1. Evidence-based healthcare involves making clinical decisions based on current and valid scientific evidence rather than personal experience alone. This includes evidence-based medicine, public health, nursing, and other fields.
2. The process of evidence-based healthcare involves acquiring evidence through a systematic search of medical literature, appraising the evidence based on factors like validity and relevance to the clinical question, and applying high-quality evidence to individual patients while considering clinical judgement.
3. When searching medical literature, the PICO framework is used to design focused clinical questions that can be input into databases using controlled vocabularies and Boolean operators to retrieve the most relevant evidence. Studies are then appraised based on how directly and validly they
1. Evidence-based healthcare involves making clinical decisions based on current and valid scientific evidence rather than personal experience alone. This includes evidence-based medicine, public health, nursing, and other fields.
2. The process of evidence-based healthcare involves acquiring evidence through a systematic search of medical literature, appraising the evidence based on factors like validity and relevance to the clinical question, and applying high-quality evidence to individual patients while considering clinical judgement.
3. When searching medical literature, the PICO framework is used to design focused clinical questions that can be input into databases using controlled vocabularies and Boolean operators to retrieve the most relevant evidence. Studies are then appraised based on how directly and validly they
1. Evidence-based healthcare involves making clinical decisions based on current and valid scientific evidence rather than personal experience alone. This includes evidence-based medicine, public health, nursing, and other fields.
2. The process of evidence-based healthcare involves acquiring evidence through a systematic search of medical literature, appraising the evidence based on factors like validity and relevance to the clinical question, and applying high-quality evidence to individual patients while considering clinical judgement.
3. When searching medical literature, the PICO framework is used to design focused clinical questions that can be input into databases using controlled vocabularies and Boolean operators to retrieve the most relevant evidence. Studies are then appraised based on how directly and validly they
1. Evidence-based healthcare involves making clinical decisions based on current and valid scientific evidence rather than personal experience alone. This includes evidence-based medicine, public health, nursing, and other fields.
2. The process of evidence-based healthcare involves acquiring evidence through a systematic search of medical literature, appraising the evidence based on factors like validity and relevance to the clinical question, and applying high-quality evidence to individual patients while considering clinical judgement.
3. When searching medical literature, the PICO framework is used to design focused clinical questions that can be input into databases using controlled vocabularies and Boolean operators to retrieve the most relevant evidence. Studies are then appraised based on how directly and validly they
Current best evidence is up-to-date information to look at the effects of different forms of health care, the harm from treatment, the accuracy of diagnostic tests and the prognostic factor - Evidence-based {Public Health, Medicine, Physical Therapy, Nutrition, Nursing , so on….}
Clinic decisions are based on experience with a population of patients rather
than on personal or other experience of doc or other health care workers.
Evidence-based medicine (EBM):
Is a systematic approach to the acquisition, appraisal, and application of research evidence to guide decisions in healthcare.
Why do we need EBM?
Major concerns are that 1- clinical decision bases on personal experience NOT current valid scientific evidence 2- Information sources as books do not often provide current valid scientific evidence to make clinical decisions Example:
Summary: If you require evidence based real time information, you should not consult textbooks What are the skills of EBM ? Acquiring the evidence Appraising the evidence Applying the evidence
PG. 1 Chapter 1: Evidence-based Healthcare
1. Step 1: Acquiring the evidence
Determine the type of question to select the best source of information
1.1: Ask a focused clinical question (what is the problem?)
We use PICO framework to design a research questions to ask database.
P à Patient or Problem or Population I à Intervention or exposure What are the patient’s characteristics (age, What main intervention is being considered gender) with the problem? (medication or exercises)? C* à Comparison or Control (placebo) O à outcome What is the main alternative comparison What is the desired effect being treatment(s) being considered? considered? And What are the side effects? * Comparison is not always present in a PICO analysis
There are five type of questions: {Therapy, Prevention, Diagnosis, Prognosis and Etiology}
PG. 2 Chapter 1: Evidence-based Healthcare Examples: In adults with depression, Is Duloxetine (DE) more effective than Therapy Escitalopram (EM)in relieving depressive symptoms? In hypertensive patients, does the use of Calcium channel blockers prevention (CCBs) as compared to angiotensin-converting enzyme (ACE) reduce the risk of progression to end-stage renal disease? In stroke patients, is CT scan more accurate than 2D-Doppler Diagnosis unltrasound for diagnosis of carotid artery disease? In low-back pain (LBP) patients, Treated with opioids with in the first prognosis two week of LBP onset what is the probability of work disability at 3 months? Among college students, by how much does smartphone addiction etiology (SPA) Increases the risk of dry eye disease?
