AN Introduction to EBMAN Introduction to EBM

The Need forThe Need forEvidence-Based Evidence-Based MedicineMedicine

Evidence: گواه مدرک، سند،

Evidence Based Medicine:شواهد بر مبتنی پزشکی

دریای در انسان خرد اوقات بسیاری دردانش بسیاری مواقع و میشود گم دانش

فراموش اطالعات از دریایی در انسانگردد .می

“The Rock” T.S. Elliot

The Life is ShortThe Life is Shortand and

The Evidence is Too Hard to FindThe Evidence is Too Hard to Find

بر هدف : مبتني طبابت چرا؟؟؟ شواهد

چه که فراموشکنیم اگرشد، می گفته باید

آنچه فریب آسان بسیارشود می گفته که را

خورد .خواهیم

Limitations of Current Clinical Practice

There is good evidence that the There is good evidence that the quality of care we give our quality of care we give our patients could be betterpatients could be better

• clinical examples, in which lack of good evidence has led to harm for our patients

• common patterns of thinking that introduce bias ("heuristics")

• the wide variation in current clinical practice among physicians

• the difficulty of managing medical information, when results conflict and thousands of articles are published every month

• our knowledge declines over time, as we get further from medical school, and unfortunately traditional CME doesn't work

Annual death rates in USA

• AIDS: 16,516• Breast cancer: 42,297• Highway accidents: 43,458• Between 44,000 and 98,000 deaths due

to medical errors

From these calculations, Doctors are approximately 9,000 times more dangerous than gun owners.

• Number of physicians in the US ----- 700,000

• Accidental deaths caused by physicians per year --- 120,000

• Average accidental death per physician per year -----0.171

• Number of gun owners in the US ----80,000,000

• Number of accidental gun death per year ----- 1,500

• Average deaths per gun owner per year ------- 0.0000188

Variation in current practice

• As new tests and therapies are developed, how do physicians decide which to adopt? 

Managing medical information

 

Why Is It So Hard to BeUp-to-date?

• Annually– 3 million articles– 30,000 journals– Creates a stack 750 meters tall

After removing the adsMulrow CD. BMJ 1994;309:599

Why Is It So Hard to BeUp-to-date?

Doubling time of biomedical science is about 20 months in 2001

Web Growth

• Approximately 1.5 million web pages are being added daily, and overall doubling time of web documents is about 8 months