intro to EBVM Flashcards
archie cochrane
realized in WW2 that much of medicine used did not have sufficient evidence to justify its use
david sackett
developed evidence based medicine
evidence based medicine
conscientious explicit and judicious use of current best evidence in making decisions about the individual patients
evidence based vet medicine
use of current best evidence in making clinical decisions
means integrating individual clinical expertise w best available external clinical evidence from systematic research
difference of ebvm to ebm
- limited or no scientific evidence available in ebvm
- often weaker evidence
- vets handle often greater levels of uncertainty and risk
ebvm steps
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
reasons for formulating a clinical question
- makes efficient use of time
- allow targeted search of literature/ evidence using keywords
- allows you to make clear, objective conclusions
2 kinds of clinical questions
- 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
PICO
- systematically clarifying the clinical question before searching the literature
- P; population
- i: intervention
- C: comparison
- o; outcome
intervention
what you plan to do for the patient
- therapy/ prevention
- diagnostic test
- exposure risk factor
- patient risk factor
comparison
alternative choice
- treatment (standard)
- diagnosis (old test)
- risk factors
outcome
the results you plan to accomplish
peer reviewed; scientific journal
- original research article
- review
- letter to editor
- editorial
non peer reviewed
- conference and scientific meeting proceedings
- textbooks
- internet
- government publications and reports
evidence pyramid (top is strong evidence, bottom is weak evidence)
- 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
critical appraisal in EBVM steps
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
what does epidemiological measures include
- 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
factors that influence which treatment to choose
- 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
audit the outcome
how well did the EBVM derived treatment work
keep in contact w O and keep good records
