How can we actually do it in practice? Flashcards
What are the steps of EBVM?
- convert info needs into answerable Qs
- track down the best evidence w/ which to answer them
- critically appraise the evidence for validity
- apply results to clinical practice
- evaluate performance
what are the 5 A’s of EBVM?
- ASK (defining a clinical Q that is of interest & (hopefully) answerable
- ACQUIRE (finding the best available evidence to answer the question)
- APPRAISE (assessing the quality of the relevant evidence found)
- APPLY (implementing the evidence into clinical practice where appropriate)
- ASSESS (evaluating the impact of the implementation & changes in clinical practice)
DONT NEED TO USE ALL 5 STEPS TO PRACTICE EBVM
What are 3 basic strategies for dealing w/ cases that clinicians trained in EBVM tend to use?
- appraising mode
- searching mode
- replicating mode
what is appraising mode?
- conditions that we commonly encounter
- need to be “up to the minute” & sure of what we are doing
- invest time & effort in both steps 2 (searching) & 3 (critically appraising)
What is searching mode?
- conditions we encounter less often
- clinicians seek out critical appraisals already performed by others
- step 3 is omitted (critical appraisal)
- step 2 (searching) is restricted to sources that have already been critically appraised
What is replicating mode?
- blindly seek, accept & apply the recommendations we receive from authorities in relevant branch of vet med
- this is the way most med & vet students are trained
- however, are the experts also operating in the replicating mode?
- is the expert valid?
What are the 2 types of answerable clinical Qs?
- background Qs
- ask for general knowledge about a disorder
- 5 Ws - foreground Qs
- specific knowledge about managing patients
As you get more experience with a condition which kinds of questions do you tend to ask?
More foreground questions and less background questions
What types of clinical questions should you ask in practice?
- treatment (Which diet is best to feed cats w/ chronic renal disease?)
- prognosis & incidence (Does sex affect survival in flat-coat retrievers w/ cancer?)
- etiology & risk (what are the risks of general anesthesia in ferrets?)
- Diagnosis (which diagnostic test is most reliable for diagnosing Johne’s disease in cattle?)
- Prevalence (What is the prevalence of heartworm infections in Ca that live in Manitoba?)
What is PICO?
- P: patient/population &/or problem being addressed
- I: intervention or treatment/exposure, prognostic factor being considered
- C: comparison intervention or exposure, when relevant
- O: clinical outcomes of interest (what do you actually want to measure?)
Why is PICO important?
to be satisfactorily answered the question must be focused & well articulated for all 4 parts of its anatomy
what if too many Qs arise?
- patients may have several active probs (possible Qs about diagnosis, prognosis, therapy for each prob; your Qs may be too numerous to even ask, let alone answer)
- what is the most important issue for this patient now?
- which Q, when answered, will help me most?
- then selecting from the many the few Qs that are most important to answer right away
What to do when you dont have time to read all the available evidence & need a short easy summary?
Critically Appraised Topics (CAT) or Best Evidence Topic (BET): short summaries of the best avail evidence on a focused clinical Q
Veterinary resources for searching mode?
- best bets for vets (best evidence topics)
- veterinary evidence journal (knowledge summaries)
- banfield pet hospital (critically appraised topics (CAT))
- clinical evidence in equine practice online collection (systematic reviews & CATS)
What is the search strategy for the used of meloxicam in dogs with osteoarthritis?
(dog OR dogs OR canine OR canines OR Canis) AND (osteoarthritis OR osteoarthritic OR OA OR arthritis OR arthritic) AND (meloxicam OR loxicam OR metacam OR inflacam OR rheumocam)
