Prevention, Screening & Health Maintenance
PCM III

Evidence Based Medicine

Goals: At the end of the session the student should be able to:

• Review the basic paradigms of EBM and traditional medical practice;
• Know how medical practice is increasingly judged in terms of compliance with evidence based guidelines that reduce variability in the practice of medicine;
• Raise critical questions about patient care (diagnosis and treatment) that consider evidence, quality, cost-effectiveness and patient preferences;
• Understand the important characteristics of each study design including the strengths and weaknesses inherent to each approach;
• Develop a process of how to review a publication of scientific results for articles about treatment or screening;
• Explore the methods of critical analysis of diagnostic and/or therapeutic evidence with the framework of clinical decision making in the clinical clerkships.

Preparing for September 7 PCM 3 Discussion:

• Next, review and answer the items from the "User's Guide" as they apply to the article. For reference (and help) you can go to the web site: http://www.cebm.utoronto.ca/practise/ca/therapyst/q1.htm
  You will not be required to hand the work in, but be assured that test questions will cover these items.
• Looking over the pdf handout "Clinical Trials and Evidence: The Basics" is also advised.

Evidence-Based Medicine: New Skills That Physicians Must Learn
William Barron, M.D. (PowerPoint Presentation)

Objectives:

• Describe the EBM paradigm;
• List 3 ways that Loyola is judged by outside sources that are related to externally determined measures of quality;
• Apply principles of EBM to patient care outcomes;
• Know how to define quality-based patient care;
• Know how recommendations for preventive care are based on the strength of the evidence;
• Know that not everyone agrees on the evidence nor with the recommendations.

Reading Guide:
Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine.  Based on the Users' Guides to Evidence-Based Medicine and reproduced with permission from JAMA. (1992 Nov 4;268 (17): 2420-5) Copyright 1992.  American Medical Association. http://www.cche.net/principles/ebm.asp

Evidence-Based Medicine Application:
Review of Statistical Tools for Diagnostic Tests and Treatment Methods
Jeffrey Murawsky, M.D. (Power Point Presentation)

Objectives:

• Review the Statistical Tests used in the evaluation of Diagnostic Test in Evaluating Treatment Effect
  - Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value
  - Number needed to treat, Odds Ratio, Relative Risk
• Be able to identify the types of studies used in the medical literature
• To provide a structure to evaluate the literature for treatment effect or test characteristics

Evidence-Based Medicine: Critically Reviewing the Literature
Brian P. Schmitt, M.D., M.P.H. (PowerPoint Presentation)

Objectives:

• Be able to formulate an effective clinical question to aid in direct patient care;
• Understand the historical context for trial design;
• Effectively analyze the data of a treatment trail, understanding the strengths and weaknesses of the design.

A Practical Approach to Reviewing an Article About Treatment or Harm
Jeffrey Murawsky, M.D.

Article for Review:

Aspirin and lopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischemic attack in high risk patients (MATCH): randomized, double-blind, placebo controlled trial Diener HC, Brass LM, Cimminello C, Csiba L, Didier L, Matias-Guiu J, et al. Lancet 2004; 364:331-7

At the end of this session, participants should be able to understand and use a structured framework to evaluate a primary source article about harm or treatment using the rational clinical exam approach by answering the following questions.

1. Are the results of the study in question valid?
2. What are the results of the study?
3. Will this effect how I care for patients?

The Rational Clinical Examination