intro to EBVM

Question 1

archie cochrane

Answer 1

realized in WW2 that much of medicine used did not have sufficient evidence to justify its use

Question 2

david sackett

Answer 2

developed evidence based medicine

Question 3

evidence based medicine

Answer 3

conscientious explicit and judicious use of current best evidence in making decisions about the individual patients

Question 4

evidence based vet medicine

Answer 4

use of current best evidence in making clinical decisions

means integrating individual clinical expertise w best available external clinical evidence from systematic research

Question 5

difference of ebvm to ebm

Answer 5

• limited or no scientific evidence available in ebvm
• often weaker evidence
• vets handle often greater levels of uncertainty and risk

Question 6

ebvm steps

Answer 6

1) formulate an answerable clinical question
2) search for evidence to answer the question
3) critically appraise the evidence
4) apply the answer to your patient
5) audit the outcome

Question 7

reasons for formulating a clinical question

Answer 7

• makes efficient use of time
• allow targeted search of literature/ evidence using keywords
• allows you to make clear, objective conclusions

Question 8

2 kinds of clinical questions

Answer 8

• background; comprises of general knowledge of field of interest
• foreground; much more specific, helps you make decisions, question involves a comparison, helpful to have a series of questions and narrow them down later to a refined clinical question

Question 9

PICO

Answer 9

• systematically clarifying the clinical question before searching the literature
• P; population
• i: intervention
• C: comparison
• o; outcome

Question 10

intervention

Answer 10

what you plan to do for the patient
- therapy/ prevention
- diagnostic test
- exposure risk factor
- patient risk factor

Question 11

comparison

Answer 11

alternative choice
- treatment (standard)
- diagnosis (old test)
- risk factors

Question 12

outcome

Answer 12

the results you plan to accomplish

Question 13

peer reviewed; scientific journal

Answer 13

• original research article
• review
• letter to editor
• editorial

Question 14

non peer reviewed

Answer 14

• conference and scientific meeting proceedings
• textbooks
• internet
• government publications and reports

Question 15

evidence pyramid (top is strong evidence, bottom is weak evidence)

Answer 15

• meta analysis (strongest)
• systematic reviwe
• randomized control trial
• control trial
• observational study (cohort, case-control or cross sectional)
• case series/ case report
• lab studies, expert opinion

Question 16

critical appraisal in EBVM steps

Answer 16

1) are the study results valid?: study design, epidemiological measures, causality, bias and confounding
2) are the results clinically important
3) are the results relevant to my patient

Question 17

what does epidemiological measures include

Answer 17

• odds ratio, relative risk, risk difference
• difference between means or proportions
• confidence intervaks
• number needed to treat: how many cases have to be treated to prevent or cure ONE additional case of the disease

Question 18

factors that influence which treatment to choose

Answer 18

• efficacy of treatment based on evidence critically appraised
• cost; immediate cost and ongoing costs
• convenience
• patient/ owner preference, values and expectations
• clinical experience and skills

Question 19

audit the outcome

Answer 19

how well did the EBVM derived treatment work

keep in contact w O and keep good records