1.2: Searching the medical literature
à PICO framework is the gateway to medical literature, why?
è Databases don’t understand questions or sentences è Databases classify articles according to separated PICO elements è Databases obtain information by processing the PICO elements connected together by Boolean operators (AND, OR, NOT)
§ Point 1: Are obesity people an increased risk of mortality from covid-19 as compared to non-obesity people? à P (concept1) àO (concept3) à I (concept2) Extract Key Concepts an abstract idea, which can usually be presented in more than one way with words & phrases in the text of articles E.g. Smartphone and students.
§ Point2:
PG. 3 Chapter 1: Evidence-based Healthcare § Point3: Medical Subject Headings (MeSH) to obtain Controlled vocabulary and Keywords
Controlled vocabulary: a standardized representation of concepts in bibliographic databases
E.g. the controlled vocab for mobile phone in PubMed is cell phone. Example1:
Concept 1 Concept 2 Concept 3
indicate MeSH term
§ Point4: Boolean operator
Why this point is important? to select all possible papers.
Concept 3
Concept 2
Concept 1
39K
1.3M 1.6M
1.3: Retrieving the medical literature and get copy
PG. 4 Chapter 1: Evidence-based Healthcare
2. Appraising the evidence
(Do we have to read all 164 articles ? This step is to assess the evidence by reading abstract.) 2.1: Appraising directness à Directness: How well the PICO in the article corresponds to the PICO of your clinical question.
2.2: Appraising validity
à Validity: Will we believe it ? 1) Internal validity: the study was designed and it is free from bias (accurate results) - Bias: systematic deviation of the findings from the truth, which leads to under- estimation or over-estimation of the outcome measure. 2) External validity: the results of the study are applicable to your patient or population (generalizability).
2.3: Appraising the results Does it work?
1- 𝐄𝐟𝐟𝐞𝐜𝐭 𝐬𝐢𝐳𝐞: is magnitude of effect of intervention (exposure) on the outcome of interest Ex: smoking (smoker) and heart attack
2- which measure is it used to present the relationship?
Mean difference, relative risk reduction, absolute risk reduction, sensitivity, specificity, likelihood ratio, odds ratio, hazard ratio, etc.
3- The aim is to decide if the observed effect is clinically relevant
E.g.: Drug A reduce the weight 5 kg /3 months and Drug B reduce the weight .5 kg/3months Drug A is clinically relevant.
Scientific articles may simply be untrue , why?
• small 𝐞𝐟𝐟𝐞𝐜𝐭 𝐬𝐢𝐳𝐞 • tiny clinically relevant • invalid measure analyses • conflicts of interest
3. applying the evidence
3.1 Assessing applicability: - the results of a study can be expected to hold true for a particular patient - Consider the biologic & socio-economic differences
3.2 Individualization (the results how will affect my patient):
• Studies report the average effects of interventions at group level • We deal with individual patients whose responses may not be average • The effect is based on patient
3.3 Sharing the decision
- Help the patient understand the quality of the evidence - Respect patient/population values - Assess performance of the patients
Evidence does not abolish your clinical judgement, evidence is just a guide PG. 5 Chapter 1: Evidence-based Healthcare
Classification system for EBHC resources
1) Hierarchy of evidence in primary studies Systematic review is a study deign has strongest evidences.
Your goal is to identify
the strongest source of evidence to answer your focused clinical question
2) Level of processing of the evidence
a) Primary studies Disadvantage:[complex & time consuming, huge data(20M papers are published annually)]
b) Systematic reviews (why have strongest evidence?)
a study type that assesses the results of all studies addressing a research question & provides a summary estimate of effects across studies. It includes quality of methodology of included studies and Meta-analysis (statistical technique that combines the results of several studies in a single weighted estimate of effect size)
c) Clinical guidelines statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.
Epidemiology The study of the occurrence, states, and processes in specified populations, including the study of the determinants influencing such processes, and the application of this knowledge to control relevant health problems.
PG. 6 Chapter 1: Evidence-based Healthcare
Study designs ( Epidemiology)
Clinical Epidemiology “The application of epidemiological knowledge, reasoning, and methods to study clinical issues and improve clinical care”
Biostatistics Refers to the application of statistical principles & methods to test research questions in healthcare
Epidemiology (research designs) & biostatistics (statistical tests) provide
information (research evidence) to inform clinical decisions (EBHC)
