Evidence-Based Medicine: How to Practice and Teach EBM PDF
Preview Evidence-Based Medicine: How to Practice and Teach EBM
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 1 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 2 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? 3 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 4 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 5 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 6 Dedication This book is dedicated to Dr. David L. Sackett. 7 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. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). 8 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 responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method 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 appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-7020-6296-4 Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Content Strategist: Pauline Graham Content Development Specialist: Fiona Conn Project Manager: Janish Ashwin Paul Design: Ashley Miner/Brian Salisbury Illustration Manager: Karen Giacomucci 9
Description:The list of books you might like
