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
