B12. Evidence based medicine

Question 1

Definition of evidence based medicine? Sackett DL, et al. BMJ 1996;312:71-72

Answer 1

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients

Question 2

what do we mean by evidence?

Answer 2

-published research (including how patients fell about illness)
-type of research varies with the question
-EBM mainly interested in studies with patients to test the effect of an intervention

Question 3

describe randomised control trial?

Answer 3

double blind (one note)

Question 4

Evidence based medicine definition Greenhalgh T. How to read a paper. 4th edition. London: BMJ Publishing Group, 2011

Answer 4

‘Evidence-based medicine is the use of mathematical estimates of the risk of benefit and harm, derived from high quality research on population samples, to inform clinical decision-making in the diagnosis, investigation
or management of individual patients’

Question 5

what is evidence based practice?

Answer 5

“integration of best research evidence with clinical expertise and patient values”

Question 6

sources of information?

Answer 6

primary literature, secondary literature, tertiary literature (one note for more detail)

Question 7

hierarchy of evidence?

Answer 7

one note

Question 8

what are the five steps of evidence based practice?

Answer 8

-formulate a clinical question
-assemble evidence
-critical appraisal of evidence
-reflection

Question 9

a well defined clinical question can be seen to be compromised of what four elements?

Answer 9

-patient/ patient population
-intervention available
-comparison of alternative
-outcomes desired

Question 10

criticisms of EBM

Answer 10

-Too good for the drug companies
-Volume of evidence is unmanageable
-Not measuring the right outcomes
-Evidence gaps lead to treatment gaps
-Statistical significance may be marginal in clinical practice
-Driven ‘rules’ rather than patient centred
-Maps poorly to complex multi-morbidity

Question 11

what is real EBM

Answer 11

-Ethical care of the patient is its top priority
-Individualised evidence that is understandable
-Involves expert judgement rather than rule following
-Shares decisions with patients
-Builds strong patient-professional relationships
-Applies principles at community level for evidence based public health

Question 12

achieving real EBM?

Answer 12

-Patients need to demand better
-Training needs to extend beyond critical appraisal
-Guideline producers need to consider how they will be used
-Studies must meet usability standards as well as methodological
-Resist the generation of ‘evidence’ by vested interests
-Research agenda needs to broaden
-focus on patient and apply right evidence