intro to evidence based practice Flashcards
what are the four types of evidence based sections we are going to learn
evidence based medicine
healthcare
practice
dentistry
what is evidence based medicine
the conscientious explicit and judicious used of best evidence in making decisions about care of individual patients
what is evidence based medicine composed of
best research evidence with clinical expertise and patient values
why do we need EBM
Change in disease levels • Advancement of technology • Different treatment philosophies • Increased patient expectation • Ethical, legal implications • Emphasis on cost-effectiveness • Resource constraints
what is evidence based dentistry
it is an approach to oral healthcare that requires judicious intergration of
systematic assessments of clinical relevant scientific evidence
dentists clinical expertise
the patients treatment and needs
what is the definition of evidence based dentistry
The process of making decisions based on known evidence
what are the advantages of evidence based dentistry
• Improves the effective use of research in clinical practice
• Uses resources more effectively
• Relies on evidence rather than authority for
clinical decision making
• Enables practitioner to monitor and develop clinical performance
what is the five step model of evidence based practice
ask the question find the evidence appraise the evidence act on the evidence evaluate your performance
where do we find the evidence
eg medline
the cochrane library
database of abstracts if reviews of effectiveness (DARE)
how do we find the evidence
develop a search stratergy
how do we appraise the evidence
validity
clinical importance
clinical relevance
what is the definition for validity
is the degree to which the results of the study are likely to be true believable and free of bias
what is the definition for bias
is any factor( other than experimental) that could change the study results in a non random way
what is internal validity
the extent to which the findings can sustain the conclusions- eg A causes B, the treatment has caused benefit
what is external validity
the extent to which the conclusion can be generalised to a wider population
what can threaten internal validity
information/observational bias detection bias observer bias (within and between observers) measurement bias interview bias recall bias reporting bias (obsequiousness bias) bias due to confounding factors
what threatens external validity
selection bias
sampling bias
non response bias
how do we appraise the evidence
types of studies
levels of evidence- eg 1,2,3,4,
what does it mean if the quality of evidence is a I
evidence from at least one properly randomised controlled trials
what does it mean if the quality of evidence is a II-1
evidence from well designed controlled trials without randomisation
what does it mean if the quality of evidence is a II-2
evidence from well designed cohort or case controlled analytic studies- from one or more research group
what does it mean if the quality of evidence is a II-3
Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments.
what does it mean if the strength of the evidence was 1
strong evidence from at least one published systematic review of multiple well designed randomised controlled trials
what is the gold standard of trials
randomised controlled trials
why are randomised controlled trials gold standard
prevent selection bias
control of confounding
power and sample size
what dow e use to help appraise quality of evidence
CASP- clinical appraisal skills programme
