, M.D. Assistant Professor of Medicine, Oncology Stanford University Concurrent Chemotherapy / RT Regimens Cisplatin 50 mg/m 2 on days
More informationSOCQ121/BIOQ121. Session 2. Evidence and Research. Department of Social Science. endeavour.edu.au
SOCQ121/BIOQ121 Session 2 Evidence and Research Department of Social Science endeavour.edu.au Review What is knowledge? How has knowledge changed over time? Name some of the complementary medicine modalities
More informationGRADE, Summary of Findings and ConQual Workshop
GRADE, Summary of Findings and ConQual Workshop To discuss Introduction New JBI Levels of Evidence and Grades of Recommendation Moving towards GRADE Summary of Findings tables Qualitative Levels Conclusion
More informationMapping the Informed Health Choices (IHC) Key Concepts (KC) to core concepts for the main steps of Evidence-Based Health Care (EBHC).
KC No KC Short Title KC Statement EBHC concept EBHC sub concept EBHC statement EBHC Step Reported 1.01 Treatments can harm Treatments may be harmful Explain the use of harm/aetiologies for (rare) adverse
More information