EBM

Question 1

Evidence based medicine - What is it?

Answer 1

The conscientious, explicit & judicious use of current best evidence in making decisions about the care

[integrating individual clinical expertise with the best available external clinical evidence from systematic research]

Question 2

How do you incorporate EBM into Pharmacotherapeutic Decision Making

Answer 2

Recognize info needs & convert them into answerable questions

Conduct efficient searches for the best evidence with which to answer these questions

Critically appraise the evidence for its validity and usefulness

Apply the results to patient situations to best assist clinical decision making

Question 3

Ask an answerable question: Steps

Answer 3

P = Patient

I = intervention

C = comparison

O = outcome

Question 4

Conducting an Efficient Search: Steps

Answer 4

Ask a colleague for his or her expert opinion.

Review practice guidelines for appropriate disease management

Consult electronic databases of systematic reviews and/ or meta-analyses

Conduct a literature search using an electronic database

Question 5

Critically appraise evidence: Steps

Answer 5

Assessing Validity through biases

Question 6

Internal validity

Answer 6

The extent to which the conclusions of a study are correct for the subjects under investigation

Question 7

Selection bias

Answer 7

Systematic diff. in characteristics between those selected for study and those who are not

Question 8

Performance bias

Answer 8

Systematic diff in the care provided, apart from the intervention being evaluated

Question 9

Attrition bias

Answer 9

Associated w/ the dropping out or the differential exclusion of subjects from a study

Question 10

Detection bias

Answer 10

Systematic differences in outcome assessment

Question 11

Applying results to patient situations to best assist clinical decision making

Answer 11

Clinical relevance:

Magnitude of efficacy&raquo_space; risks, costs, benefits of existing interventions

Question 12

CER

Answer 12

Control Event Rate

Question 13

EER

Answer 13

Experimental Event Rate

Question 14

RR

Answer 14

Relative risk

The ratio of risk of an event occurring in one group compared to another group

Question 15

RRR

Answer 15

Relative Risk Reduction

Percent of baseline risk removed

RRR = (CER - EER)/ CER

Question 16

ARR

Answer 16

Absolute Risk Reduction

ARR = (CER-EER)

Question 17

ARI

Answer 17

Absolute Risk Increase

ARI= EER- CER

Question 18

NNT

Answer 18

Number to treat
Always rounded up to the nearest whole number

NNT = 1/Absolute Risk Reduction

Percentage of subjects treated with the intervention who experienced the adverse outcome compared with the control

Question 19

NNH

Answer 19

Number needed to harm
1/ ARI

Number of subjects needed to be treated to prevent one adverse event

Explanation: If NNH is 111, 111 patients treated with this treatment would result in one major adverse effect (whatever effect their testing)

Question 20

How do we actually practice EBM?

Answer 20

Converting the need for info into an answerable question

Tracking down the best evidence

Appraising evidence for validity, impact and applicability.

Integrating appraisal with clinical expertise & patient’s uniqueness.

Evaluating effectiveness & efficiency of 1-4 & seeking improvement next time.

Question 21

Keeping up tp date by using evidence - based medicine

Answer 21

Areas important to my practice

Scan the literature

Critically appraise the evidence for validity and usefulness

Usefulness of med info = (relevance * validity) / work factor