Intro Flashcards
What is evidence based medicine?
applying the best & most relevant scientific evidence, integrated w/ clinical expertise, whilst taking into account each patient & owner’s individual circumstances when making clinical decisions
What are the origins of EBM?
- pioneered by grp of physicians at McMaster University in Hamilton
- specific approach to clinical decision making
- was emphasized in their Problem Based Learning approach
- applying population or epidemiologic research to individual patient care
- now widely adopted in human medicine
- just gaining momentum in vet med
What is the importance of EBVM?
- b/c of how quicky new knowledge enters the field, the most important skill you will be taught is the ability to keep yourself current
- EBVM will provide you with the explicit skills required to identify & appraise research evidence, & give you the ability to provide the best possible care for your clients & patients over your entire career
What does EBM suggest?
- personal experience may be misleading (just b/c an animal recovers doesn’t mean your treatment worked)
- randomized studies are required to validate results
- predictions based on physiological principles are often wrong
- reading the literature requires more than common sense to evaluate the evidence
Why should we practice EBVM?
- b/c we can (research is more accessible than ever before)
>evidence can be accessed via internet sources rather than going to library, open access journals, pubmed - b/c our clients can too (Dr. Google)
- we need the info (info that is needed & is known; info that is needed by not known; info needs that arent recognized)
What are essential skills for the practicing vet?
ability to find additional info & judge the quality of that info
What are barriers to the EBM process?
- info available is spread out over many diff sources & you & your team dont have time or resources to seek them out
- there is limited time to analyze evidence @ pt of care
- it can be challenging to evaluate the value of information, particularly when it has been provided by commercial organizations
- evidence-base in some areas of vet science may be poor or even lacking (we may need to rely on poorer quality evidence @ times (fewer clinical trials); clinical research is not always well focused on needs of practice)
- there is a lack of methodically performed rigorous, large-scale clinical studies in vet med
What are the limitations of EBVM?
- our literature base is MUCH, MUCH smaller than human med
- we have to place more emphasis on poorer sources of evidence
- lots of our clinical Qs have v little or v poor evidence available
- lack of evidence shouldnt demoralize us
- it tells us where clinical info gaps exist & where clinical experience is vital
- owners prefer truth & dont mind uncertainty
What is the difference btwn “just in time” info vs keeping up to date?
- there are some diseases/conditions that we will see so rarely that it doesnt pay to try to keep up to date on the latest therapies
- will either refer those or find info “just in time” in order to deal w/ them (searching mode)
- there are other conditions that we see v regularly that we will want to stay abreast of the latest developments in those areas so that we will know how to deal w/ them on a regular basis (appraising mode)
What is key for EBVM?
- ability to efficiently & accurately search for best available evidence
- basic understanding of criteria for determining strength of evidence
What is the evidence based pyramid?
Filtered resources:
- meta-analysis
- systematic reviews
- critically appraised topics
Unfiltered resources:
- randomized controlled trials (RCT)
- cohort studies
- case control studies
- case reports/ case series
- textbooks/ background info/ expert opinion
What are filtered resources?
- summarize, examine, & appraise the evidences of multiple individual studies (unfiltered resources)
- often make recommendations for practice
- BE AWARE THAT FILTERED RESOURCES ARE ONLY AS GOOD AS THE INDIVIDUAL STUDIES (UNFILTERED RESOURCES) EXAMINED & THE RIGOR W? WHICH THE REVIEW WAS CONDUCTED
What are unfiltered resources?
- original research studies that provide evidence related to a particular research topic
- generally unfiltered resources are published journal articles (peer reviewed journal articles have been vetted by experts in field)
- FOR UNFILTERED SOURCES, YOU NEED TO TAKE EXTRA CARE TO APPRAISE THE RESOURCES TO ENSURE THEY ARE VALID & RELIABLE
5 developments that have made EBM possible?
- development of strategies for efficiently tracking down & appraising evidence (PubMed, etc.)
- creation of systemic reviews & concise summaries (filtered resource)
- creation of evidence- based journals of secondary publication (filtered resource); (Veterinary Evidence, Best Bets for Vets)
Have vets always used evidence to make clinical decisions?
yes. but much of our evidence has been informal, unsystematic, & haphazard
- we need to be able to search for & critically assess the available research
- we should at least know when we are using the best available evidence & when we are not
