Exam #1: Medical Literature

Question 1

What is the definition of evidence based medicine?

Answer 1

The use of mathematical estimates of risk, benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation, or management of individual patients

Question 2

What four things does EBM practice emphasize?

Answer 2

1) Best evidence
2) Clinical expertise
3) Patient values
4) Patient circumstances

Question 3

What are the major reasons to implement EBM in clinical practice?

Answer 3

• Improved pt care
• Exhausting # of questions to answer per day
• Traditional sources outdated
• Skill & experience increases w/ age but UTD knowledge wanes

Question 4

What are the five basic steps in EBM?

Answer 4

1) Ask answerable questions
2) Search for best evidence
3) Critically appraise validity & relevance
4) Integrate evidence w/ expertise, pt values/ preference AND apply
5) Evaluate results

Question 5

What is the difference between “Doing Mode, Using Mode, Replicating Mode?”

Answer 5

Doing= carrying out first 4 steps of EBM personally

Using= personally skipping critical appraisal as it has been done previously by experts in field
- E.g. UpToDate

Replicating= following opinion on of experts in field

Question 6

What is the mnemonic to ask a question that can be answered?

Answer 6

PICO:

P= patient or problem
I= intervention 
C= comparision intervention
O= outcome

Question 7

What is a background question?

Answer 7

Question that seeks general knowledge

Question 8

What is a foreground question?

Answer 8

Question that seeks specific knowledge for patient management

Question 9

What must be included in developing an answerable question?

Answer 9

Patient concerns

Question 10

What are the problems with using textbooks for EBM?

Answer 10

Too often out of date

Question 11

What are the problems with using traditional journals for EBM?

Answer 11

Reading the published volume is insurmountable

Question 12

What are the best sources of EBM?

Answer 12

Electronic/ online

Question 13

What are the general properties of useful sources of EBM?

Answer 13

• Rapid access
• Targeted to a specific question
• Evidence based i.e. contain current research info
• Portable
• Simple

Question 14

What constitutes best evidence?

Answer 14

Evidence is:

• Current
• Valid
• Clinically relevant

Question 15

Outline the hierarchy of reliability for sources in EBM.

Answer 15

• Systematic reviews/ meta-analyses of RCTs*
• RCTs
• Prospective studies
• Retrospective studies
• Cross-sectional surveys
• Case series
• Case reports

*RCT= Randomized Controlled Trials

Question 16

What source is best for current, evidence-based clinical information?

Answer 16

UpToDate

Question 17

What is The Cochrane Collaboration for?

Answer 17

Best source for systematic reviews & meta-analyses

Question 18

What are the basic components of clinical validity?

Answer 18

• Peer-reviewed?
• Is the location/ pt. population valid?
• Is the source sponsored in a way that may BIAS results?
• Will info. impact pt. care?
• Common or uncommon problem?