HYMR Evidence Based Medicine Flashcards
A practitioner desires to know whether pregabalin can be used to prevent migraine headaches. Which of the following would be the most specific MEDLINE search strategy to answer this question?
A. “Headache/dt” and “Anticonvulsants”
B. (“Lyrica” or “Pregabalin”) and “Headache”
C. “Pregabalin” and “Migraine Disorders/pc”
D. “Migraine Disorders” and “Anticonvulsants”
C. “Pregabalin” and “Migraine
- To utilize the most specific search strategy, the most specific search terms should be used. “Migraine” is more specific than “headache”, and “pregabalin” or “Lyrica” is more specific than “anticonvulsants”.
- Medline searching also contains two-letter subheading terms to help narrow a search to a more specific area.
. The two-letter subheading, “dt”, however, represents drug therapy while the two-letter subheading, “pc”, represents prevention and control. Since the question addresses
prevention rather than treatment, the search strategy that is most specific is selection “c”
High-Yield Core Concept:
* Search strategies to increase the specificity will result in a few number of results. This is an important consideration within step 2 of the process of answering a clinical question utilizing the 5 steps of evidence-based medicine (EBM).
High-Yield Fast Fact:
* Truncation is a search strategy that would increase the number of results by including all words that start off with the same letters (e.g., the use of card* to include words cardiology, cardiomegaly, cardiomyopathy, cardiovascular, and cardiothoracic).
When implementing the principles of evidence-based medicine (EBM) in the answering of a patient specific clinical question which of the following represent the “5-As”? (Select ALL that Apply)
Ask
Attest
Acquire
Account
Assess
Apply
Correct Answer: Ask, Acquire, Assess, Apply
- The 5-A’s” of implementing the principles of evidence-based medicine (EBM) include: * ASK the clinical question
- ACQUIRE the best available evidence through a good search strategy
- APPRAISE the literature that was found
- APPLY what you obtained from the literature to the clinical question being asked
- ASSESS the impact of your decision and application of the evidence in your
practice
A Medline search is conducted to identify randomized trials evaluating tramadol efficacy for osteoarthritis in elderly patients. An original search produced 131 citations. What would be the best way to narrow the quantity of citations to a more reasonable number?
A. Read all 200 citations and select the randomized trials that address tramadol efficacy in elderly
B. Limit the search to English, tramadol and randomized trials
C. Limit the search to English, randomized trials, and elderly
D. Limit the search to tramadol, osteoarthritis, randomized trials, and elderly
C. Limit the search to English, randomized trials, and elderly
- For the best use of the researcher’s time, the search should be limited, using appropriate limits, rather than reading all citations and determining relevance for each citation.
- Tramadol and osteoarthritis are MeSH headings, not limits, and would not be used to limit the search.
- Searches can be limited based on language, publication type, and age, so the third answer choice would be the optimal search strategy to create a more reasonable citation number.
High-Yield Core Concepts:
* Strategies to reduce the number of results is referred to as increasing the search ‘specificity’.
Search strategies are considered an important part of the process of implementing evidence-based medicine (EBM) when answering a clinical question. Search strategies are implented in step 2 of the 5 step process of EBM or the 2nd A (i.e.. Acquire the best available information).
High-Yield Fast Fact:
* The use of Boolean language such as “AND” or “NOT” make the results less inclusive and thus would decrease the results.
Which of the following is the most accurate statement about evidence-based medicine?
A. Evidence-based medicine is restricted to data derived from the best clinical trials, meta analyses, and systematic reviews
B. Evidence-based medicine should be incorporated into teaching models and the clinical setting so that students learn to integrate these principles into patient care
C. Evidence-based medicine involves transforming areas of uncertainty into answerable questions and applying results in the laboratory setting
D. Evidence-based medicine is applied by most health care providers when making clinical decisions
B. Evidence-based medicine should be incorporated into teaching models and the clinical setting so that students learn to integrate these principles into patient care
- Evidence-based medicine (EBM) is the careful, thoughtful, overt application of current best available evidence in decision making for patient care.
