Evidence Based Medicine

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Evidence Based Medicine

• Reda Kamel
• Professor of Rhinology
• Cairo University Egypt

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Evidence Based Medicine

• How should physicians fulfil their obligation to
  apply the latest and best evidence to the care of
  their patients?
• the average physician spends 30-60 minutes per
  week keeping up with the literature
• How many hours do you..?

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Evidence Based Medicine

• How to translate the evidence into decision in
  clinical practice ? patients may live better
  life.

Evidence
Decision
Decision Making
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Evidence Based Medicine

• The Five Steps of EBM
• Asking Answerable Questions
• Finding the Best Evidence
• Critically Appraising the Evidence
• Acting on the Evidence
• Evaluating your Performance Courses in EBM

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Evidence Based Medicine

• Problem ? Question
• Evidence ? Answer
• Appraisal Evaluation ? Decision
• Integrate Apply
• Evaluate performance Improve EBM

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Evidence Based Medicine
Question
Evidence
Appraisal
Apply
Improve
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Category of Evidence

• Ia Evidence from meta-analysis of randomized
  controlled trials
• Ib Evidence form at least one randomized
  controlled trial
• IIa Evidence from at least one controlled trial
  without randomization
• III Evidence from non-experimental descriptive
  studies, such as comparative studies, correlative
  studies, and case control study
• IV Evidence from experts committee reports
  opinion or clinical experience of respected
  authorities or both

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Strength of recommendation

• A Directly based on category I evidence
• B Directly based on category II evidence or
  extrapolated recommendation from category I
  evidence
• C Directly based on category III evidence or
  extrapolated recommendation from category I or II
  evidence
• D Directly based on category IV evidence or
  extrapolated recommendation from category I , II
  or III evidence

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Evidence Based Medicine
Ia Meta-analysis of RCTs
Ib At least one RCT
II Nonrandamized but controlled trials
III Other types of trials
IV Expert openion
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Category of Evidence
I
II
III
IV
V ?? XX
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Category of Evidence
CRTs
CTs
Others
Experience
Just because
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Strength of recommendation
CRTs
CTs
Others
Experience
Just because
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Strength of recommendation
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Evidence Based Medicine

• Evidence based medicine is an important method of
  preparing guidelines
• The implementation of guidelines is equally
  important

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Evidence Based Medicine

• How to translate the evidence into decision in
  clinical practice ? patients may live better
  life.

Evidence
Decision
Decision Making
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EBM Conclusions

• Difficult
• Time Consuming
• Not priority

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EBM Conclusions

• Evidence Based Evaluations
• Regularly updated summaries, to answer common
  important clinical questions

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Knowledge is Power

• www.redakamel.com
• rhinology_at_redakamel.com

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