Lecture 12

PN
PNCC304
304– PND 401 Drug Information
Drug Information
Lecture 12
December 23 - 28
Lecture
Fall, –1
2023-2024
February 19-24, 2022
Ming Ming Wen, Ph.D.

Dept. of Clinical Pharmacy & Pharmacy Practice
Faculty of Pharmacy
Learning Outcomes
2
After completion of this lecture, you should be able to
 Compare between various EBM resources

 Find the best available evidence from
EBM database
Evidence information hierarchy
(Evidence Pyramid)
Evidence-
• Evidence based reviews are always on based Review
the top of the pyramid because the articles
numbers of publications of these
reviews are far fewer than the
numbers of published clinical studies.
Clinical
Studies
Step 2. Search the literature for relevant articles
Remember:
Different types of questions are best answered by different types of studies.
You need to look for the best type of studies that are available and relevant.
Question Look for
Intervention or Therapy Randomized controlled trial
Diagnosis/Screening
a) To assess the accuracy a)Cohort study where all subjects receive both
of the test: the study test and gold standard reference test
b) To assess effect of test b) Randomized Controlled Trial

on health outcomes:
Prognosis Longitudinal cohort study
Aetiology/Risk factors • Randomized controlled trial
• Cohort study-for rare exposure with common
outcome
• Case-control study-for rare outcome with
common exposure
Type of study to find the evidence depends on the type of
questions asked.
Type of Clinical
Suggested best type of study
Question
Therapy Meta-analysis > Systematic Review > RCT > Cohort
Cohort study (Test procedure compared to

Diagnosis
a gold standard procedure)
Prognosis Cohort > Case-control > Case series
Etiology RCT > Cohort > Case-control > Case series

1 Heneghan, Carl, and Douglas Badenoch. Evidence-Based Medicine Toolkit. 2nd ed. Malden, Mass.: BMJ
Books/Blackwell Pub., 2006.
2 Glover, Jan, and Lei Wang. Find it Fast: The Clinical Question 5
Poll question
Do cohort studies have higher evidence

potential than case control studies?
Rating the Strength of Evidence
STRENGTH OF
DEFINITION
RECOMMENDATION
Recommendation based on consistent and good quality patient-
A
oriented evidence.*
Recommendation based on inconsistent or limited quality
B
patient-oriented evidence.*
Recommendation based on consensus, usual practice, expert
C opinion, disease-oriented evidence,** and case series for
studies of diagnosis, treatment, prevention, or screening
* Patient-oriented evidence measures outcomes that matter to patients: morbidity,
mortality, symptom improvement, cost reduction, quality of life.
** Disease-oriented evidence measures intermediate, physiologic, or surrogate
endpoints that may or may not reflect improvements in patient outcomes (e.g.,
blood pressure, blood chemistry, physiological function, and pathological findings).
Ref: Association of American Family Physician (AAFP)

Databases providing Evidence-Based Medicine
8
EBM resources
, Lexicomp
1. Cochrane Library (Cochrane Reviews)
https://www.cochranelibrary.com/
 The Cochrane Collaboration is the
main international organization which
includes a network of researchers
and clinicians who collaborate
internationally to publish systematical
reviews of treatments and
interventions in Cochrane Library.
 It is designed to support “evidence-
based medicine” to health care
providers using the most current
clinical evidence which can guide
clinical decisions to individual
patients.
Egyptian Knowledge Bank
2. PubMed- Clinical Queries
13
14
It’s important to select the filter of your clinical

question type to narrow the search result.
3. TRIP database
https://www.tripdatabase.com/
4. PubMed via PICO
https://pubmedhh.nlm.nih.gov/pico/index.php
• Designed for handheld devices.
• Convenient at the point of case setting.
5. Natural Medicine
https://naturalmedicines.therapeuticresearch.com/databases.aspx
6. The Centre for Evidence-Based Medicine
https://www.cebm.net/
Summary:
Selection of evidence literature:
• It is important when searching for evidence that search terms
are referred back to your original PICO question.
• The steps of finding evidence:
1) Identify terms to fit your PICO question
2) Look for secondary sources (PubMed, Cochrane Library
etc.)
3) If no result in 2), then search for primary sources (RCT,
cohort study etc.)
Consider the category/type of the clinical question first
before starting searching EBM databases, such as therapy,
diagnosis, prognosis, prevention, etiology, cost-
effectiveness, and quality-of-life.
Poll Question
20
 For all clinical questions that need EBM answers, you

should always start by searching secondary sources
such as PubMed or Cochrane Library.
21

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PN

Ming Ming Wen, Ph.D.

After completion of this lecture, you should be able to

 Compare between various EBM resources

b) To assess effect of test b) Randomized Controlled Trial

Therapy Meta-analysis > Systematic Review > RCT > Cohort

Cohort study (Test procedure compared to

Prognosis Cohort > Case-control > Case series

Etiology RCT > Cohort > Case-control > Case series

Do cohort studies have higher evidence

Ref: Association of American Family Physician (AAFP)

It’s important to select the filter of your clinical

 For all clinical questions that need EBM answers, you

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