Evidence based practice I Flashcards
What is evidence based practice?
Evidence based medicine is the use of current best evidence in making decisions about the care of individual patients.
Why is EBP relevant to optometrists?
All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence
What are the 5 steps of the EBP process in the correct order?
Ask > acquire > appraise > apply > audit
What do you do for the “ASK” part of the EBP process?
Formulate a question from the clinical scenario, which you need to research literature/studies for.
Which acronym do you use for the “ask” part of the EBP process?
PICO:
P: Population - who are the relevant patients?
I: Intervention - What is the intervention, treatment, test, etc that you are interested in? They can also be diagnostic tests.
C: Comparison - Is there an alternative strategy to compare with the intervention? This “gold standard” therapy, placebo, or an alternative treatment (or none)?
O: Outcomes - What are the consequences of the interventions you are interested in? (not necessarily the main study outcome).
What do you do for the “acquire” part of the EBP process?
Search for the best evidence and peer reviewed literature using Cochrane Eyes and Vision Database (best source), PubMed, Scopus (meta-search), google scholar, etc. Use key words and terms for literature search.
What do you do for the “appraise” part of the EBP process?
Critically assess the evidence and evaluate the research evidence (should be most reliable/valid). Make a hierarchy of evidence (pyramid), the closer to the top, the ‘better’ the evidence.
What does the heirarchy of evidence look like (for “appraise”)?
What do you do for the “apply” part of the EBP process?
Apply the appraised evidence to treating patients in combination with clinical expertise, patient’s preferences, suitable for the practice environment.
Review appointments: continue to measure V.A. and evaluate efficacy. If ineffective, why?
Check patient’s compliance to the intervention - if the px keeps removing the patch, consider atropine drops. Parents can help.
What do you do for the “audit” part of the EBP process?
Evaluate the outcome of the EBP process. “Is it the best possible outcome? Would I change anything?”
What is the best quality evidence (for appraise)?
Clinical practice guidelines > Cochrane (meta-analysis) > RCT
- The horizontal lines represent how focused the data is. Smaller the line, the more focused the line is and we can be more confident of the results (what we see). The wider the line, the wider the spread of results.
- The circle represents the criteria of studies that a study must pass in order for it to be accepted into the systematic review. This can range from the method to population, etc
- The diamond near the bottom represents the combined results of all the data included.
What’s the difference between systematic review and meta-analysis?
