Evidence-based Case

Report

Kartiwa Hadi Nuryanto

Division of Gynecology Oncology, Department of Obstetrics
and Gynecology
Faculty of Medicine, University of Indonesia, Dr Cipto

"Evidence-based medicine is the

integration of best research evidence
with clinical expertise and patient
values."

What is
idence-based Medicine
Sackett, D. L. (2000).Evidence-based medicine: How to
practice and teach EBM(2nd ed.). Edinburgh; New York:
Churchill Livingstone.

 Evidence-Based Medicine (EBM)

Evidence-Based Practice (EBP)
Evidence-Based Clinical Practice
(EBCP)
Evidence-Based Health Care (EBHC)
Evidence-Based Nursing (EBN)
Sacketts definition refers to all of these;
EBP and EBHC are more universally
used.

EBP :

EBM :

1.Assess the patient

2.Ask the question
3.Acquire the evidence
4.Appraise the evidence
5.Apply: talk with the
patient

1.Ask focused
question
2.Find the evidence
3.Appraise the
evidence
4.Make a decision
5.Evaluate
performance

(from Introduction to Evidence

Based Practice tutorial)

 Clinical expertise: the clinicians

cumulated experience, education, and
clinical skills
Patient values: The patient brings to the
encounter his or her own personal and
unique concerns, expectiations, and
values.
Best Research Evidence: usually found in
clinically relevant research that has
been conducted using sound
methodology

What is Evidence-based Case

Report
A form of implementation of EBP
Used in various steps in managing
patients
Usefulness of information :

Low

Validity

High

High
quality =
valid &
relevant
informatio
n

Composition of EBCR
Case

Case Report

Question
s

Clinical questions (PICO)

Methods

Searching strategies based on

evidence-based
Critical appraisal

Result

Selected articles (table?)

Discussio
n

Strength and Weakness of the articles

Conclusio
n

Solution for patients problems

Case series and Case

reports
Collections of reports on the
treatment of individual patients or
a report on a single patient.
No control groups with which to
compare outcomes, so limited
statistical validity.

Forming a question
Identify key patient problem
Phrased to facilitate finding an
answer
What treatment might be
considered
Alternative treatments to consider
Outcome to avoid or promote

PICO
P
I

= Patient or problem
= Intervention, prognostic
factor,
or exposure
C = Comparison
O = Outcomes
Depending on types of study

Methods
Searching strategies :
PubMed, Medline, Ebsco, Springerlink,
Sciencedirect, Elsevier, Cochrane
Appropriate key word(s) And, Or, Not
PICO
Study design, inclusion-exclusion criterias
Flowchart

Critical appraisal
Number of articles
Abstract versus full text paper
Table

Database

Search strategy

Pubmed

Therapy/Broad[filter] AND
(diabetes[Title/Abstract] AND
statin[Title/Abstract]) AND
"cardiovascular"[Title/Abstract])
AND prevention[Title/Abstract])

Embase

diabetes/exp AND statin/exp

AND cardiovascular AND
prevention/exp AND human/de

Cochrane statin AND diabetes AND

cardiovascular

Hits

Selection
articles
253
5

217

Flow Chart

Critical Appraisal
Sample relevance
Population, intervention, indicator,
outcome
Differences, similarities

Study validity
Bias
Confounding

Study Design Based On Type of

Question
Diagnosis

Prognosis

Therapy

Etiology

Prediction

Presence/absenc Progression of the

disease
e of disease

Result of
intervention

Risk factor / etiology

Patient

Patients
suspected of
having the
disease

Pasien (has been

diagnosed) that at
risk of an incident

Pasien (has been

diagnosed) that at
risk of an incident

Population at risk

(Indicator/
Comparison)

As in practice

As in practice

Manipulation

As in practice;
exposure/risk

Outcome

The result of
standard tests

Mortality, morbidity, Mortality, morbidity,

quality of life
quality of life

Study Design

Cross-sectional

Prospective

Prospective

Prospective
, case-control

Outcome
Measurement

Absolute risk

Absolute risk

Relative risk /
Difference in risk

Relative risk

Mortality, morbidity,
quality of life

Results
Best available evidence
PICO
Relevance and vailidty

Precision
Consistency
Differences

Discussion
Interpretation of the best available
evidence
Recommendation for the patients
Reason fo the recommendation

Thank You