Intro To EMB

Question 1

Evidence based medicine

Answer 1

Patient oriented evidence (POEM)

The evidence based medical literature is reviewed and summarized

Intent is to present evidence based results in a concise and easily readable way that is applicable to clinical practice

Should always review original work for interventions or outcomes affecting patients

Question 2

Outcomes of care

Answer 2

Outcomes: measurable or observable results of illness or treatment

Outcomes are objective data points

Question 3

Objective outcomes

Answer 3

Outcomes are objective data points

You do it with our senses, smell, touch and hearing

Question 4

Subjective outcomes

Answer 4

Comes from subject (patient)

How he/she is experiencing pain

Ask 1-10 how pain is

Question 5

Categories of outcomes

Answer 5

Outcomes that matter:

Morbidity 
Mortality
Pain
Quality of life
Pain

Surrogate outcomes - not directly measure outcome (indirectly)

Physiological
Laboratory
Biological - genetic disposition

Question 6

Advantages of surrogate outcomes

Answer 6

Some surrogates are reliably associates with clinically important outcomes

Surrogates used in everyday clinical practice so clinicians can compare their patients results to the published results

Surrogates less expensive to study

Treatments become available sooner - potentially reducing harm and suffering from a disease

Can see intervention sooner than with outcomes that matter

Question 7

EBM skills

Answer 7

Locating applicable info

Critically appraise info

Developing focused clinical questions

Question 8

Locating applicable information

Answer 8

Develop your own research protocol

Develop a search practice that is:

Prospective: in advance - search articles you are interested in

Concurrent: pt comes to office and asks a question

Retrospective: do EBM as a follow up - when patient leaves you can answer question at a later time

Question 9

Critically appraising information

Answer 9

The process of evaluating trustworthiness and relevance of a resource within the context of a given clinical scenarios

Within a hierarchy of evidence

Question 10

How to create focused clinical question

Answer 10

PICO

Population - patient
Intervention - treatment
Comparison
Outcome

Question 11

The EBM process

Answer 11

ASSES the patient, clinical problem

ASK a focused Question

AQUIRE the evidence

APPRAISE the evidence

APPLY: talk with the patient

SELF-EVALUATION

Question 12

Hierarchy of evidence

Answer 12

As you move up pyramid: stronger methodology, less bias, controls for comparison

Meta-analysis - stringiest
Systemic reviews
RCT
Cohort studies 
Case control studies
Case reports/case series

Question 13

Levels of evidence

Answer 13

A - high-quality evidence that considers all important outcomes (RCT, systemic reviews of RTCs, meta-analysis, systemic reviews using comprehensive search strategies)

B - anything that is not RCT

C - consensus or expert opinion