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)
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
What are the different types of evidence?
What are three examples of descriptive studies?
What are some examples of explanatory studies?
What are some examples of research synthesis?
What are the least and more strong study designs?
Debatable
Remember: observational –> cohort is king
it is almost a control trial
