3.4 Evidence Based Medecine: Anticoagulants and Stroke

Question 1

What is Evidence-Based Medicine? (Who Cares?)

Answer 1

EBM provides clinicians with an efficient and systematic way of searching for information and critically appraising it in order to find the best evidence to support clinical decisions.

It provides an opportunity to determine what is truly the best treatment for patients.

Question 2

Why use EBP?

Answer 2

EBP provides risk management protection as to standard of care when something goes wrong and something will inevitably go wrong

Matter of Professional Survival

Question 3

What is the Evidence-Based Medicine Process?

Answer 3

Step 1 – Formulate the question
Step 2 – Search for answers
Step 3 - Appraise that evidence
Step 4 - Apply the evidence
Step 5 – Assess the outcome

Question 4

Step 1 - Formulate the question

Answer 4

P – Patients or problem of interest
I – Intervention of interest
C – Comparison of treatments
O - Outcome of interest

Example: In healthy male patients over 40 years old, does the addition of aspirin, compared to usual care, decrease cardiovascular morbidity and mortality rates?

Question 5

Step 2 - Search for answers…What is the hierarchy of evidence? Best and worst kinds?

Answer 5

1a - Systematic review of randomized controlled trials (RCTS)

1b - Individual RCT with narrow confidence interval

1c- All or none case studies

2a - Systematic review of cohort studies

2b - Individual cohort studie or RCT with <80% follow up

2c - Outcome research; etiological studies

3a - Systematic review of case-control studies

3b - Individual case-control study

4 - Case Series

5 (WORST) - Expert opinion

Question 6

What questions should you ask yourself when you do Step 3? [Appraise that evidence (or trust someone else to do it for you)]

Answer 6

Are the results valid?
What are the results?
Will the results help me in patient care?
How do my patient’s personal values and choices affect the decision?

Question 7

Important Terms! (According to the ppt)

Define:
ARI
ARR
NNT
NNH

Answer 7

ARI= absolute risk increase
ARR=absolute risk reduction
NNT= number needed to treat to benefit one
NNH= number needed to treat to harm one (both values calculated from raw event rates)*

Question 8

Define NNT

Answer 8

The Number Needed to Treat (NNT) is the number of patients you need to treat to prevent one additional bad outcome (death, stroke, etc.). For example, if a drug has an NNT of 5, it means you have to treat 5 people with the drug to prevent one additional bad outcome.

Question 9

5 Steps of EBM

Answer 9

1. Convert information need into answerable questions.
2. Track down the best evidence to answer the question (with maximum efficiency).
3. Critically appraise the evidence for its validity and usefulness.
4. Integrate appraisal results with clinical expertise and patient values.
5. Evaluate outcomes.