evidence based med

Question 1

definition of EBM

Answer 1

main postulate if EBM in that any clinical decision and any technological operation should be based on strict scientific evidence.

Question 2

where does scientific evidence come from? whys it important ?

Answer 2

epidemiological studies

- these studies are important because they identify risk factors for disease

Question 3

what purpose do epidemiological serve? (3)

Answer 3

health promotion
prophylaxis
screening

Question 4

Practising EBM means development of…

Answer 4

medical criteria and standards

Question 5

medical criteria is

Answer 5

1. mandatory
2. optional
3. recommended

Question 6

example given in notes - varicocele

clinical - palpable
subclinical - non palpable

(?????)

Answer 6

1. mandatory - taking history and physical examination - palpation
   - principles : find the condition in an upright position and when pt is laid down .. does it disappear
2. 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

Question 7

action areas of EBM (3)

Answer 7

1. the patient
2. published scientific literature
3. public health

Question 8

action areas on 1. patient

Answer 8

treatment of pt based on scientific evidence

Question 9

action areas for 3. public health

Answer 9

to create health scientific strategies and effective healthcare

Question 10

sources of info for EBM (7)

Answer 10

1. ELECTRONIC DATA BASE
2. MEDICAL JOURNALS
3. MONOGRAPHS
4. SYSTEMIC REVIEWS + SHORT COMMUNICATIONS
5. META ANALYSIS
6. CLINICAL PRACTICE GUIDELINES
7. CLINICAL TRIALS

Question 11

electronic database - expand

Answer 11

means electronic libraries i.e pubmed

• can be open access
• have to pay for it

Question 12

medical journals - expand

Answer 12

many of them are published online

w. open access

Question 13

monographs - expand

Answer 13

books , textbooks

NB - not updated - info is dated

Question 14

systemic reviews + short communications - expand

Answer 14

type of literature review 
collected 
critically analysed 
multiple research 
good cos high value of evidence

Question 15

meta analysis - expand

Answer 15

statistical analysis that combines results of multiple independent scientific studies

Question 16

clinical practice guidelines -expand

Answer 16

give a statement for goal clin practice i.e European association of urology

Question 17

clinical trials - expand

Answer 17

to assess efficacy, safety and tolerability

Question 18

summary points for EBM

Answer 18

1. EBM practice requires clinical experience
2. skills for interpretation and implementation of results
3. patient collab in assessment of benefits and risks of different therapeutic approaches

Question 19

list of scientific evidence in descending order

Answer 19

1. meta analysis
2. systemic review
3. evidence obtained from trials with precise design such as cohort studies , case control studies or placebo control studies
4. expert analysis - done by expert groups on well known scientists in their field of expertise
5. critical appraisal of the evidence

Question 20

recommendations are given based on

Answer 20

level of evidence [LE]

grade of reccomendation [GrR]

Question 21

indices for LE

Answer 21

from 1 to 5
1 - highest level of LE
5 - no scientific evidence

Question 22

indices for GrR

Answer 22

A to D

Question 23

End points of EBM

Answer 23

trusted evidence
informed decision
better health

Question 24

legal aspects in EBM

Answer 24

• docs are protected by the law
• good collab between physician and pt is recommended
• patient should be encouraged in making decisions