Intro Flashcards
What is the best available research evidence, combined with clinical expertise and patient values?
Evidence-based Chiropractic Practice
EBC was started up by a group of medical educators at McMaster’s university when?
1980’s
Chiropractic interventions are difficult to investigate by what?
Experimental Methods
Because chiropractic interventions are difficult to investigate by experimental methods there are fewer chiropractic articles that use what?
Placebo Control Group
EBC is unique because chiropractors commonly utilize what?
Multiple Treatment Modalities
What are the multiple treatment modalities that chiropractors use?
Manipulations
Exercises
Ergonomic Advice
Physiotherapy
Clinical trials often utilize what?
One Modality (to isolate and compare it w/placebo or alternative)
What was limited for chiropractic research in the past which hampered progress?
Finances
What has changed as far as finances for chiropractic research?
Federal Funds available
What is clinical expertise?
Skills and knowledge gained by clinicians through clinical experience and practice.
EBC relies heavily upon the practitioners past what?
Clinical Experience
EBP is the integration of the best evidence with the past training and expertise of the clinician which results in?
Better patient care
Evidence is added to patient care to replace what
Outdated information
What are patient preferences?
Personal Values, Concerns, Expectations that pts have about their care.
The belief patients have about care that is being offered to them is known as?
Personal Values
Personal values may be related to?
Philosophical or Religious issues
What are some patient concerns?
Finances
Time Constraints
Office Location
The degree that patients accept a doctors recommendations is known as what?
Patient Expectations
Patient expectations often are wide-ranging and can have a significant impact on?
Clinical Results
Practitioners may not have enough information to answer clinical questions for what?
Complicated Cases
Practitioners need to stay current in light of an overwhelming amount of?
New Research
The best practices uses the most valid clinical tools available which are established through?
Research
EBP is good to determine the most effective form of?
Treatment
EBP utilizes valid and reliable what?
Diagnostic Tests
Insurances often pay for services when provided with an explanation grounded in credible evidence that justifies what?
Clinical Procedures
Patients who present for care with unusual conditions that are unknown to the practitioners is what?
Patient Specific
EBP is good for what?
Specific Conditions
EBP is good to self educate by attending
Seminars and Conferences
Pracititioners gather the best available evidence how?
On their own
Because some elements of EBP are difficult to master make time to do what?
Read Journals
Search for Answers to Clinical Questions
What are the 5 steps of EBP?
- Ask clinically relevant question
- Search literature to find evidence to answer question
- Appraise evidence for validity and applicability to clinical circumstances
- Apply relevant evidence to clinical situation
- Evaluate effectiveness in carrying out 1-4 and revise
Clinical questions should be clinically relevant and a good question will help guide the search for?
Evidence toward relevant material
What are the 2 types of questions?
- Background Q
2. Foreground Q
Background Q are simple 2-part questions that address what?
Basic facts about a pt’s health problem
Background Q don’t fully address the best what?
Diagnostic or Treatment options
Foreground questions are more complex than?
Background Q
Foreground Q are derived from
Primary Sources
Secondary Sources
What are the elements of a good clinical question (PICO)?
P-patient or problem
I-intervention
C-comparison intervention
O-outcome of interest
What is patient oriented evidence that matters (POEMs)?
Outcome in a study that should be something patients care about.
What is disease oriented evidence (DOE)?
Studies that involve outcomes that may be of interest to researchers and practitioners, but are of little interest to patients.
What is something that is helpful in forming a conclusion or judgement?
Evidence
Evidence is found primarily in journal articles that deal with what?
Effectiveness and safety of treatments
Validity and reliability of diagnostic tests
Incidence and prevalence of disease in populations
What is considered to be the gold standard for determining if a treatment is effective?
Systematic Reviews
RCT’s
What are the four C’s below RCT’s on the pyramid?
Cohort
Case-Control
Case Studies
Case Reports
What typically begins with case reports/series then advances to observational studies then to RCT’s?
Clinical Investigation
Studies that rank higher on the hierarchy of evidence pyramid are not what?
Always better
Evidence rating systems are used to rate what?
Quality and Class structure of evidence
Guideline formation
The relative strength of evidence depends on what?
Position of hierarchy of study designs
Critical Appraisal
Study’s validity
The degree of confidence that one may have in evidence depends on what?
Strength of research
How various pieces of research on that topic blend together.
When there is little or no evidence the practitioner must decide whether or not to do what?
Render treatment
Lack of evidence is not the same as?
Evidence of Lack
