Asking Clinical Questions Flashcards
What is EBP?
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.
What are the features of the best research?
It must be clinically relevant
Illuminates accuracy of diagnostic tests
Highlights importance of prognostic markers
Establishes efficacy and safety of strategies
Seeks to understand patient experience
What are the 3 major tenets of EBM?
An increasing sophisticated hierarchy of evidence
Need for systematic summaries of the best evidence to guide care
Requirement for considering patient values in important clinical decisions
What does evidence hierarchy tell us?
Not all evidence is equal so hierarchy helps us differentiate information more likely to be valid or true
Is evidence alone enough for treatment?
No, decisions must be informed and guided by patient values and preferences
What are the basic steps in EBP?
Assess: A question arises during care of patient
Ask: Completely articulate all parts of the question
Acquire: Conduct a thorough focused search and select highest quality of evidence
Appraise: Evaluate the evidence for validity and clinical applicability
Apply: Use clinical expertise to integrate applicable evidence with attention to patient values
How is the assess step of EBP conducted?
A thoughtful assessment is conducted incorporating all the important data.
(Comprehensive understanding of pathophysiology and the thorough history and physical examination)
How is the “ask” step of EBP conducted?
Formulating an answerable clinical question which addresses 1 or 2 key issues that come up and to develop a focused clinical question.
How must the question be phrased in EBP “ask” step?
Clinical question must be directly relevant to the patient or problem at hand and phrased in such a way that facilitates the search for an answer.
What does a good question consist of?
PICO TT
Patient population problem of interest (most important characteristics)
Intervention (Describe the main intervention and prognostic factor)
Comparison (Describe the main alternative being compared to)
Outcome (Describe what you’re trying to accomplish, measure, improve)
Type of question
Type of research design
How is the type of question established?
Questions are phrased based on the purpose of asking them.
What are the reasons for asking different styles of questions?
Diagnosis/screening
Therapy/intervention
Prognosis
Harm/Aetiology
Prevention
Cost-Effectiveness
Quality of Life
Differential diagnosis
Qualitative
What is a null hypothesis?
Baseline hypothesis. If it is supported nothing unusual is going on; the factor under investigation has no explanatory power. The alternative hypothesis indicates there IS an association between therapy and outcome.
What are the 5 main types of clinical questions?
Therapy/intervetnion
Diagnosis
Prognosis
Aetiology/harm
Prevention
