1. Evidence-Based Medicine
Lecture 3
Kanar Hidayat

2. What is “evidence-based medicine?”
Introductory question for participants: “How would you define evidence-based medicine?”

3. Two essential questions…
What is the purpose of medicine?
How do I decide what to do?
You have to know where you’re going before deciding how to get there…
in medicine physicians must work with patients to decide on both overarching goals, and on the best way to reach those goals. In both travel and medicine, you have to know where you’re going before deciding how to get there.

4. What is the purpose of medicine?
Patient care
Public health
Research
Improving the quality of patients’ lives…
While medicine has many facets, including direct patient care, public health, and research endeavors, the common goal of all medical ventures is improving the quality of patients’ lives. This common underlying goal can serve as the “destination” to guide all medical journeys and endeavors, regardless of which facet or field of medicine is the stage for the patient’s medical journey.

5. What is evidence-based medicine?
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
Sackett, et al. BMJ 1996;312:71-72
This characterization highlights the three important parts of evidence-based medical practice: the patient, the evidence, and careful application of generalized evidence to the individual patient.
Konshiakas judeshias Wise))Consiankas( honest, faithfull), judeshias

6. Evidence-based medicine
Cost-effective
Better Health care
EBM and traditional medicine both take evidence into account, but EBM needs better evidence
One of the main achievements of EBM has been the development of systematic reviews and meta- analyses

7. How do I decide what to do?
How do I make decisions?
Dogma: “Natural is best”
Tradition: “We’ve always done it that way”
Convention: “Everyone does it this way”
Evidence-Based: “Evidence supports this way”
Some decisions are guided by dogma, or an a-priori set of beliefs (eg, “natural is best.”). Some decisions are guided by tradition (eg, “we’ve always done it that way”), relying on the collective wisdom of the ages. Some decisions are guided by convention (eg, “everyone else does it that way”), relying on the collective wisdom of colleagues. An evidence-based approach makes decisions based on critical evaluation and reflection (eg, “the evidence supports doing it this way”).

8. How do I decide what to do?
The answer is according to EBM: use of current best evidence!

9. Evidence types in EBM Meta-Analysis Randomized Controlled Trial
Systematic reviews

10. Randomized Controlled Trial

11. Meta-Analysis

12. Systematic reviews

13. Types of review articles
Reviews that are not systematic traditional narrative reviews'

14. Lecture 4 Kanar Hidayat 2016-2017
Level of Evidence
Lecture 4
Kanar Hidayat

15. Definition:
The National Cancer Institute defines levels of evidence as "A ranking system used to describe the strength of the results measured in a clinical trial or research study. The design of the study (such as a case report for an individual patient or a randomized double-blinded controlled clinical trial) and the endpoints measured (such as survival or quality of life) affect the strength of the evidence.

16. Evidence Pyramid
Systematic reviews and meta-analysis are situated at the top of what is known as the “Evidence Pyramid” (see figure below). As you move up the pyramid the amount of available literature on a given topic decreases, but the relevancy and quality of that literature increases. Systematic reviews and meta-analysis are considered to be the highest quality evidence on a research topic because their study design reduces bias and produces more reliable findings. However, you may not always be able to find (or need to find) the highest level of evidence to answer your research question. In the absence of the best evidence, you then need to consider moving down the pyramid

17. Meta-analysis Combines the results of different studies
Estimate an average or common effect.
The highest level for evidence based medicine!

18. Systematic Reviews
Identify all relevant published and unpublished evidence
Select studies or reports for inclusion
evaluate the quality of each study or report
Synthesize the findings from individual studies or reports in an unbiased way
Interpret the findings and present a balanced and impartial summary of the findings with due consideration of any fault in the evidence.
Bias= baiased = prejudge Impartial= natural assess= judge

19. Randomized control trails
RCT is a type of scientific(medical) experiment, where the people being studied are randomly allocated one or other of the different treatments under study. The RCT is often considered the gold standard for a clinical trial. RCTs are often used to test the efficacy or effectiveness of various types of medical intervention and may provide information about adverse effects, such as drug reactions.
Intervention = mee bemoeien

20. Cohort studies
a type of medical research used to investigate the causes of disease, founding links between risk factors and health outcomes.
Cohort studies are usually forward- looking
Retrospective cohort study; means to take a look back at events that already have taken place

21. Cohort studies
Cohort =unit

22. Case-control studies
a case-control study is always retrospective because it starts with an outcome then traces back to investigate exposures. Is designed to help determine if an exposure is associated with an outcome.

24. Using Pubmed