EBM

Question 1

What are the key characteristics of a systematic review?

Answer 1

. Set objectives and criteria for eligibility criteria for studies
. Reproducible methology
. Systematic search that aims to identify all studies eligible for the review
. Assessment of the validity of the results of the included studies (e.g. assess risk and bias)
. Systematic synthesis and presentation of the results of the included studies

Question 2

What is meta-analysis?

Answer 2

The use of statistical methods to combine and summarize the results of independent studies (more precise than just one study)

Question 3

What is evidence-based medicine?

Answer 3

Systematically reviewing, appraising, and using clinical research findings to help deliver optimum care to patients

Question 4

What is the PICO format? What does PICO stand for?

Answer 4

. A format used to formulate questions that fit into using EBM
. P- person or population in question
. I- Intervention
. C- comparison (if appropriate)
. O- outcomes considered

Question 5

A lady comes to you asking whether having a mammography will reduce her risk of dying from breast cancer.
Write the PICO format for this scenario and propose an appropriate question for the systematic review.

Answer 5

P- the lady
I- mammography
O- death

Does mammography breast screening reduce the risk of mortality in women?

Question 6

Describe the types of bias present in systematic reviews?

Answer 6

Some papers with significant positive result more likely to be:
. Submitted and published (publication bias)
. Published in a major journal written in English
. Published in a journal indexed in a literature database (studies in less developed countries less likely to have this)
. Cited by other authors (citation bias) and quotes by newspapers

Question 7

Why is EBM not always ideal?

Answer 7

. Quality mark of evidence base has been corrupted due to financial incentives
. Volume of evidence has become unmanageable
. Statistically significant benefits not always significant in clinical practice
. Care prone to becoming more management-driven rather than patient-centred due to following guidelines
. Evidence based guidelines aren’t very good for people with multiple morbidities