Evidence-Based Medicine

and Application

What is EBM
Evidence-based medicine (EBM)
is the integration of
- The best research evidence
- Clinical expertise
- Patient values
conserns and expectations)
Patient circumstances

Clinical Decision

Best research evidence

valid and clinically relevant
research
from the basic sciences of medicine
from patient-centered clinical
research
the accuracy of diagnostic tests
(including the clinical examination),
the power of prognostic markers,
and the efficacy and safety of
The therapeutic,
evidencerehabilitative,
can help and
us
preventive
support
theregimens
patient care

process

Clinical expertise
The ability to use our clinical skills
and past experience to rapidly
identify:
each patients unique health state and
diagnosis,
their individual risks and benefits of
potential interventions,
their personal circumstances and
expectations

Patient values
The unique preferences,
concerns
and expectations and circumstances
( clinical state and setting)

each patient brings to a clinical

encounter and all of them must be
integrated into
clinical decisions if they are to serve
the
patient

The results of the Integration of the

three elements
Clinicians and patients form a
diagnostic and therapeutic alliance
which optimizes clinical outcomes
and quality of life

 The practice of EBM is usually

triggered by patient encounters
which generate questions about
the effects of therapy, the utility
of diagnostic tests, the prognosis
of diseases, or the etiology of
disorders

The evidence
does not make a decision
it can help support the patient care
process
enhances the opportunity for optimal
clinical outcomes and quality of life
generate questions about the effects of
therapy, the utility of diagnostic tests, the
prognosis of diseases, or the etiology of
disorders
requires new skills of the clinician,
including efficient literature-searching, and
the application of formal rules of evidence
in evaluating the clinical literature.

The Steps in the EBM

Process
Step 1. (The patient) Start with the patient
-- a clinical problem or question arises out
of the care of the patient .Converting the
need for information (about prevention,
diagnosis, prognosis, therapy, causation,
etc.) into an answerable question.
Step 2. (The question) Construct a well built
clinical question derived from the
caseTracking down the best evidence with
which to answer that question
Step 3 (The resource and Evaluation) Select
the appropriate resource(s) and conduct a
searchCritically Appraising that evidence for
its validity (closeness to the truth), impact
(size of the effect), and applicability
(usefulness in our clinical practice)

The Steps in the EBM Process

(contd)
Step 4 (Return to The patient)
Integrating that evidence with clinical
expertise and with our patients
unique biology, values, and
circumstances patient preferences
and apply it to practice
Step 5 (Self-evaluation) Evaluating
our effectiveness and efficiency in
executing steps 1-4 and seeking ways
to improve them both for next time
and evaluate our performance with
this patient

The practice of evidence-based

medicine

process of lifelong
self-directed
problem-based learning
need for clinically important
information about diagnosis,
prognosis, therapy and other clinical
and health care issues

WHAT ARE THE LIMITATIONS OF

EBM?
practice of EBM naturally engenders
negative and positive reactions from
clinicians
EBM is not an effective cost-cutting
tool

Thank You