Introduction to Evidence-Based Health Care Flashcards
Why is research evidence important in health care?
Guide decisions to apply relevant research
evidence to improve patient outcomes
What is the steps for establishing evidence-based medicine?
ask, acquire, appraise, apply, act
What is the driving force behind EBM?
Major concerns over basing clinical decisions on personal experience
rather than current valid scientific evidence
• Information sources (e.g. journals, textbooks, expert opinions) do not often provide current valid scientific evidence
What are the two types of clinical questions?
Background questions, foreground questions
what is the purpose of background questions?
Seek general knowledge about a condition
Ask who, what, where, when, how & why questions
what is the purpose of background questions?
Seek general knowledge about a condition
Ask who, what, where, when, how & why questions
what is the purpose of foreground questions?
- Seek specific knowledge about a specific patient or population to guide clinical decision making
- Investigate comparisons (e.g. two treatments, two diagnostic or screening tests)
What are the sources of information for background questions?
Print or online textbooks & literature reviews
What are the sources of information for foreground questions?
Clinical guidelines, systematic reviews, primary research studies
What does PICO stand for?
P = patient problem/ population I = intervention/ exposure C = comparison/ control O = outcome
Identify the PICO terms:
Is there a difference in overall survival between obese children compared to children of normal weight at initial diagnosis of leukemia?
P: children with initial diagnosis of leukemia
I: obesity
C: normal weight
O: overall survival
What are the PICO question types? (5)
Therapy (treatment) Prevention Diagnosis Prognosis (forecasting) Etiology (causation)
What are BOOLEAN operators?
AND/OR/NOT
What is a concept?
an abstract idea, which can usually be presented in more
than one way with words & phrases in the text of articles
what is controlled vocabulary?
a standardized representation of concepts in bibliographic databases
What do you need to look for to see if a particular article is appropriate for your research?
It needs to be direct, make sure the PICO terms in the article corresponds to the PICO terms of your clinical question
What are the types of validity?
Internal and external validity
How can you assess internal validity?
Check if the research has any bias
How can you assess external validity?
Check if the results of the study is applicable to your patient population
Name the components of the hierarchy of evidence from least to most reliable (8)
- Expert opinion/editorials
- case reports, case series
- cross-sectional studies
- case-controlled studies
- cohort studies
- randomized control trials
- Systematic reviews
- Primary studies
What is the effect size?
numeric expressions of magnitude of effect of an intervention
(exposure) on the outcome of interest
What is the aim of appraising results?
to decide if the observed effect is clinically relevant (important)
or not
What is applicability, and what should be considered with assessing applicability?
the extent to which the results of a study can be expected to hold true for a particular patient. You should consider biologic & socioeconomic differences between the study population & your patient or population
What are the steps of acquiring the evidence?
1, Asking a focused clinical question
2. Searching the medical literature
3, Retrieving the medical literature
What are the steps of appraising evidence?
- Appraising directness
- Appraising validity
- Appraising the results
What are the steps for applying evidence?
- Assessing applicability
- Individualizing the results
- Sharing the decision
What are the levels of processing evidence?
- Primary studies
- Systematic reviews
- Clinical guidelines
What is a systemic review?
a study type that assesses the results of all studies addressing a research question & provides a summary estimate of effects across studies
What are clinical guidelines?
Are “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”
