Introduction to the Principles of Evidence-Based Medicine - PowerPoint PPT Presentation

About This Presentation
Title:

Introduction to the Principles of Evidence-Based Medicine

Description:

Introduction to the Principles of Evidence-Based Medicine and Evidence-Based Dentistry Dr. Kannika Chukiatmun DDS., MD. Feb 2002. ... – PowerPoint PPT presentation

Number of Views:445
Avg rating:3.0/5.0
Slides: 59
Provided by: Institute57
Category:

less

Transcript and Presenter's Notes

Title: Introduction to the Principles of Evidence-Based Medicine


1
Introduction to the Principles of Evidence-Based
Medicine and Evidence-Based Dentistry
Dr. Kannika Chukiatmun DDS., MD. Feb
2002.
2
????????????????????????????
?????????????????????????
??????????????????????????
????????????????????
3
?????????????
???????
?????
???????????????
?????????????????
4
??????????????????????????
?????
???????
????????????????????????????
????????
5
?????????????????????????????????????????????????
????????? ???????????????????????????????????
??????????????????????????? ??????????????????????
?????????? ??????????????????????????????????
???????????????????????????????????????????????
???????????????????????????????????????????
Evidence-Based Medicine
????????????????
6
?????????????
  • ?????????????????????
  • ???????????????
  • ???????????????
  • ???????????????????????????????????
  • ????????? ????????? ????????????????

7
?????????? Evidence-based
1. Clinical experience ? ? Evidence
2. Basic pathophysiologic knowledge ? ? new data
3. Intuition ? ? critical appraisal
4. Expert opinion ? ? all
8
Previous recommended treatments
Systematic review CPG
??????????? ???????????? ?????
?????
Searching of evidence Critical appraisal
New regimen of treatments
9
Clinical decision making
Patient circumstance
Evidence from research
Preferences Value Right
10
Evidence-based policy-making
Value for money in terms of marginal and
opportunity costs
Resources
Values
Evidence
Data about public preferences
Evidence about cost-effectiveness
11
Dentistry
  • 1. Shifts in health care technology
  • molecular biology
  • infection control
  • material science
  • management system
  • (Health care improvement / Computer assist)

12
Dentistry
  • 2. Increasing information
  • Dentist / patient
  • Research / published data
  • Academy
  • Company
  • (Information Technology)

13
Dentistry
  • 3. Patients role in treatment plan
  • Patients right
  • Insurance system
  • Health care reform

14
Identify clinical problems
Search for evidence
Up date evidence
Discard Store
Make sense of evidence
Act on evidence
(D.Rucgards and A.Lawrence Evidence based
dentistry.BDJ 1995179270-273)
15
EBD organizations
  • Center for EBD -U.K.
  • Cochrane collaboration oral health group
  • - U.K., Canada, Australia, New Zealand
  • - USA
  • - Germany, Denmark, Switzerland
  • - Japan etc.

16
EBD organizations
  • European cochrane centers
  • -Aarhus (Denmark)
  • K containing tooth paste in
    hypersensitivity
  • - Cork (Ireland)
  • Endodontics

17
EBD organizations
  • Scandinavian Society for prosthetic
  • Small groups / Individual partners
  • - Malta (Surgery)
  • - Switzerland (Cost-efficiency)
  • - Netherland (Radiography)

18
Activity
  • Collecting and exchanging information
  • Reviewing of evidences
  • Quality control of research and publication
  • Clinical Practice Guideline
  • Evidence-based journals
  • EBM Tool/Notes/Hand books
  • Training the tutors

19
Restorative Dentistry
  • Toxic from amalgam filling
  • Dental restoration What type of filling?

Preventive Dentistry
  • Fluoride gel application

Oral Surgery
  • Prophylaxis removal of 3rd molar

20
Obstacles
  • 1. Lack of information about EBD
  • 2. Revision of the quality of dental research
  • - Small number of clinical trials
  • - Gray zone in dentistry
  • - Gap knowledge

21
Obstacles
  • 3. Training and continuing education
  • 4. Application in day-to-day practice
  • 5. Community

22
EBD
  • .. must always be regarded as an adjunct to,
    and not as substitute for, sound clinical
    judgement and patient preferences
  • (Asbjorn Jokstad EBD, NOV.1998)

23
Evidence-Based Dentistry
Practical Approach Dr.Kannika Chukiatmun
DDS.,MD. Feb 2002
24
?????????????
  • ?????????????????????
  • ???????????????
  • ???????????????
  • ???????????????????????????????????
  • ????????? ????????? ????????????????

25
?????????????
  • 1. ?????????????????????
  • P Patient Whom is it
    about ? Population
  • I Intervention Which manoeuvre ?
    Intervention
  • C Comparison
  • O Outcome What
    outcome ? Out come - Out put
  • - Impact
  • Clinical significance

26
Asking Clinical Problems
  • P - Patient / Situation
  • I - Intervention
  • (Therapy / Diagnosis / Prevention /
    Management / Economic / Exposures / Causes /
    Prognostic factors)

27
Asking Clinical Problems
  • C - Comparison
  • (Placebo / Standard methods)
  • O - Outcome
  • (Best result / negative or positive effect)

28
Where do clinical questions come from?
  • Clinical evidence How to gather clinical
    findings properly and interpret
  • them
    soundly?
  • 2. Diagnosis How to select
    and interpret diagnostic tests?
  • 3. Prognosis How to
    anticipate the patients likely cause?
  • 4. Therapy How to select
    treatments that do more good than harm?
  • 5. Prevention How to screen and
    reduce the risk of disease?
  • Education How to teach yourself,
    the patient, and the family what is
  • needed?

