B12 Evidence-based medicine (EBM)

Question 1

what is the definition of EBM?

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’
• taking the best evidence we have and applying that to giving the best patient-specific care possible

Question 2

what do we mean by evidence in EBM?

Answer 2

• published research
• mainly interested in studies with patients to test the effect of an intervention

Question 3

what is an RCT? explain

Answer 3

• randomised controlled trial
• ideally it is double-blind (subjects and healthcare professionals don’t know which group is which)
• other factors are minimised (make 2 groups evenly balanced with ethnicities, genders, ages, all at the same stage of disease etc.)

Question 4

what is evidence-based practice?

Answer 4

• integration of best research evidence with clinical expertise and patient values
• putting the evidence into practice specific to patients and what will work best for them eg. ‘I want to go back to work’

Question 5

what is primary literature?

Answer 5

• original and ‘cutting edge’ information
• consists of research studies, case reports, editorials and letters to the editor

Question 6

what is secondary literature?

Answer 6

• indexing and abstracting services
• usually available online or via CD-ROM
• used to access primary literature

Question 7

what is tertiary literature?

Answer 7

• represents core knowledge established via primary literature
• comprises textbooks and full text databases

Question 8

what are the 5 steps of evidence-based practice?

Answer 8

1. formulate a clinical question
2. assemble evidence
3. critical appraisal of evidence
4. applying the evidence
5. reflection

Question 9

what 4 elements is a well-defined clinical question comprised of? state the 4 letters

Answer 9

PICO

Question 10

describe what PICO is used for and explain each element of it

Answer 10

• PICO is the 4 elements required in a well-defined clinical question

P: patient / patient population (who are we looking at? what condition is it and is it mild or severe?)

I: intervention available (what is the intervention? is it a medicine or another form of care?)

C: comparison of alternative (against old medicine?)

O: outcomes desired (what outcome is of interest?)

Question 11

state and explain some criticisms of EBM

Answer 11

• too good for drug companies (medicines easily approved by NICE)
• volume of evidence is unmanageable
• not measuring the right outcomes
• statistical significance may be marginal in clinical practice
• driven ‘rules’ rather than patient-centred (pushes us towards guidelines)