Evidence-Based Medicine: How to Practice and Teach EBM

407 Pages·2018·3.84 MB·English

by  Sharon E. Straus et al.

Evidence-Based Medicine
HOW TO PRACTICE AND TEACH EBM
FIFTH EDITION
Sharon E. Straus, MD
Professor, Department of Medicine, University of Toronto, Ontario, Canada
Paul Glasziou, MRCGP, FRACGP, PhD
Professor, Faculty of Health Sciences and Medicine, Bond University, Australia
W. Scott Richardson, MD
Professor of Medicine and Campus Associate Dean for Medical Education,
AU/UGA Medical Partnership Campus, Athens, Georgia, USA
R. Brian Haynes, MD
Professor Emeritus of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, Ontario, Canada
With contributions by
Reena Pattani, MD MPH
Assistant Professor, Department of Medicine, St. Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
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Areti Angeliki Veroniki, PhD
Banting Postdoctoral Fellow, Knowledge Translation Program, Li Ka Shing
Knowledge Institute of St. Michael's, Toronto, Ontario, Canada
Edinburgh London New York Oxford Philadelphia St. Louis Sydney 2019
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Table of Contents
Cover image
Title Page
Dedication
Copyright
Contents of EBM Toolbox
Index of Teaching Moments
Preface
Acknowledgements
Introduction
What is evidence-based medicine?
Why the need for a new edition of this book?
How do we practise EBM?
Can clinicians practise EBM?
What's the “E” in EBM?-
What are the limitations of EBM?
How is this resource organized?
References
1 Asking answerable clinical questions
Background and foreground questions
Our reactions to knowing and to not knowing
Where and how clinical questions arise
Practising evidence-based medicine in real time
Why bother formulating questions clearly?
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Teaching questions for EBM in real time
References
2 Acquiring the evidence
Orientation to evidence-based information resources: where to find
the best evidence
How to deal with the evidence that finds US (“push” evidence):
keeping up to date efficiently
Walking the walk: searching for evidence to solve patient problems
References
3 Appraising the evidence
Further reading
4 Therapy
Further reading about individual randomized trials
Further reading about systematic reviews
Further reading about individual randomized trials and qualitative
studies
Further reading about clinical decision analysis
Further reading about economic analysis
Further reading about n-of-1 trials
References
5 Diagnosis and screening
What is normal or abnormal?
Is this evidence about the accuracy of a diagnostic test valid?
Does this (valid) evidence demonstrate an important ability of this
test to accurately distinguish patients who do and don't have a
specific disorder?
Sensitivity, specificity, and likelihood ratios
Practising evidence-based medicine in real time
Screening and case finding—proceed with caution!
References
Further reading
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6 Prognosis
Types of reports on prognosis
Are the results of this prognosis study valid?
Is this valid evidence about prognosis important? (Box 6.2)
Can we apply this valid, important evidence about prognosis to our
patient? (Box 6.3)
Practising evidence-based medicine in real time
References
Further reading
7 Harm
Types of reports on harm/etiology
References
Further reading
8 Evaluation
How am I doing?
Is our practice improving?
How much of our practice is evidence based?
Evaluating our performance as teachers
References
Further reading
9 Teaching evidence-based medicine
Three modes of teaching EBM
Teaching EBM—top 10 successes
Teaching EBM—top 10 failures
Teaching and learning EBM on an inpatient service
Teaching and learning EBM in the outpatient clinic
Writing structured summaries of evidence-based learning episodes
Incorporating EBM into existing educational sessions
Integrating EBM into a curriculum
Integrating EBM into 4-year medical school curriculum—a worked
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example,
Learning more about how to teach EBM
Tips for teaching EBM in clinical teams and other small groups
References
Appendix 1 Glossary
Terms you are likely to encounter in your clinical reading
Terms specific to treatment effects
How to calculate likelihood ratios (LRs)
Sample calculation
Calculation of odds ratio/relative risk
Appendix 2 Confidence intervals
Statistical inference
Calculating confidence intervals
Multiple estimates of treatment effect
Confidence intervals in meta-analysis
Clinical significance section
Comment
References
Index
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Dedication
This book is dedicated to Dr. David L. Sackett.
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Copyright
Copyright © 2019 Sharon E. Straus, Paul Glasziou, W. Scott Richardson and R.
Brian Haynes. Published by Elsevier Limited. All rights reserved.
First edition 1997
Second edition 2000
Third edition 2005
Fourth edition 2011
Fifth edition 2019
The right of Sharon E. Straus, Paul Glasziou, W. Scott Richardson and R.
Bryan Haynes to be identified as authors of this work has been asserted
by them in accordance with the Copyright, Designs and Patents Act 1988.
Chapter 4 was updated for this edition by Reena Pattani. Appendix 2 was
originally written by Douglas G. Altman of the ICRF Medical Statistics
Group and the Centre for Statistics in Medicine, Oxford, UK, and
updated for this edition by Areti Angeliki Veroniki.
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Notices
Knowledge and best practice in this field are constantly changing. As
new research and experience broaden our understanding, changes in
research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own experience
and knowledge in evaluating and using any information, methods,
compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional
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With respect to any drug or pharmaceutical products identified, readers
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and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all
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