To Evidence -based medicine HR.JABBARI MD INTERNIST PULMUNOLOGIST NRITLD EDC TTC

THE LIFE IS SHORT AND THE EVIDENCE IS TOO HARD TO FIND H.R.JABBARI MD

What I’ve done/do/don’t do Done :I’ve been graduated and gotten of data in pulmunology Do :I run an in-patient practice in university hospital(8-14) and an out-patient private practice (15-22or more) Don’t :I’ve cancelled my journal subscription and…….

The problems We need evidence(about the accuracy of tests.the power of prognostic markers.the comparative efficacy and safety of interventions. Etc.) about 3 question for every in-patient and 2question for every 3 out-patient we get less than 1/3 of it

Problems in practicing EBM Rapid and accelerating pace of medical research and hence of research output(>2 million new papers and 15,000 new clinical trials are published each year). Absence of specific evidence. Uncertainty associated with clinical evidence

Medical information * Relevant to every day practice * Correct (Valid) * Easy to obtain

Patient - Oriented Out Comes The findings have potential to change our practice What we already do While important POE.

* Too common in the medical literature * Often brought to our attention by pharmaceutical pharmaceutical * Eager to change our practice Disease - Oriented Evidence DOEs

Patient Oriented Evidence that Matters * Addresses a clinical problem or clinical question that primary care physicians will question that primary care physicians will encounter in their practice encounter in their practice * Uses patient - oriented out comes * Has the potential to change our practice if results are valid and applicable POEMs

POEMsDOEs Common Un common Read these Read if you have time Dangerous Worth less

What is EBM? The best research Clinical expertise Patient value HR.JABARI NRITLD

Five developments 1) Searching Methods Development 2) Reading Design 3) EBM Journals 4) Computerized Associated Technology 5) Strategies for Life-long Learning HR.JABARI NRITLD

Steps 1- Converting the need for information 2- Tracking down the best evidence 3- Critically appraising validity 4- Integrating appraisal with other issues 5- Evaluating effectiveness and efficiency How do we actually practice EBM? HR.JABARI NRITLD

Can clinicians actually practice EBM? 1) Do clinicians really recognize these methods? 2) Can clinicians actually consider it on a busy clinical service ? 3) Can clinicians actually provide EB-care to their patients? HR.JABARI NRITLD

Does providing EB care improve outcomes for patients? HR.JABARI NRITLD

What are the limitations of EBM? 3 Universal limitations: Shortage of coherent evidence Difficulty in applying Barriers 3 Unique limitations: Need to develop new skills limited time of busy clinicians Late and slow outcomes of EBM efficacy HR.JABARI NRITLD

What are the other uses of EBM ? Fosters generic skills Provides a common language Provides framework for life-long learning Reinforces communication and clinical skills HR.JABARI NRITLD