Evidence Based Medicine Flashcards
Describe evidence based medicine
The concept of evidence based medicine has been evolving over the past 30 years.
Methods to critically appraise clinical information and classify it according to the strength of evidence was first presented in a Canadian Medical Association Journal series on how to critically appraise literature in the early 1980s.
Concepts emerging from the literature on “critical appraisal” promoted what has become known as evidence based medicine (EBM), suggesting that clinicians should use critically appraised information in clinical practice for optimal care of their patients
Define evidence based medicine
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients
What are the criticisms of evidence based medicine
- Attempts over the last 2 decades of the twentieth century to implement EBM in the UK and elsewhere generated a controversy that has questioned the value of EBM in clinical practice • Some practicing doctors regard EBM as an academic exercise for medical students that has no relevance to clinical practice • Often the translation of results from RCT’S conducted in teaching hospitals is not appropriate for General Practice
- It is impossible for any clinician to have the time to critically appraise even one article per week let alone the number that would need to be appraised to answer questions (estimated at 3.5 per clinical session) arising in a busy practice. • Governments, healthcare commissioners and providers have used the jargon of EBM to justify decisions, directives, or incentives that are seen by clinicians as inappropriate
List the hierarchy of studies
• Systematic reviews and meta-analyses • Randomised Controlled Trials • Cohort studies • Case-control studies • Ecological studies • Descriptive/cross-sectional studies • Case report/serie
Why should EBM matter to clinicians
Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication skills Professionalism
Describe the role of EBM in clinical decision making
• Evidence based medicine does NOT replace clinical decision making and is only a tool
Describe the role of EBM in clinical findings
– how to properly gather and interpret findings from the history and physical examination.
Describe the role of EBM in aetiology
– how to identify causes for disease (including its iatrogenic forms)
Describe the role of EBM in clinical manifestations of disease
– knowing how often and when a disease causes its clinical manifestations.
Describe the role of EBM in differential diagnosis
– when considering the possible causes of a patient’s clinical problem, how to select those that are likely, serious and responsive to treatment.
Describe the role of EBM in diagnostic tests
– how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
Describe the role of EBM in prognosis
– how to estimate a patient’s likely clinical course over time and anticipate likely complications of the disorder
Describe the role of EBM in therapy
– how to select treatments to offer a patient that do more good than harm and that are worth the efforts and costs of using them.
Describe the role of EBM in prevention
– how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.
What % of treatments are known to be beneficial
11%. We don’t know the effectiveness of around 50% of treatments.
