EVidence Based Veterinary Medicine Flashcards
“Evidence-based medicine is the integration of best research _______ with clinical ______ and patient ______”
- Dave Sackett
“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”
- Dave Sackett
“Evidence-based veterinary medicine is the explicit use of _______ best evidence in making clinical decisions”
- Peter Cockcroft
“Evidence-based veterinary medicine is the explicit use of current best evidence in making clinical decisions”
- Peter Cockcroft
What is clinical evidence?
Using clinical signs to carry a diagnosis. Making a final diagnosis based on clinical evidence(s)
What is scientific evidence?
Using scientific _________ to make an informed decision. Medical decisions are about the _______ of a disease, the _______ of a diagnostic test, ________ and ________ of an intervention, and the ________ or clinical _______ of a condition
Using scientific literature to make an informed decision. Medical decisions are about the causation of a disease, the accuracy of a diagnostic test, safety and efficacy of an intervention, and the prognosis or clinical course of a condition
What is practice evidence?
Reviewing the ________ of your performances. Assess and compare your procedures to ___ practices.
Reviewing the outcome of your performances. Assess and compare your procedures to best practices
relisten to three eamples
- Background questions: …ask for general mechanism of a disorder
- Answer is part of our “general knowledge” and explains the nature and pathophysiological mechanism of a disease
- The structure of background questions usually have two components:
- A question _____ (5?) with a ____
- A __________: a disorder, test, treatment, pattern of disease, pathophysiology, or other aspect of the disorder
- Background questions: …ask for general mechanism of a disorder
- Answer is part of our “general knowledge” and explains the nature and
pathophysiological mechanism of a disease - The structure of background questions usually have two components:
- A question root (who, what, when, where, why, or how) with a verb
- A subject: a disorder, test, treatment, pattern of disease, pathophysiology, or other aspect of
the disorder
- Foreground questions: …ask for _____ knowledge about _____ a patient with a disorder
- These questions are at the heart of EBVM and are designed to provide informational need about recent _______, diagnostic ____, or current _________ of causation of illness.
- Well-constructed foreground questions usually follow the acronym ______
- Foreground questions: …ask for specific knowledge about managing a patient with a disorder
- These questions are at the heart of EBVM and are designed to provide informational need about recent therapies, diagnostic tests, or current theories of causation of illness.
- Well-constructed foreground questions usually follow the acronym PICO(T)
As you go forward in time, you move from ___________ questions to __________ questions. You have to pull information from clients
As you go forward in time, you move from beginner questions to foreground questions. You have to pull information from clients
What are the five A’s of the EBVM framework?
- Ask an answerable clinical question
- Access (systematically search to see what general knowledge is available)
- AND rank epidemiological evidence to help answer clinical question
- Appraise evidence
- AND then ‘meta’-analyze only relevant valid evidence (systematically review)
- Apply the best evidence:
- Amalgamate the valid evidence with other relevant information to make a good decision
AND - Act on your (or owner) decision
- Amalgamate the valid evidence with other relevant information to make a good decision
- Audit your practice
- i.e. check your actual ‘actions’ – against ‘best’ evidence-based practice
- ASK: Structure of clinical questions
- Use the acronym PICO (T) to formulate the clinical question:
- P = Patient (Population) and Problem (Disease)
- I = Intervention (Exposure+) –> the one you want to trye
- C = Comparison of intervention (Exposure-) –> can be placebo, but also can be standard treatment you are trying now?
- O = Outcome of interest –> this is important
- T = Timeframe [optional] – depends on the outcome of interest
you have to ask an answerable question
Sometimes this is also called a three part question
P= 1
IC = 2
DT = 3
How do you search for this in the literature?
come up with all of the synonyms related to this word
* Identify key concepts/words using PICO terms
Synonyms, related terms, and alternative spellings
* dog
* dogs, canine, canines, canis, bitch, bitches, puppy, puppies, pup, pups…
* wound
* wounds, lesion, lesions, burn, abrasion, abrasions, ulcer, ulcers…
* honey
* Manuka, Medihoney, Activon…
Note: Need at least 4 letters before the truncation symbol… can’t use ‘dog’ or ‘pup’
Varies by database, so check “help” section for each database
How do you search for this in the literature?
come up with all of the synonyms related to this word
* Identify key concepts/words using PICO terms
Synonyms, related terms, and alternative spellings
* dog
* dogs, canine, canines, canis, bitch, bitches, puppy, puppies, pup, pups…
* wound
* wounds, lesion, lesions, burn, abrasion, abrasions, ulcer, ulcers…
* honey
* Manuka, Medihoney, Activon…
Note: Need at least 4 letters before the truncation symbol… can’t use ‘dog’ or ‘pup’
Varies by database, so check “help” section for each database
- –> accepts everything after that letter. Called the trunkation symbole
What are Boolean operators?
