LBM 4 : EBM and Critical Aappraisal will make you updated

STEP 1

 Medical journal

A journal that contained with medical materials (Hilmi)

A journal that explained medical materials (dido)

 Prognostic articles

An article that explain about guess of medical thing in how the disease will affect the patient
(thariq)

An article that explain or predict the outcome of an illness (yoga)

Sebuah artikel yang berisi tentang prediksi bagaimana pasien dengan faktor resiko yang
dialami pasian tersebut (azkiyatin)

Conclusion : An article which explain how the outcome (impact of the illness)

 EBM (Evidence Based Medicine)

Utilization of a valid resource of scientific to determine to heal the patient (silvia)

Learning method in the learning proccess based on the best scientific evidence (soraya)

The way filter data and information in health until we can take information which is valid
and up to date for treat the patient (dita)

Conclusion : a way/method to use the valid and best resource to treat the patient.

 Critical apparaise

A systematic method to asses the usefullness of the result of validation (dila)

A process to criticize and analize the validity of best scientific evidence before making
decisions (tasi)

Checking something with the deep assesment which based on valid and best evidence (adib)

Conclusion : a systematic method/process to assess the usefullnes and validity of scientific

evidence

 PICO
Doctor’s method to determine a diagnose to the patient, with giving some question to the
patients to know what the patient’s disease (yanu)
Abbreviation (singkatan) for Patient and problem – Intervention – Comparison – Outcome
(yoga)
  Diagnostic articles

An article which is contained a method to determine of the disease based on the symptoms
(yanu,dita)

 Modern physicians
A physicians that know a lot of information about knowledge and always develop it. (hilmi)

 Management of patient
 Therapuetic
Healing (dila)

STEP 2

1. what is the characteristic of EBM

2. What is the purpose of EBM
3. How is the process of EBM
4. Why EBM is needed
5. What is the obstacle (kendala) of EBM
6. What is the advantage of EBM
7. Why physicians have to do EBM
8. what is example of PICO
9. Why physicians use PICO
10. How we can appraise published article
11. What are the advantage and disadvantage of critical appraisal
12. Why we need critical appraisal
13. How to do critical appraisal
14. How to develop critical appraisal
15. What is the first step to make the patient’s problem clear
16. What is the solution to solve the gap between research and clinical practice
17. What criteria of published material that appraised by the physicians

STEP 3

1. what is the characteristic of EBM

 have a valid and uptodated information (dita)
 have a responsibled scientific evidence (thariq)
 have a realistic data of the patient (yanu)
 have a good credibility (dila)
2. What is the purpose of EBM
 to make an accurate thinking (silvi)
 to give a good medical service (soraya)
 to make a clinical decision based on the best evidence (tasi)
 to produce a doctor who can analyze and solve problem well (azkiyatin)
3. How is the process of EBM
 Identificate the problem, search the information, do a critical appraisal, apply critical
appraisal to the patient, evaluate the results (soraya,dila)
4. Why EBM is needed
 Because there’s so much research but the clinicians not use that article (hilmi)
 Because EBM help us to identifying and solving a problem in medicine based on
evidence we collect and we search (adib)
5. What is the obstacle (kendala) of using EBM
 The lack of personal IT skill (silvia)
 Difficult to collect the valid and enough information from the patient (yanu)
 Need much of time (adib)

6. What is the advantage of EBM
 To produce the accurate thinking (azkiyatin)
 Help the doctor to diagnose the patient, based on evidence before (dido)

7. The history of EBM
8. what is example of PICO
9. Why physicians use PICO
10. How we can appraise published article
11. What are the advantage and disadvantage of critical appraisal
12. Why we need critical appraisal
13. How to do critical appraisal
14. How to develop critical appraisal
15. What is the first step to make the patient’s problem clear
16. What is the solution to solve the gap between research and clinical practice
17. What criteria of published material that appraised by the physicians
18. What question that can be answered if we use critical appraisal to analyze published
journal
19. What you have to do before you decided the good article to read
20. How is the association between critical thinking, critical appraisal, and EBM
 STEP 7

1. What is the obstacle (kendala) of using EBM

Hambatan dalam Pemanfaatan bukti untuk kasus yang individual:
Banyaknya variasi individu dan peningkatan sub grup pasien semakin membuat aplikasi
kedokteran berbasis buti menjadi sulit.
Hasil penelitian yang dipakai sebagai butik merupakan hasil penelitian pada populasi yang
berbeda sehingga karakteristiknya tidak sama dengan paien yang kita hadapi.
(ferious suwito
Maj kedokt indon volum 61, nomor 2 Februari 2011
Halaman 49)

Decision making by reading journals has some drawbacks.

