EBM Principles 1 Flashcards
Steps in EBM
Identify clinical problem
Define structured problem
Find best evidence
Examine validity of evidence
Assess results and apply to patient care
The two principles of EBM
Posits a hierarchy of evidence to guide clinical decision-making
Evidence alone is never sufficient to make a clinical decision.
Hierarchy of evidence base
Systematic reviews & Meta analyses
RCTs
Cohort
Case control
Cross sectional survey
Case reports
Where do n of 1 trials occupy in the hierarchy of evidence?
Highest grade
The five types of clinical problems
Therapy
Harm
Diagnosis
Prognosis
Causation
What is the therapy clinical problem?
Determining the effect of interventions on patient-important outcomes
How are therapy questions usually answered?
RCTs
Meta-analysis
What is the harm question?
Ascertaining the effects of potentially harmful agents on patient-important outcomes
How are harm questions answered?
RCTs
Meta-analysis
What is the diagnosis question?
Establishing the power of a test to differentiate between those with and without the condition
How is the diagnosis question answered?
Cross-sectional studies
How is the prognosis question answered?
Cohort studies
How is the causation question answered?
Case-control
Cohort studies
How is a clinical question structured
Patients
Intervention/exposure
Comparison
Outcomes
Explain the patient part of the clinical question
The group which you need to make a clinical decision on
Explain the intervention part of the clinical question
The treatment or cause being evaluated
Explain the cause part of the clinical question
The alternative to decide for or against
Explain the outcome part of the clinical question
The effect that will be produced by the outcome
How much scientific literature can be covered in a typical literature search?
60-70%
Name some databases to use in a literature search
Medline
Embase
CINAHL
PsycLIT
Cochrane Library
SIGLE
Who produces Medline?
National Library of Medicine
When did Medline start?
1966
What does Embase consist of?
3 linked databases Excerpta Medica and 2 specialised databases for pharmacology and psychiatry
What does CINAHL stand for?
Cumulative Index to Nursing & Allied Health
What does CINAHL specialise in?
Literature relating to nursing and allied health professionals
Who produces the PsycLIT database?
American Psychological Association