Chapter 5 Evidence- Based Health Care Flashcards
What is patient-oriented evidence?
provides information on areas about which patients would be most concerned – mobility, mortality, symptom improvement, health care cost, quality of life – holistic view of a patient’s health status
What is disease-oriented evidence?
physiological information (i.e. BP) and joint ROM measures or symptoms (headache, nausea)
What are patient-oriented outcome measures?
self-reported questionnaires that patients complete throughout treatment to assess quality of life
Generic patient-oriented outcome – broad perspective
Disease or anatomical patient-based outcome – quality of life from narrow POV
What are the steps to practice evidence-based medicine?
Develop a clinical question
Search for the best evidence
Evaluate the evidence for validity, impact and applicability
Integrate the evidence into the clinical decision
Evaluate the efficiency and effectiveness of steps 1-4
How do you develop a clinical question?
PICO or PICO/T format to develop clinical questions
P = Patient/Problem
I = Intervention/Variable of Interest
C = Comparison
O = Outcome
T = Time
How would you search the literature?
Filtered information – other clinicians and researchers have already searched the existing evidence, evaluate it and synthesized a clinical recommendation
Clinical practice guidelines, meta-analysis, systematic reviews
Busy – efficient and effective way
Unfiltered information – individual research studies and expert opinions
Search terms – words with precise meaning
Boolean terms – “AND”, “OR”, “NOT”
Medical Subject Heading (MeSH) – controlled medical vocabulary
How would you evaluate the evidence?
Impact – level of importance
Reliability – how reproducible the results are
Validity – do the results really represent what we think they represent
Larger quantities of strong evidence 🡪 greater impact
Hierarchy or level of evidence – helps clinicians
Effect size – measures the difference in outcomes between the treatment and nontreatment groups (larger effect size = more meaningful)
Strength of Recommendation Taxonomy scale
Oxford Centre for Evidence-Based Medicine
Grading of Recommendations Assessment, Development and Evaluation
Appraisal scales
What are filtered evidence types?
Meta-analysis: a study that pools results of 2+ studies to obtain an overall answer to a question or interest
Systematic review: a methodical review of the existing literature on a clearly described specific question
Critically appraised topic: a short summary of the best available evidence on an individual topic
Cochrane review: a systematic review created by a global independent network of health practitioners from over 120 countries
What are unfiltered evidence types?
Randomized controlled trial: a research study in which a group of patients is randomized into an experimental group or a control group
All-or-none: case series in which all of the patients experience the same outcomes
Cohort study: a research study in which two groups of patients, one that did receive treatment/injury of interest and one that did not, are followed and an outcome of interest is measured
Case-control: a research study in which two groups of patients, one that did receive treatment/injury of interest and one that did not, are examined by looking back at existing records
Case series: describes characteristics of between two and five patients with an uncommon disease/injury or who have undergone a similar procedure
Case report: describes characteristics of a single patient with an uncommon disease/injury or who has undergone unique treatment
Controlled laboratory study: an in vitro or in vivo investigation in which one group receiving an experimental treatment is compared with one or more groups receiving no treatment or an alternate treatment
Descriptive laboratory study: an in vivo or invitro study that describes characteristics such as anatomy, physiology, or kinesiology of a broad range of subjects or a specific group of interest
Expert or consensus opinion: an idea that cannot be substantiated by direct evidence, hypothesis based on related information
What is reliability?
How reproducible the results are when the measurement should be the same
Intrarater reliability – the consistency of the measurements made by a single researcher or instrument
Interrater reliability – the consistency of the measurements made by several researchers or instruments
Interclass correlation coefficients – values to report for reliability
Kappa coefficient – categorical data
Weighted kappa coefficient – ordinal data
What is validity?
Assurance that measurements represent what we think they represent
How would you integrate evidence into clinical decisions?
Gather information 🡪 determine how to use that evidence
EBHC – provide best possible care by integrating evidence with clinical experience and the individual’s values/circumstances
Based on strength, types of outcomes measured, consistency of results, applicability
How would you evaluate the efficiency and effectiveness of Steps 1-4?
Was the clinical question well formulated?
Did we use the best databases?
Did we use the best search terms?
Could the search be streamlined by searching multiple databases or using multiple search terms in a single search?
Could we appraise the evidence?
Could the evidence be integrated into the clinical decision?