** very important **
- Use Boolean Operators
AND- Both terms must appear in result
- “and” is usually default (e.g. Google, CAB)
- both must be in the same paper; has to have all of these words in same paper; reduces scope of paper aka narrowing your search, less sensitive and more specific
OR - Either term must appear in result
- Both terms must appear in result
- anything goes here
- additive
NOT
* First term, omits second term
* Usually expressed as ‘minus’ (-) before word
- omitting
- Piece it all together
Possible search query:
(dog OR dogs OR canine* OR Canis OR bitch* OR pupp)
AND
(wound OR lesion* OR abrasion* OR laceration*)
AND
(honey OR Manuka OR Medihoney OR Activon) - Revise as needed based on what’s being retrieved
- …think Se/Sp and screening strategy
- Expand scope = higher sensitivity, but more abstracts to read (more false positives)
- ACCESS: Literature databases
- LIU-POST Library Resources
- Guide setup by librarian
- https://liu.cwp.libguides.com/vetmed
- Journal Finder
- Enter the Journal name in the Journal Finder search box
- http://0-search.ebscohost.com.liucat.lib.liu.edu/login.aspx?profile=pfi
- Inter-library loans
- ONLY if material is not owned by LIU (after searching through Journal Finder)
- Interlibrary Loan Services
- https://liu.cwp.libguides.com/c.php?g=45855&p=1012489
- Your name, LIU email address, Phone
- Bibliographic info
- Title, Authors, Journal, Year, Volume, Issue, and Pages
- DOI (digital object identifier)
Where do you look for abstracts?
If publishing, use CAB abstracts
What is appraising a paper?
This means how do you read a paper?
Has to be in an IMRAD format
How are you strategic when reading a paper?
Does this answer your clinical question? aka the PICO
If it does not, toss it. If it does, keep going
* Why are you reading that paper?
* Only relevant evidence needs to be appraised
* Does it answer a clinical question?
* Think PICO(T)
* Population/patient
* Intervention… compared to what?
* Is the outcome useful or sensible?
Title and Abstract
* Usually indicates if this is a relevant paper
* Sometimes not enough information to know if your PICO will get answered
Objective(s) / Aim of the study
* Usually clearly written in the _____ paragraph of the Introduction!
Objective(s) / Aim of the study
* Usually clearly written in the last paragraph of the Introduction!
What are the different types of evidence?
- Tips when reading
- Don’t get bogged down by statistics
- Statistical significance doesn’t necessarily equal biological importance!
- Look for sample size calculations/justification
- It should state how many subjects are needed in order to observe a statistical difference
- If the expected difference between the groups is small, you need a greater number of animals
- The number of animals should be adhered to (and add up correctly)
- If not, the findings may be untrustworthy
Look for 30 cases and 30 controls.
- Only read the results if the methods are good enough
- Tables and Figures usually summarize key findings related to the objective!
- does it make biological sense? is there a large magnitude?
- Only read information that is related to the original aim/objective
- If authors cannot find anything significant, they’ll write about something else entirely!
…unrelated findings should be interpreted with caution
- You don’t need to read the Discussion section!
- You can make up your own mind if the study is valid, and what the findings are and if
relevant - Who paid for the study?
- Source of research funding may influence the study design or interpretation
What are three examples of descriptive studies?
What are some examples of explanatory studies?
What are some examples of research synthesis?
What is a narrative review?
It is tefchnically a research synthesis but it is only one person’s opinion
Very weak eveidence for your clinical question
Usually biased views as to what works
What are the least and more strong study designs?
Debatable
Remember: observational –> cohort is king
it is almost a control trial
