Drug lit midterm (exam 1) - EBM Flashcards
What is Evidence-Based Medicine?
Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
good but eliminates our knowledge tho…
What is EBM?
EBM is the integration of best research evidencewith clinical expertiseand patient values.
so this includes our knowledge and what patients care about
Why EBM?
Relying on primary knowledge
- Overestimate efficacy
- Underestimate risks
can lead to:
Variation in clinical services
- Inappropriate care
- Lack of care
- Increased costs
Which of the following best describes evidence-based medicine?
Medical practices are solely based on personal experience and intuition.
The integration of clinical expertise, patient values, and the best available research evidence in decision-making.
Relying exclusively on traditional or alternative medicine without considering scientific studies.
A rigid adherence to standardized treatment protocols regardless of individual patient needs.
Making medical decisions solely based on the latest trends and popular opinions in the healthcare community.
The integration of clinical expertise, patient values, and the best available research evidence in decision-making.
Sources of Knowledge in Medicine
Reference to tradition - what we have always done
Reference to authority- follow the expert
Trial and error- try until something works
Logical reasoning- coming up with idea based on reason
Scientific method- hypothesis experiment more reputable way to get answers
The Problem…
Practice continues to rely on sources of knowledge other than scientific method
why? we are afraid of doing something new based on evidence
Gap between new researchfindings and incorporationinto practice
Publication to Implementation
this is a forest plot
study of aspirin (which was meant to decrease mortality)
shows lots of evidence in 1 table
randomized control trials in 1 publication - meta analysis
shows how evidence has progressed over time
when apsirin became routine practice but was proven unsafe and then changed 10 years later
Cochrane Library Logo
meta-analysis
studies where smaller studies are combined to see true impact of study
figure slide 11
Rx was still prescribed even tho it was harmful which goes to show that the doctors we not up to date on the literature
Evidence Based Practice
Making a conscientious effort to base clinical decisions on research that is most likely to be free from bias, and using interventions most likely to improve how long or well patients live.
EBM Process
PPCP
EBM Process: (cycle)
assess
ask
acquire
appraise
apply
PPCP: (cycle)
collect
assess
plan
supplement
follow up: monitor and evaluate
Patient Scenario
JL is a 70-year-old woman with type 2 diabetes mellitus (DM) presenting for a prescription refillfor hydrochlorothiazide (HCTZ).
JL tells you that her doctor suggested switching her blood pressure medication from HCTZ to lisinopril to better protect her kidneys from damage related to type 2 DM since she had an abnormal urine test.
JL is reluctant to make this change because her friend had a “bad reaction” to lisinopril.
She would like to know what you think about her doctor’s suggestion.
Assess
Assess patient and/or problem to determine pertinent issues
Background Questions
Covers the more basic scientific concepts
Does not refer to a particular patient situation
Can be answered using tertiary resources
Foreground Question
Covers how these concepts are applied to an individual patient’s circumstance
Must have adequate background knowledge to ask and answer these questions
Think – Pair – Share
How would you assess this situation?
What background questions wouldyou ask about the disease stateor medications in question?
mechanism of action
side effects
storage
stability
contraindication
how does DM2 damage kidneys
lisinopril is an ACE inhibitor
how long for DM2 to cause kidney damage
Developing a Clinical Question
Four parts to the question (PICO)
The __________ or problem being addressed
The __________ or exposure being considered
The __________ intervention or exposure when relevant
The clinical _________________ of interest
The _patient_________ or problem (disease most often) being addressed
The _intervention_________ or exposure being considered
The _comparison _________ intervention or exposure when relevant
The clinical __outcome_______________ of interest
Think – Pair – Share
What is the PICO question for this scenario?
P:
I:
C:
O:
Question:
P: elderly woman with DM2 + HTN
I: lisinopril
C: HCTZ
O: protect kidneys or prevent diabetic nephropathy
Question: is lisinopril better at protecting that kidney than HCTZ in elderly ppl with DM2
Classification of Questions
Therapy or prevention
Etiology or harm
Prognosis
Diagnosis
Economic impact
Hierarchy of evidence
Evidence-Based Guidelines
background info, expert opinion
case report/case series
case control study
cohort study
non-randomzed controlled trials
randomized controlled trials
systematic reviews & meta-analysis
In which order is it recommended that you search resources?
Primary, secondary, then tertiary
Secondary, primary, then tertiary
Tertiary, primary, then secondary
Primary, tertiary, then secondary
Secondary, tertiary, then primary
Tertiary, secondary, then primary
Tertiary, secondary, then primary
