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Veterinary Epidemiology > Evidence-Based Veterinary Medicine > Flashcards

Evidence-Based Veterinary Medicine Flashcards

1
Q

What is evidence-based veterinary medicine?

A

integration of best research evidence with clinical expertise and patient values to make clinical decisions

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2
Q

What are the 3 types of evidence?

A
  1. clinical - using clinical signs or diagnostic tests to carry a diagnosis
  2. scientific - using scientific literature to make an informed decision 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
  3. practice - reviewing the outcome performances to assess and compare procedures and best practices
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3
Q

What is the difference between background and foreground questions?

A

BACKGROUND - asks about the general mechanism of a disorder —> general knowledge to explain the nature and pathophysiological mechanism of disease

FOREGROUND - asks about specific knowledge about managing patients with a disorder —> recent therapies diagnostic tests, current theories about causation

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4
Q

How are background and foreground questions structured?

A

BACKGROUND - who, what, where, when, why, or how; disorder, test, treatment, disease pattern, pathophysiology

FOREGROUND - PICO(T)

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5
Q

What are the 5 A’s of evidence-based veterinary medicine?

A
  1. ASK an answerable question
  2. ACCESS or systematically research information and rank epidemiological evidence
  3. APPRAISE evidence and met-analyze relevant valid evidence (systematic review)
  4. APPLY the best evidence by amalgamating valid evidence with other relevant information and acting on your or the owner’s decision
  5. AUDIT your practice by checking them against the best evidence-based practice
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6
Q

How are clinical questions structured?

A

Patient (population) and problem (disease)
Intervention (or exposure)
Comparison of intervention (no exposure, placebo, conventional therapy)
Outcome of interest
(T)imeframe depending on outcome of interest (improvement by a certain time)

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7
Q

Do wounds in dogs heal quicker with Manuka honey?

  • How will the clinical question be structured?
  • Make this question into a proper foreground question.
A
  • P: dogs with acute superficial wounds
  • I/C: dressings and Manuka honey vs. dressing alone
  • O/T: more rapid wound healing

In dogs with acute superficial wounds, does using a dressing with Manuka honey vs. a dressing alone result in more rapid wound healing?

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8
Q

How is information based on a clinical question accessed?

A

use search strategies and queries using key concepts and words using PICO(T) terms

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9
Q

How is the truncation symbol (*) used in database searches?

A

“wildcard” = used following 4 letters to include all possible word combinations

pupp* = puppies, puppy, …

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10
Q

What 3 Boolean operators are used in database searches?

A
  1. AND - bother terms must appear in result (usually default in Google)
  2. OR - either term appears in search result (more inclusive)
  3. NOT - first term included, second is omitted (good when a certain term is commonly associated to something else that is not of interest)
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11
Q

Boolean operators:

A
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12
Q

How should hits in a literature database be revised?

A

think about the Se/Sp and screening strategy and expand scope, if needed

  • higher sensitivity, but more abstracts to read (false positives)
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13
Q

What literature databases are commonly used to access papers?

A
  • PubMed: easy, Boolean operators
  • CAB Abstracts (CABI): extensive, covers many journal resources
  • Google Scholar: good for finding specific papers rather than searching for relevant papers
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14
Q

What format should papers be written in?

A

Introduction
Methods
Results
Discussion

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15
Q

You cannot read every paper, so how do you decide upon the most relevant one?

A

BE STRATEGIC

  • only analyze/appraise relevant evidence (Why are you reading the paper?)
  • PICO(T) (Does it answer a clinical question?)
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16
Q

How should the title and abstract be analyzed?

A

can be used to indicate the relevance of a paper, but sometimes they do not contain enough information to know if PICO(T) will be answered

17
Q

Where are objectives/aim of the study usually found?

A

last paragraph of the introduction

18
Q

How can the types of evidence and study design be found within a paper?

A

search title, abstract, and methods —> sometimes a different method is used but not documented correctly

(if the study is relevant to the clinical situation and the study design is appropriate … you can now assess the quality)

19
Q

Why are statistics not always relevant?

A

statistical significance doesn’t necessarily line up with biological importance

20
Q

How should sample sizes be shown in a paper? What is the general rule of thumb for the proper sample size?

A

paper should state how many subjects are needed in order to observe a statistical difference and the number of animals should be adhered to (and add up), or else the findings may be untrustworthy

30 cases / 30 controls

21
Q

When should results of a paper be read? What information should be read?

A

only if the methods are good enough (tables and figures are good summaries of key points)

only information that is related to the original aim/objective - if there is no significance, authors may write about something else entirely (unrelated findings should be interpreted with caution)

22
Q

Why is reading the discussion section not necessarily important? What influences on the study should be analyzed?

A

just answering a clinical question, not developing ideas in the field of research —> make up your own mind if the study is valid or relevant

sources of research funding —> motivation

23
Q

Attacking a paper:

A
24
Q

How does study design affect the strength of evidence?

A

descriptive/expert opinion do not have as much strength compared to meta-analyses and systematic reviews

25
Q

Study designs and evidence:

A
26
Q

What are the 2 types of checklists used to critically write and read papers?

A
  1. OFFICIAL REPORTING STANDARDS: designed to help authors/researchers
  2. IN-CLASS EBVM: designed to help readers

guidelines only - provides structure and lists minimum information necessary for reporting a study

27
Q

What checklists are used by authors of the different study designs?

A
  • meta-analyses, systematic reviews: PRISMA
  • controlled trials: REFLECT
  • observational studies: STROBE
  • diagnostic test evaluations: STARD
28
Q

For what studies do EBVM checklists for readers exist?

A
  • controlled trials
  • cohort, cross-sectional
  • case-control
  • diagnostic evaluations

(none exist for systematic reviews or meta-analyses)

29
Q

What is critically appraising a topic (CAT)?

A

standardized summary of research evidence regarding a clinical question generated from a specific patient situation or problem

30
Q

What are literature evaluation forms (LEFs)?

A

forms made to evaluate the quality of the information in a research paper based on a point system (meta-analyses give more points than a case report or expert opinion)

13-15 points = very good

31
Q

What is a CAT report?

A

a template used after literature evaluation forms (LEFs) are completed that discusses and appraises and summarizes the topic by ranking papers based on scores from the LEF

32
Q

What are the 5 general steps to critically appraising a topic?

A
  1. develop a clinical topic - use PICO(T)
  2. search and retrieve relevant literature
  3. read articles and assess quality of information by filling out EBVM checklists and literature evaluation forms (LEFs)
  4. assemble and discuss informaion
  5. formulate an answer (conclusion) by filling out a CAT report

Veterinary Epidemiology (13 decks)

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