Evidence-Based medicine Flashcards
What is the old definition of EBM?
A systematic approach to analyse published research as the basis of clinical decision-making
What is the current definition of EBM?
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients
What does the practice of EBM entail?
Integrating individual clinical expertise with the best available external clinical evidence from systematic research
What is clinical expertise?
Proficiency and judgement acquired by clinicians through clinical practice and experience
What does external clinical evidence?
Clinically relevant research: can both invalidate previously accepted diagnostic tests and treatments and replace them with better ones
What are fears of EBM?
- that it will degenerate into “cookbook” medicine, however, it requires a bottom-up approach that integrates the best external evidence with individual clinical expertise and patient-choice
- EBM will be hijacked by purchasers and managers to cut the costs of health care
ancient era EBM
teaching was mainly authoritative and passed on with stories
what were the 2 main themes of renaissance era EBM
- bloodletting [its eventual disappearance demonstrates the evolution of EBM]
- Scurvy
Who made strides in the diagnosis of scurvy?
Sir James Lind
Why was the translation of evidence of scurvy into practice imperfect?
Due to the delay that the pathophysiological explanation of scurvy remained speculative
Who was involved in the treatment of burns?
Ambroise Pare
Who was involved in the use of lithotomy [operation to remove bladder stones]?
William Cheseldon
Who introduced amputation techniques?
Edward Alanson
Who was the pioneer of EBM?
Ernest Amory Codman
What did Ernest Amory Codman do in the transitional era EBM?
developed the “end result idea” where he detailed the preoperative and posteoperative care: he stated that hospitals are responsible for the care given
When was the first bone sarcoma registry?
Transitional era EBM
List the 4 stages of EBM
- Ancient era EBM
- Renaissance era EBM
- Transitional era EBM
- Modern era EBM
Who are the 2 key figures of modern era EBM?
- Archie Cochrane
- David Sackett
What did Archie Cochrane do?
- He was first to set out the vital importance of RCTs for assessing the effectiveness of treatments
- set up the cochrane collaboration
What is the cochrane collaboration?
dedicated to tracking down, evaluating and synthesising RCTs in all areas of medicine.
it produces and disseminates systematic reviews of health care and promotes the search for evidence in teh form of clinical trials and interventions
What did David Sackett do?
Defined the term EBM
he set up the world’s first EBM center
What are 2 goals of science?
- Understanding a phenomenon
- Predicting events when a certain variable in altered
What is systematic review?
A weight of the evidence provided by mnay experiments of a single matter
What is the strongest type of evidence?
Systematic reviews
What is the weakest type of evidence?
Expert opinion
What is the study of methodolgy?
The attempt to understand what kind of reasoning we can apply to a given problem in order to make a prediction
What do different types of evidences require?
A specific type of methodology
What is the paternalistic model?
That the doctor known everything and the patients simply listen and take what is ordered
How was medical knowledge obtained in antiquity?
A product of individual observation
What was antiquity based on?
personal experience and knowledge of herbal remedies
What did people think knowledge was in antiquity?
Apodictic knowledge: it was certain
Which people are chosen for a drug trial?
People who haven’t responded well to previous drugs
Why do we not give a drug to the whole population who haven’t responded well to treatment?
Because then we wouldn’t be able to distinguish whether people are improving because of the drug or the placebo effect
Which differences are considered in a drug trial?
- The difference between the patients that have improved and that have not
- the difference among the people who got better and did not in the control group
What if the differences between the 2 groups of a drug trial is identical/close together?
It means that the drug tested as positive as the placebo
What are the reasons for giving placebos instead of drugs?
- The drug has failed a RCT because of certain side effects
- A placebo has no cost
