1. Introduction to Evidence Based Medicine
Dr. Tina Dewi Judistiani, dr. SpOG
Dept Epidemiology and Biostatistics
School of Medicine – Universitas Padjadjaran

2. KEY REFERENCES
Greenberg RS, Daniels SR, Flanders D, Elley JW, Boring JR. Medical Epidemiology. 1st ed. Prentice-Hall International Inc. London .1993
West S. Basic Public Health Concepts : What is Screening? Wilmer Eye Institute - Johns Hopkins University. Available from
Coggon D, Rose J, Barker DJP. Epidemiology for the uninitiated. Available from uninitiated/10-screening
Loong TW. Understanding sensitivity and specificity with the right side of the brain. BMJ 2003: 327:
Sedlmeier P and Gigerenzer G. Teaching Bayesian reasoning in less than two hours. Journal of Experimental Psychology: General. 130 (3): , 2001.
Glaziou , P. Centre of Evidence Based Medicine, Oxford.

3. I am here to learn EBM because ….
PRESENTATION ONE
11/09/2018
I am here to learn EBM because ….
I have no idea
I will be a practicing doctor
I will be working on researches
I will help others use evidence
I plan to teach EBM
Introduction to Evidence-Based Practice

4. Life long learning
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 preparation.
Born: 12-Jul-1849 Birthplace: Bond Head, Ontario, Canada Died: 29-Dec-1919 Location of death: Oxford, England
The Principles and Practice of Medicine (1892, For thirty years, the authoritative general medical text)
Sir William Osler ( ), from: The Student of Medicine Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford

5. What kind of doctor would you become ?
PRESENTATION ONE
11/09/2018
What kind of doctor would you become ?
Smart young doctor
William Osler, 1900
Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford
Introduction to Evidence-Based Practice

6. Do you want to get there ? Wise & experienced smart young doctor
PRESENTATION ONE
11/09/2018
Do you want to get there ?
Wise & experienced smart young doctor
Paul Glasziou , Centre for Evidence-Based Medicine University of Oxford
Introduction to Evidence-Based Practice

7. How is the construction building of Learning EBM like ?
Research design
Critical appraisal
EBM

8. EBM learning What is Evidence-based practice?
PRESENTATION ONE
11/09/2018
EBM learning
What is Evidence-based practice?
Asking well-formulated Questions
Searching for evidence
Critical Appraisal
Diagnostic studies
Intervention studies
Prognostic studies
Introduction to Evidence-Based Practice

9. Introductory Lecture: Objectives
PRESENTATION ONE
11/09/2018
Introductory Lecture: Objectives
1. What
What is evidence-based medicine?
What does it look like in practice?
2. How
Formulate Clinical Questions
Search for Evidence
Appraisal of research
Apply to clinical problem
Introduction to Evidence-Based Practice

10. What is evidence-based medicine?
PRESENTATION ONE
11/09/2018
What is evidence-based medicine?
“Evidence-based medicine is the integration of best research evidence available with clinical expertise and patient values” Dave Sackett
Patient
Concerns
Clinical
Expertise
Best research
evidence
EBM
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.
This definition of what EBM is and isn’t has gained wide acceptance and made it easier for us to get our points across.
Introduction to Evidence-Based Practice

11. PRESENTATION ONE
11/09/2018
Rule 31 – Review the World Literature Fortnightly* *"Kill as Few Patients as Possible" - Oscar London
5,000?
per day
1,500 per day
95 per day
Medical Articles Per Year
Introduction to Evidence-Based Practice

12. Is keeping up to date Mission Impossible?
PRESENTATION ONE
11/09/2018
Is keeping up to date Mission Impossible?
Bluegreenblog 2006
Introduction to Evidence-Based Practice

13. Coping with the overload: three possible things you might try
PRESENTATION ONE
11/09/2018
Coping with the overload: three possible things you might try
A. Read an evidence-based
abstraction journal (and cancel other journals)
B. Keep a logbook of your
own clinical questions
C. Run a case-discussion journal club with your practice
Introduction to Evidence-Based Practice

14. Reminding : The 4 steps of “pull” EBM
PRESENTATION ONE
11/09/2018
Reminding : The 4 steps of “pull” EBM
Formulate an answerable question
Track down the best evidence
Critically appraise the evidence
Individualise, based clinical expertise and patient concerns
Introduction to Evidence-Based Practice

15. Step 1 Formulate an answerable clinical question
PRESENTATION ONE
11/09/2018
Step 1 Formulate an answerable clinical question
Structure of researchable questions – PICO-T
Population/Patients
Intervention
Comparison
Outcome
Time
Introduction to Evidence-Based Practice

16. What are your clinical questions?
PRESENTATION ONE
11/09/2018
What are your clinical questions?
A 35 year old man says his brother recently died of an acute myocardial infarction He is worried about whether he might have one and what the chances are that it would happen to him
-> PICO Table
Introduction to Evidence-Based Practice

17. Types of question: stroke
PRESENTATION ONE
11/09/2018
Types of question: stroke
Cohort Study
Inception Cohort Study
Survey
Frequency
Prognosis
Risk Factors
ECG
Angiography
MRI
Degenerative process in the Coronary artery
Treatments
Randomised Trial
Treatment Effect
Symptoms
Signs, Tests
Cause(s)
Cross Sectional Study
Past current future
Introduction to Evidence-Based Practice

18. 2. Searching: finding good answers?
PRESENTATION ONE
11/09/2018
2. Searching: finding good answers?
Introduction to Evidence-Based Practice 27

19. Searching made easy  PRESENTATION ONE 11/09/2018
Introduction to Evidence-Based Practice

20. 3. Rapid Critical Appraisal
PRESENTATION ONE
11/09/2018
3. Rapid Critical Appraisal
It’s peer-reviewed, therefore it must be OK?
Introduction to Evidence-Based Practice 29

21. WORKSHEET FOR EACH STUDY TYPES
USE THE TOOLS
WORKSHEET FOR EACH STUDY TYPES

22. Step 4: Applying to the individual
PRESENTATION ONE
11/09/2018
Step 4: Applying to the individual
What do the results mean on average?
What do they mean for this individual?
Introduction to Evidence-Based Practice