*EBM should be utilized in all teaching models to help students learn how to incorporate these skills in lifelong learning as well as daily practice when caring for patients. - EBM uses the best evidence and is not limited to clinical trials, meta analyses or systematic reviews.
- Results from questions answered by EBM should be applied in practice rather than in the laboratory setting.
- Ideally, while all health care providers should use EBM when making clinical decisions, many rely on more traditional information sources rather than EBM resources.
When applying the principles of evidence-based medicine (EBM) to a search strategy, which of the following best describes the use of a “wildcard”?
A. To increase the specificity of the search strategy
B. To decrease the number of results
C. To include different spellings of a similar word
D. To limit the study types included in results
C. To include different spellings of a similar word
- The use of the wildcard strategy in a search of the clinical literature allows the user to obtain more results by including other spellings of a similar word. Sometimes words are spelled differently based on geographic or language differences.
- A good example for the use of a wildcard search strategy is with the word “hematology”, which can also be spelled as “haematology”. As such, a “wildcard” is added to the word to inform the database being searched to also look for words that may have another letter at a certain position (e.g., h?ematology where the “?” tells the database to also include spellings of hematology that include the “a” before the letter “e”.
- The use of a wildcard search strategy would increase the number of search results, not decrease them and as such would increase the sensitivity of the search (not specificity).
High-Yield Core Concept: - The use of a wildcard search strategy will allow the user to locate more results since the database would include other spellings of a similar word.
In the original and current definition of evidence-based medicine (EBM), which of the following components are factored in when answering a clinical question? (Select ALL that Apply)
Clinical Expertise / Experience
Impact Factor of the Journal
Patient Factors/Preferences
Best Available Evidence
Medical Education / Resources
Correct Answer: Clinical Expertise / Experience, Patient Factors / Preferences, Best Available Evidence
- The Evidence-Based Medicine Working Group originally published their approach to Evidence-Based Medicine (EBM) and teaching the practice of medicine in JAMA in 1992. * The EBM Working Group indicated that when a clinician integrates clinical expertise (i.e.. experience), the best available evidence, and patient factors or preferences collectively in answering a clinical question then that is the application of “evidence-based medicine” into clinical practice and decision making. The Venn diagram is a good way to visualize this process in its proper perspective (see image below).
- The other choices are distractors. Unfortunately, the integration of evidence into teaching in its proper perspective is not explicitly outlined or incorporated, but is rather assumed to be taking place.
In the context of applying the principles of evidence-based medicine (EBM) when formulating the structure of a clinical question what does the “T” best represent in PICOT?
A. Test Used
B. Time Frame
C. Treatment Group
D. Technique Used
B. Time Frame
- Putting a clinical question into a proper format is important not only for creating a search
strategy, but is also important to finding the best available evidence to answer the question in its proper context.
Some clinicians will use the PICOT format instead of PICO to add an additional element to the context of the clinical question that can be both important and relevant.
The PICOT format stands for: - P = Patient or Population or Problem
- I = Intervention of interest
- C = Control or comparative group/intervention
- O = Outcome of interest
- T = Timing of the outcome or data collection (this is the most common but some
have also used it designate the type of study they want to answer the question).
In the context of applying the principles of evidence-based medicine (EBM) when formulating the structure of a clinical question what does the “C” best represent in PICO?
A. Control or Comparison
B. Clinical Concern
C. Category of Question
D. Context of Clinical Case
A. Control or Comparison
- Putting a clinical question into a proper format is important not only for creating a search strategy, but is also important to finding the best available evidence to answer the
question in its proper context.
The PICO format stands for: - P = Patient or Population or Problem
- | = Intervention of interest
- C = Control or comparative group/intervention
- O = Outcome of interest
High-Yield Core Concept:
* Putting a clinical question into a PICO format can aid in applying the principles of EBM in its proper context or intended role.
