Evidence Based Medicine Antonius Nugraha Widhi Pratama, Apt. Bag Farmasi Klinik dan Komunitas Fakultas Farmasi Universitas Jember

Reference Glasziou, P., Del Mar, C., 2003, Evidence-based Medicine Workbook Finding and applying the best evidence to improve patient care, London: BMJ Publishing Group Some BMJ articles

Tugas minggu lalu Apakah yang dimaksud dengan EBM? Mengapa EBM penting untuk saat ini dan di masa mendatang? Siapa sajakah yang membutuhkan EBM? Sebutkan situs-situs manakah di internet yang menyajikan informasi EBM? Jelaskan dengan singkat dan jelas langkah-langkah dalam melakukan EBM! Apakah yang dimaksud dengan level of evidence Ib dan grade of recommendation A?

What is EBM? “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S., 1996. Evidence based medicine: what it is and what it isn’t. BMJ 312, 71 -72.

EBM ... Replaced the older term ‘clinical epidemiology’ and synonimous with ‘evidence-based practice’. The ‘evidence’: empirical evidence about what actually works or doesn’t work in practice. EBM is about actual clinical outcomes.

Why Do We Need EBM? Large info gap: research and clinical practice Overloaded research information Not easily accessible for busy practitioner

Why Do We Need EBM? Bridge of the gap: systematic reviews Speciality by speciality

Farmasis Klinik dan EBM Untuk membantu dokter (tim) dalam memberikan keputusan klinis Untuk layanan informasi obat dan pengobatan kepada pasien ataupun tenaga kesehatan lain

Steps in EBM Formulate an answerable question Track down the best evidence of outcomes available Critically appraise the evidence (ie find out how good it is) Apply the evidence (integrate the results with clinical expertise and patient values) Evaluate the effectiveness and efficiency of the process (to improve next time)

Steps in EBM 1. Formulate an answerable question

Steps in EBM 1. Formulate an answerable question A 28-year-old male presents with recurrent furunculosis for past 8 months; these episodes have been treated with drainage and several courses of antibiotics but keep recurring. He asks if recurrences can be prevented.

Steps in EBM 1. Formulate an answerable question George has come in to your surgery to discuss the possibility of getting a vasectomy. He says he has heard something about vasectomy causing an increase in testicular cancer later in life. You know that the risk of this is low but want to give him a more precise answer.

Steps in EBM 1. Formulate an answerable question Jeff , a smoker of more than 30 years, has come to see you about something unrelated. You ask him if he is interested in stopping smoking. He tells you he has tried to quit smoking unsuccessfully in the past. A friend of his, however, successfully quit with accupuncture. Should he try it? Other interventions you know about are nicotine replacement therapy and antidepressants. Population/patient? ................... Intervention/indicator ? .............. Comparator/control ? ................... Outcome ? ...........................

Steps in EBM 1. Formulate an answerable question Susan is expecting her first baby in two months. She has been reading about the potential benefits and harms of giving newborn babies vitamin K injections. She is alarmed by reports that vitamin K injections in newborn babies may cause childhood leukaemia. She asks you if this is true and, if so, what the risk for her baby will be. Population/patient? ................... Intervention/indicator ? .............. Comparator/control ? ................... Outcome ? ...........................

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available [smoking patient] AND [acupuncture OR nicotine replacement therapy] AND [success]

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available Acupuncture and related therapies do not appear to help smokers who are trying to quit.

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available

Steps in EBM 2. Track down the best evidence of outcomes available Dipiro, JT;2007 ; 7th Ed., Infectious Disease

Steps in EBM 1. Formulate an answerable question

Were the groups of subjects representative and comparable? Steps in EBM 3. Critically appraise the evidence (ie find out how good it is) Were the groups of subjects representative and comparable? Was the outcome measurement accurate? Was a placebo used? Could the results have been due to chance? Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of Pharmaceutical Education, 71 (4) Article 63

Berlatih EBM Secara Mandiri Apakah zinc dapat memperpendek durasi diare? Apakah probiotik baik untuk digunakan pada diare akibat antibiotik pada anak? Apakah beta-blocker baik untuk hipertensi? Apakah barbiturat baik untuk digunakan pada pasien geriatrik?

Internet Sources of EBM http://www.cochrane.org http://www.evidence-basedmedicine.com http://www.clinicalevidence.com http://www.bestbets.org http://sumsearch.uthscsa.edu/searchform45.htm http://www.urmc.rochester.edu/miner/educ/ebnfi lt.htm http://www.cchs.usyd.edu.au/pedro http://www.jr2.ox.ac.uk/bandolier/whatnew.html http://www.tripdatabase.com

TERIMA KASIH EBM