29
(No Transcript)
30
?????????????
  • ???????????????
  • Libraries
  • Specialist information centers
  • Information resources / Databases
  • Internet sites
  • Journals / Books / Gray Literature / Other
    materials
  • Experts opinion / Peer Reviews / Colleagues
    etc.

31
3 way of finding things on the web
  • - Direct tip offs
  • - Serendipity
  • - A Systematic Search

32
?????????????
  • 2. ???????????????
  • - ???????????????
  • - ??????????????????????? / ????????
  • - ????????? EBM / EBD

33
???????????????
  • 1. ???????????????
  • Search Engines
  • - Hot Bot - Google - Excite
  • - Infoseek - Yahoo
  • - Alta Vista - Northern Light
  • Meta Search Engine
  • - Dogpile - Meta Crawler
  • - Cyber 411 - Pre Fusion

34
???????????????
  • 1. ??????????????? (???)
  • Specialty databases
  • - The Internet Sleuth
  • - Beaucoup
  • - Search . com

35
???????????????
  • 2. ????????????????????
  • ENTREZ Inspec
  • BioMedNet MATH SCI etc.
  • STN International
  • Metadex

36
???????????????
  • 3. ????????????????????
  • MEDLINE HTA
  • OMNI Health STAR
  • CINAHL AIDSLINE
  • EMBASE CANCERLIT etc.

37
???????????????
  • 4. ????????? EBM / EBD
  • EB Web sites/ ScHARR (Netting the Evidence)
  • The Cochrane Library
  • Best Evidence
  • TRIP
  • CASP etc.

38
Search rules and syntax
  • Boolean logic - AND, OR, NOT (BUT NOT)
  • Proximity operators - ADJACENT
  • - NEAR
  • - FOLLOWED BY etc.
  • Implied boolean - /-,

39
Search rules and syntax
  • Ctrl - F
  • Book mark
  • Truncation (, , )
  • Wild cards (?)

40
Search features
  • 1. Phrase searching
  • 2. Tresaurus searching
  • 3. Field searching

41
Field searching
  • Term (field / tag) Operator Term (field / tag)

42
EBM Search
  • Usefulness Relevance x Validity
  • Effort

43
Seeking the evidence
  • 1. Medline search (Vendors, IGM, PubMed)
  • 2. Cochrame library and DARE database
  • 3. Best evidence CD-ROM
  • (Access via TRIP, DARE, IDEA)
  • 4. Health star HTA sites (Via IGM)
  • 5. NHS Economic Evaluation Database (NEED CRDS)

44
Seeking the evidence
  • 6. TRIP Database (18 databases of EB linkes)
  • 7. Internet Database of EB Abstracts and Articles
    (IDEA)
  • 8. Clini web, OMNI Net Medicine Med Finder
  • 9. Lists of topic covered by EB Information units
  • - ARIF (Aggressive Research Intelligent Unit)
  • - NZHTA (NZ Health Technology Assessent Clearing
    House)
  • 10. Academic/Institution/Gov. report.

45
Where to next?
  • - Health related Web
  • - Search engines

46
?????????????
  • 3. ??????????????? (Critical Appraisal)
  • - Level of evidence, Type of evidence,
  • Study design and the
    pitfalls, Statistics used
  • - Users guide to medical literature
  • - Others guidelines /
    Modifications etc.

47
In vitro (test tube) research
The Evidence Pyramid (Research design hierarchy)
Randomized Controlled Double Blind Studies
Randomized Controlled Studies
Cohort Studies
Case Control Studies
Case Series
Case Reports
Ideas, Editorials, Opinions
Animal research
In vitro (test tube) research
48
Type of evidence
  • Primary studies
  • - Therapy
  • - Diagnosis
  • - Harm
  • - Prognosis

49
Type of evidence
  • Secondary studies
  • - Overview / Systematic review
  • - Practice Guidelines
  • - Decision Analysis
  • - Economic Analysis

50
Appropriate study designs
Qualitative Cross Sectional Case-controlled Cohort RCT Systematic review
Diagnosis ? ?? ???
Therapy ? ??
Prognosis ???
Screening ? ? ?? ???
View/beliefs perceptions ???
Prevalence/hypothesis generation ??? ???
51
Critical appraisal(The assessment of
methodological quality)
  • Evidence ? Quality rating ? Evidence table
  • Graded recommendation ? Considered judgment

    (Strength of evidence)

52
Meta-analysis Systematic reviews
Quality rating
Randomized controlled trials
Quality rating
Evidence table
Observational studies
Quality rating
Graded recommendation
Non-analytic studies
Considered judgment (Strength of evidence)
Expert opinion
53
Appraisal StrategyMethods for doing an
assessment of the strength of evidence
  • Range from quick scoring system to exhaustive
    analysis of methodology, statistics and
    reporting.
  • Anderson 2000

54
Quality of Evidence
  • Hierarchy of evidence
  • The Check List for quality of the evidence
  • Validity
  • Clinical important
  • Relevance

55
Quality of Evidence
  • The Method for Check Lists construction
  • IMRAD format
  • Introduction (WHY the author did?)
  • Method (HOW they did?)
  • Results (WHAT they found?)
  • Discussion (WHAT is that means?)
  • CONSORT and QUORUM (for RCT and Meta-analysis)

56
Evidence table
  • I D of the evidence
  • Design
  • Validity
  • Results
  • Rating -Yes / No / Not sure / N/A
  • - 5 / 4 / 3 / 2 / 1 etc.
  • Balancing table / Comparing table

57
Meta-analysis Systematic reviews
The Criteria reports
Quality rating
Randomized controlled trials
Quality rating
Evidence table
Observational studies
Quality rating
Graded recommendation
Non-analytic studies
Considered judgment (Strength of evidence)
Expert opinion
58
Remarks
Write a Comment
User Comments (0)
About PowerShow.com