9 EBM Flashcards
Busy clinicians have an obligation to understand primary (original) research in order to maintain relevant, up to date practice.
Need to utilize information management to find:
Clinically applicable primary sources and appraise them critically.
Appropriate secondary sources that summarize the relevant literature and deliver a useful, actionable bottom line.
Clinicians must also be able to sift through which articles have been evaluated with sufficient academic rigor.
Considerations?
Peer-reviewed?
Academic journal vs. “throwaway”
Sponsorship?
(pharmaceutical company, etc.)
The revised and improved definition of evidence-based medicine is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values
New Definition of EBM
New Definition of EBM
The revised and improved definition of evidence-based medicine is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values
Purpose of EBM?
- Enable clinicians to provide more accurate/up-to-date and timely information to patient questions
- Medicine is constantly evolving
- Optimal clinical decision making requires awareness of the best available evidence, which ideally will come from systematic summaries of that evidence.
- EBM provides guidance to decide whether evidence is more or less trustworthy—that is, how confident can we be of the properties of diagnostic test, or our patient’s prognosis, or of the impact of our therapeutic options?
- Evidence alone is never sufficient to make a clinical decision.
Three Fundamental Principles of EBM
Three Fundamental Principles of EBM
- Optimal clinical decision making requires awareness of the best available evidence, which ideally will come from systematic summaries of that evidence.
- EBM provides guidance to decide whether evidence is more or less trustworthy—that is, how confident can we be of the properties of diagnostic test, or our patient’s prognosis, or of the impact of our therapeutic options?
- Evidence alone is never sufficient to make a clinical
Used to rate our confidence in the estimates of the effects of health care interventions
GRADE (Grading of Recommendations Assessment, Development, and Evaluation)
Simplified process for EBM implementation
1 Assess 2 Ask 3 Acquire 4 Appraise 5 Apply
In this step, the clinician identifies the need to gather information regarding a patient-centered problem
1 Assess
Patient, Problem, or Population Intervention Comparison or Control Outcome Type of Question Type of Study
2 Ask
PICOTT
Two types of questions:
Background
Foreground
PICOTT?
Patient/Problem/Population
Intervention
Comparison/Control
Outcome
Type of study
Type of question
Ask for general knowledge about an illness, disease, condition, process or thing.
These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment
Background-
Ask for specific knowledge to inform clinical decisions.
Typically concern a specific patient or particular population.
Tend to be more specific and complex compared to background questions.
Best answered by consulting medical databases
Foreground
The process by which the clinician (researcher) selects the appropriate resource(s) to conduct a search to answer the clinical question.
3 Acquire
Prospective > retrospective studies…
y’all knew that
Evaluate how recently the summary was updated or revised
Not all topics are covered by filtered information resources
Meta-analyses, Cochrane Database of Systematic Reviews.
Clinical Practice Guidelines
Filtered Resources
Better known as “primary literature”
It’s up to YOU to assess quality, validity and applicability to your patient
Requires time and experience
Unfiltered Resources
To learn about a new topic or refresh knowledge
Provide a comprehensive overview of a disease, condition, or concept
Usually in a textbooks, Medline, Medscape, UpToDate
Background Resources
We have now identified current information which can answer our clinical question.
The next step is to read the article and evaluate the study.
4 Appraise
In Step 4, Appraise, you can employ what mnemonic device/
Patient/prob/pop Intervention Comparison/control Outcome Numbers of subjects Statistics
Is this article from a peer-reviewed journal?
Is the location of the study similar to mine?
Is the study sponsored by an organization that may influence it?
Will this information impact my patients?
Is the problem addressed in the study common to my practice?
Is the intervention or test studied feasible/available to me?
Will this change my practice?
4 Appraise
Sensationalized Headlines Misinterpreted Results Conflict of Interests Correlation vs. Causation Speculative Language Small Sample Size Unrepresentative Samples No Control Group No Blinding “Cherry-Picked” Results Results That Cannot be Replicated Journals and Citations
Bad Science
4 Appraise