The methodology used often missed and not properly considered as
critical appraisal is often not true.
The results are often not found relevant to the case at hand at the time. Search the
journal that is not targeted lead article found become less contextual.
Number of publication of articles medicine every day new problems. namely
confusion in the search for relevant articles.

(indonesia.digitaljournals.org/index.php/idnmed/article/.../208/209)

2. The history of EBM

while the World Health Organization announced on 27 October 2004 a new push to improve
patient safety by initiating a dialogue among health ministers, academics, and patient groups,
voices calling for results in minimizing medical errors have found themselves largely drowned
out, despite the Institute of Medicine’s famous 1999 report, To Err Is Human.
Evidence-based medicine (EBM) has been touted as an effective series of mechanisms not
only for improving health care quality, but also for reducing medical errors precipitated in
part by clinical practice variation
(http://content.healthaffairs.org/content/24/1/8.full)

3. what is example of PICO

Seorang pasien wanita 46 thn dgn kolitis ulseratif selama 17 thn,
mengenai kolon secara ekstensive dgn gejala yg cukup hebat. Saat ini
kolitisnya kambuh, ia tdk mau di-operasi tetapi sadar akan resiko
kanker yg ia dengar dan baca dari newsletter. Suaminya tlh
meyakinkannya akan resiko yg akan terjadi.
P = 46 yrs old women
I = Long standing ulcerative
colitis, now in remission
C = Patients without
ulcerative colitis
 O = Prevention / control of
colon cancer
(dr. Darwin Amir, Sp.S.
Bgn Ilmu Penyakit Saraf FK-Unand /
RS DR. M. Djamil
Padang
http://repository.unand.ac.id/3484/1/Evidence-
Based_Medicine_For_Students_%5BCompatibility_Mode%5D.pdf)

4. Why physicians use PICO

Because PICO is the relevant clinical questions in your patients must contain 4 element.
(dr. Darwin Amir, Sp.S.
Bgn Ilmu Penyakit Saraf FK-Unand /
RS DR. M. Djamil
Padang
http://repository.unand.ac.id/3484/1/Evidence-
Based_Medicine_For_Students_%5BCompatibility_Mode%5D.pdf)
5. How we can appraise published article
6. What are the advantage and disadvantage of critical appraisal
advantages disadvantages


7. Why we need critical appraisal

Background There is increasing concern about the quality,
reliability, and independence of practice guidelines. because no information is
available on the methodological quality of the guidelines developed by specialty
societies, we a survey on those published in peer-reviewed journals.
(http://asr.regione.emilia-
romagna.it/wcm/asr/aree_di_programma/fit/fit_governoclinico/pubblicazioni/practice_guid
el/link/practice_guidel.pdf)

8. How to do critical appraisal

It is only worth thinking about what the findings of a study mean if the study design
and methods are valid.
(http://www.medicine.ox.ac.uk)

9. How to develop critical appraisal

First is determining exactly what constitutes evidence-based care. The amount of
often contradictory research findings and “expert” opinion that is available can be
overwhelming and should not always be taken as best evidence. Accessing the best
evidence has its own set of difficulties. Then there is the final challenge of actually
incorporating that best evidence into practice, as knowing what should be done rarely
is enough to bring about an immediate change in what is done.
(http://jada.info/content/143/4/386.short)
10. What is the first step to make the patient’s problem clear
Menentukan pertanyaan klinik yg relevan dan spesifik.
(dr. Darwin Amir, Sp.S.
Bgn Ilmu Penyakit Saraf FK-Unand /
RS DR. M. Djamil
Padang
http://repository.unand.ac.id/3484/1/Evidence-
Based_Medicine_For_Students_%5BCompatibility_Mode%5D.pdf)

11. What is the solution to solve the gap between research and clinical practice
Providing tools to bridge the gap between basic research and clinical
practice. ...Solving our nation's most critical health issues means focusing on the
health ...Developing informatics solutions to serve as the foundation.
(www.ctisinc.com/focus-areas)

12. What criteria of published material that appraised by the physicians

13. What question that can be answered if we use critical appraisal to analyze published
journal
-Is the study valid ?
- is the study important?
-is the result of study can be applied to solve our patient’s problem ?

Sources: Mrs. Endang Lestari (expert lecture) Uniissula

14. what you have to do before you decided the good article to read
15. How is the association between critical thinking, critical appraisal, and EBM
Critical appraisal (critical judgment) on the strength of evidence and the correct
interpretation of research evidence is one important step that is used in today's practice
of EBM.

http://fk.uns.ac.id/static/materi/Pengantar_EBM_Prof_Bhisma_Murti.pdf