evidence based med Flashcards
definition of EBM
main postulate if EBM in that any clinical decision and any technological operation should be based on strict scientific evidence.
where does scientific evidence come from? whys it important ?
epidemiological studies
- these studies are important because they identify risk factors for disease
what purpose do epidemiological serve? (3)
health promotion
prophylaxis
screening
Practising EBM means development of…
medical criteria and standards
medical criteria is
- mandatory
- optional
- recommended
example given in notes - varicocele
clinical - palpable
subclinical - non palpable
(?????)
- mandatory - taking history and physical examination - palpation
- principles : find the condition in an upright position and when pt is laid down .. does it disappear - optional - US of scrotum. for detection of subclinical non palpable in upright position and when pt is laid down - doppler and US
clinical meaning - common reason for male infertility
action areas of EBM (3)
- the patient
- published scientific literature
- public health
action areas on 1. patient
treatment of pt based on scientific evidence
action areas for 3. public health
to create health scientific strategies and effective healthcare
sources of info for EBM (7)
- ELECTRONIC DATA BASE
- MEDICAL JOURNALS
- MONOGRAPHS
- SYSTEMIC REVIEWS + SHORT COMMUNICATIONS
- META ANALYSIS
- CLINICAL PRACTICE GUIDELINES
- CLINICAL TRIALS
electronic database - expand
means electronic libraries i.e pubmed
- can be open access
- have to pay for it
medical journals - expand
many of them are published online
w. open access
monographs - expand
books , textbooks
NB - not updated - info is dated
systemic reviews + short communications - expand
type of literature review collected critically analysed multiple research good cos high value of evidence
meta analysis - expand
statistical analysis that combines results of multiple independent scientific studies
clinical practice guidelines -expand
give a statement for goal clin practice i.e European association of urology
clinical trials - expand
to assess efficacy, safety and tolerability
summary points for EBM
- EBM practice requires clinical experience
- skills for interpretation and implementation of results
- patient collab in assessment of benefits and risks of different therapeutic approaches
list of scientific evidence in descending order
- meta analysis
- systemic review
- evidence obtained from trials with precise design such as cohort studies , case control studies or placebo control studies
- expert analysis - done by expert groups on well known scientists in their field of expertise
- critical appraisal of the evidence
recommendations are given based on
level of evidence [LE]
grade of reccomendation [GrR]
indices for LE
from 1 to 5
1 - highest level of LE
5 - no scientific evidence
indices for GrR
A to D
End points of EBM
trusted evidence
informed decision
better health
legal aspects in EBM
- docs are protected by the law
- good collab between physician and pt is recommended
- patient should be encouraged in making decisions
