Proof BASED MEDICINE for Beginners

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Prove BASED MEDICINE for Beginners Maria Fidelis Manalo, MD, Msc Epidemiology Department of Community & Family Medicine FEU-NRMF Medical Center Philippines

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Evidence-Based Medicine Definition "the faithful, express and sensible utilization of current best confirmation in settling on choices about the care of the individual patient" David Sackett

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EBM Historical Evolution Has attaches about-facing to nineteenth c.  Recently expanded enthusiasm because of data blast that expanded significantly in the most recent decade. Has turned out to be more formalized that have empowered specialists to approach restorative issues and assess medicinal writing with more noteworthy consistency and to manage huge measures of therapeutic data through a subjective approach.

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EBM Usefulness Instead of routinely looking into the substance of many diaries for intriguing articles, EBM proposes that you focus on your perusing to issues identified with particular patient issues as encountered.  This makes EBM a long lasting self-coordinated and issue based learning process.

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Misapprehensions & Misinterpretations about EBM 1) Evidence-based medication overlooks clinical experience and clinical instinct. 2) Understanding of essential examination and pathophysiology has influence in confirmation based medication. 3) Evidence-based prescription overlooks standard parts of clinical preparing, for example, the physical examination.

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Types of Questions

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(1) Background Questions Asked for general information about a disorder  Has two essentials parts: a question root ( who, what, where, how, why) with a verb a confusion

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Background Questions Textbooks answer foundation questions, they contain gathered & orchestrated intelligence for themes that don't change often.  Not all points are secured, simple to utilize, moderately cheap and can be feeling based instead of confirmation based, composed by specialists in their fields.

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(2) Foreground Questions Asked for particular learning about overseeing patients with a confusion It has 4 segments ( PICO investigation): P - Patient/Population I - Intervention C - Comparison O - Outcome

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Basis of Evidence-based care includes the combination of the best research prove with clinical mastery and patient values.             Best Clinical Evidence Patient's Needs/Preferences Clinical Experience

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Foreground Information Background Information Novice Expert Searcher At all stages you solicit both sorts from inquiries, yet as experience expands the forefront questions increase.  It is vital that you comprehend the foundation address before endeavoring to answer the closer view ones.

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EBM Principles 1. Build a well-constructed clinical question and group it into one classification (treatment, determination, etiology or forecast) 2. Discover the confirmation in social insurance writing 3. Basically assess or formally assess for legitimacy and convenience 4. Coordinate the confirmation with patient components to complete the choice 5. Assess the entire procedure

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PICO ANALYSIS Before endeavoring to look for the proof in the writing, build a well-manufactured or obviously organized question that could be broken into the accompanying four sections

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(1) P atient/P opulation What is the essential issue, ailment or existing together conditions?  On what bunches do you need information?   How might you portray a gathering of patients like the one in question?   Sometimes age or sex of a patient might be pertinent and ought to be included.  Example: post-menopausal ladies with hypertension

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(2) I ntervention What therapeutic occasion would you like to study the impact of?   Which primary intercession would you say you are thinking about, endorsing a medication, requesting a test, requesting surgery?. . . . Illustration: ERT

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What medicinal occasion would you like to study the impact of?   Which principle intercession are you considering, endorsing a medication, requesting a test, requesting surgery. . . . Case: ERT. (3) C omparison Compared to what?   Better or more awful than no intercession at all or than another intervention?   What is the fundamental other option to contrast and the mediation, would you say you are attempting to settle on two medications, a medication and a fake treatment, or two symptomatic tests?  Sometimes there is no comparison.   - Example: no ERT

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(4) O utcome What is the impact of the intervention?  What do you want to fulfill, measure, enhance, or influence with this intervention?  What are you attempting to accomplish for the patient, assuage or kill the indications, diminish reactions, lessen cost? .. . Illustration: enhance personal satisfaction

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What makes a clinical question well manufactured? Question ought to be straightforwardly important to the current issue. Question ought to be stated to encourage looking for an exact reply. Asking a well-fabricated question, in the same way as other clinical abilities, needs rehearse.

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Categories of EBM Questions After building the PICO examination, decide the classification of the question.  There are the four classifications of EBM inquiries

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1) Therapy Solves addresses about which treatment to manage, and what may be the result of various treatment options.  For most therapy questions one might need to search for the best proof specifically a randomized controlled study, and if the study can be a twofold visually impaired, so much the better.  - Example: discover the confirmation for the utilization of anticoagulants in patients with atrial fibrillation

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2) Diagnosis Solves addresses about degree to which a test is solid and clinically valuable, to choose whether the patient would profit by it Most articles look at aftereffect of a specific demonstrative test with that of a standard test viewed just like a "gold standard".  - Example: scan for the best symptomatic test for Alzheimer's malady  

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3) Etiology Solves issues about the relationship between an ailment and a conceivable cause - Example: see whether an eating regimen rich in immersed fats expands the danger of coronary illness, and if so by how much

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4) Prognosis Answers addresses about a patient's future wellbeing, life expectancy and personal satisfaction in the occasion one picks a specific treatment choice - Example: discover how might the personal satisfaction change for a patient who experiences surgery for prostate cancer  The following stride is decide the best study plan expected to answer the clinical question.

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Types of Research Studies Certain study outlines are better than others while noting specific inquiries. RCT are viewed as the best to address addresses about treatment. Etiology inquiries might be tended to by case-control & partner studies.  Other perspectives applicable to study plan incorporate fake treatment correlation assemble and development.

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1) Randomized Controlled Trial (RCT) A nswers treatment, aversion questions Randomization maintains a strategic distance from choice predisposition

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2) Cohort ponder Answers forecast, etiology, avoidance questions Cohorts are characterized populaces that, all in all, are followed trying to decide recognizing subgroup characteristics.   Researchers distinguish and think about two gatherings over a time of time. 

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2) Cohort learn At the begin of the study, one of the gatherings has a specific condition or gets a specific treatment, and alternate does not.  At the end of a specific measure of time, specialists contrast the two gatherings with perceive how they did. 

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3) Case Control consider Answers visualization, etiology, anticipation questions Identifies patients who as of now have the result of premium and control patients without that result, and think back to check whether they had the presentation of premium or not.  

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4) Case arrangement & Case Reports  Answers guess, etiology, counteractive action questions Consist both of accumulations of reports on the treatment of individual patients, or of reports on a solitary patient.