Documente Academic
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Based Medicine
How you
will
answer
your
patient?
1. Read textbooks
Not Mentioned
Experimental
Rare/Never
1 23
Specific
Routine
1960
2 65
1965 3 149 21
4 316 5
1970
7 1793 1 10
10 2544 1 2
11 2651 P<.01
15 3311 2 8
17 3929
22 5452 7
23 5767
1980 8
1
27 6125 12
P<.001
30 6346 M 1 8 4
1985 33 6571 M 7
43 21 059 1 3
M
54 22 051 P<.00001 5 2 2
65 47 185 M 1
67 47 531
M 15 8 1
1990 70 48 154
M 6 1
Odds Ratio (Log Scale)
Favours Treatment Favours Control
Lag time from time of “knowing” to time
of implementation
Negative correlation
between our up-to-date
knowledge and the years
since graduation
The
The Slippery
Slippery Slope
Slope
knowledge . ..
of current . . ........ ...
best care .... ...
...
.... ..
The “Truth”
DOE POEM
Research
Evidence
Clinical Patient
Experience Expectation
Preference
Two- Fundamental principles
1. Evidence has a hierarchy of
strength
Clinical experience
Basic research
test tube, animal, human physiology
2. Evidence alone is not enough
Patients’ values
Evidence Experience
Expectations
Four-RVRA to Appraise The Evidence