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vidence
B
ased
M edicine
The
Apply EBM Formulate
The evidence Cycle In answerable
question
Critically
Appraise Search the
The evidence evidence
STEPS IN EBM
PRACTICE
1. Formulate clinical problems in answerable questions
2. Search the best evidence: use internet or other on-
line database for current evidence
3. Critically appraise the evidence for VIA
Validity (was the study valid?)
Importance (were the results clinically
important?)
Applicability (could we apply to our patient?)
4. Apply the evidence to patient
5. Evaluate our performance
MAIN
AREA
Diagnosis
(Determination of disease or problem)
Treatment
(Intervention necessary to help the patient)
Prognosis
(Prediction of the outcome of the disease)
(I)
Formulating clinical
questions
Four elements of a well
constructed clinical
question: PICO
P I C O
B e b r i e f a n d s p e c i f
i c
II
Searching the evidence
Examples of on-line
Journals / Databases
http://bmj.bmjjournals.com
MEDLINE/PubMed
EMBASE
MDConsult
AAP Journal Club
Cochrane Library
TUGAS
PBL
III
Appraising the evidence: VIA
VIA
Validity : In Methods section:
design, sample, sample size, eligibility criteria
(inclusion, exclusion), sampling method,
randomization method, intervention, measurements,
methods of analysis, etc
Importance : In Results section
characteristics of subjects, drop out, analysis, p
value, confidence intervals, etc
Applicability : In Discussion section + our
patients characteristics, local setting
Example:
Critical appraisal for therapy