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Introduction to Evidence Based Medicine reason for existingo.tant thing is not to stop questioning. Curiosity has its own Albert Einstein Dr Aybaniz Ismayilli Clinical Research FellowProgramme  Introduction  About me  What is Evidence Based Medicine?  Why it matters?  5 Steps of EBM  Assess the patient  Formulating a Question  Searching for Evidence  Critical Appraisal of Evidence  Applying Evidence in Practice  Challenges and Limitations  Interactive Session  19/11/2024 Dr Aybaniz IsmayilliIntroduction What is Evidence Based Medicine? About me Evidence-Based Medicine(EBM) is a way of making medical decisions that combines the best available • Medical degree- Turkey research, clinician’s expertise, the values and • Foundation Training- Somerset NHS FT preferences of the patient. • Clinical Experience- General Surgery-CT1 • Current role- Research Fellow in ICU Trials and Vaccine studies Why it matters? • Passion: Research and Teaching It ensures that medical care is effective, tailored to the patient, and based on proven methods rather than outdated practices or personal opinions. 19/11/2024 3 5 Steps of EBM Assess the patient Evidence based medicine begins and ends with the patient. Formulate a Question Background/Foreground questions Components of the Clinical Question- PICO Search for Evidence Decide on the type of question and which study design will be answering that Database Critically Appraisal of Evidence Several Checklists for different study designs Integrate evidence with patient values Evaluate the outcome 19/11/2024 4F ormulating a Question Example of using PICO  What is the best management for otitis media?  In children with otitis media , do antibiotics lead to faster symptom relief compared to simply monitoring and waiting? P-children with otitis media I- antibiotics C- wait and watch O- faster symptom relief  Is Albumin better than Crystalloids?  In patients with early septic shock (P), is 20% human albumin solution (I) more effective than buffered Think about your own question  crystalloids (C) in improving clinical outcomes (O)? 19/11/2024 5 Study Designs- 1 • Case Series A description of a series of subjects with a similar diagnosis.  Nature of disease, common signs and symptoms or outcomes, rare disease • Cross-Sectional studies Looks at a group of people at one point in time. This type of study doesn’t follow people over time, so it only gives a "snapshot" of what’s happening. It can show association but it can not prove cause effect.  Prevalence, diagnostic testing • Cohort Study Follows a group of people (prospectively/retrospectively) over a period of time to see how things change eg: how smoking affects lung cancer  Incidence, nature of history of certain conditions, analysing associations, diagnosis • Case- Control Studies Retrospective analysis of one group of subjects with a known disease and one without it (control group). Not establish prevalence or incidence. 19/11/2024 6 e.G lung cancer and non-cancer groups to look for smoking history Study Designs- 2 • Randomized Control Trials Evaluates the efficacy or safety of an intervention by randomly allocating participants into two or more groups.  Causality, treatment, screening, prevention, risk • Literature review Summarizing the literature on a particular topic without following a standardized method.  Broad understanding, identification of gaps • Systematic Review Follows a structured and rigorous methodology to identify, select, and synthesize all relevant studies on a specific clinical question. Has own exclusion/inclusion criterias  Overall evidence for specific question, quality consistency of research findings, further research • Meta-Analysis Quantitative synthesis of study results from a systematic review.  Statistical effectiveness, strength of risk association 19/11/2024 7Summary Database Global UK MFT Pubmed NICE OpenAthens Cochrane BMJ Best Practice Medline Trip BestBETs Embase Medline PubMed Embase Cochrane Trip BestBETs 20XX Pitch deck title 9 Appraisal Formulated research question Introduction Credibility Hypothesis Valid study design Methods Valid outcome measure Bias Results Statistically significant Measuring tests Discussion Conclusion Generalizability Limitations 19/11/2024 10Appraisal CASP Checklists - CriticalAppraisal Skills Programme 19/11/2024 11 Apply Evidence Intervention Diagnostic testing • Availability • Can results apply to my patient? Think about patient characteristics • Affordable • Accurate • Potential risks and benefits for my patient • Patient's values and expectations • Feasibility 19/11/2024 12 Challenges and Limitation Quality of Evidence Applicability Misinterpretation Lengthy Process Information Overload Impact on Clinical Judgment 19/11/2024 13 Interactive Session 20XX 14 Interactive Session 20XX 15 Interactive Session 20XX 16 Interactive Session 20XX 17 Conclusion Questions Feedback Cetificate and slides will be send 19/11/2024 1819/11/2024