Introduction to Evidence-Based Health Care

Question 1

Why is research evidence important in health care?

Answer 1

Guide decisions to apply relevant research

evidence to improve patient outcomes

Question 2

What is the steps for establishing evidence-based medicine?

Answer 2

ask, acquire, appraise, apply, act

Question 3

What is the driving force behind EBM?

Answer 3

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

Question 4

What are the two types of clinical questions?

Answer 4

Background questions, foreground questions

Question 5

what is the purpose of background questions?

Answer 5

 Seek general knowledge about a condition

 Ask who, what, where, when, how & why questions

Question 6

what is the purpose of background questions?

Answer 6

 Seek general knowledge about a condition

 Ask who, what, where, when, how & why questions

Question 7

what is the purpose of foreground questions?

Answer 7

• 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)

Question 8

What are the sources of information for background questions?

Answer 8

Print or online textbooks & literature reviews

Question 9

What are the sources of information for foreground questions?

Answer 9

Clinical guidelines, systematic reviews, primary research studies

Question 10

What does PICO stand for?

Answer 10

P = patient problem/ population
I = intervention/ exposure
C = comparison/ control
O = outcome

Question 11

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?

Answer 11

P: children with initial diagnosis of leukemia
I: obesity
C: normal weight
O: overall survival

Question 12

What are the PICO question types? (5)

Answer 12

Therapy (treatment)
Prevention 
Diagnosis 
Prognosis (forecasting)
Etiology (causation)

Question 13

What are BOOLEAN operators?

Answer 13

AND/OR/NOT

Question 14

What is a concept?

Answer 14

an abstract idea, which can usually be presented in more

than one way with words & phrases in the text of articles

Question 15

what is controlled vocabulary?

Answer 15

a standardized representation of concepts in bibliographic databases

Question 16

What do you need to look for to see if a particular article is appropriate for your research?

Answer 16

It needs to be direct, make sure the PICO terms in the article corresponds to the PICO terms of your clinical question

Question 17

What are the types of validity?

Answer 17

Internal and external validity

Question 18

How can you assess internal validity?

Answer 18

Check if the research has any bias

Question 19

How can you assess external validity?

Answer 19

Check if the results of the study is applicable to your patient population

Question 20

Name the components of the hierarchy of evidence from least to most reliable (8)

Answer 20

8. Expert opinion/editorials
9. case reports, case series
10. cross-sectional studies
11. case-controlled studies
12. cohort studies
13. randomized control trials
14. Systematic reviews
15. Primary studies

Question 21

What is the effect size?

Answer 21

numeric expressions of magnitude of effect of an intervention
(exposure) on the outcome of interest

Question 22

What is the aim of appraising results?

Answer 22

to decide if the observed effect is clinically relevant (important)
or not

Question 23

What is applicability, and what should be considered with assessing applicability?

Answer 23

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

Question 24

What are the steps of acquiring the evidence?

Answer 24

1, Asking a focused clinical question
2. Searching the medical literature
3, Retrieving the medical literature

Question 25

What are the steps of appraising evidence?

Answer 25

1. Appraising directness
2. Appraising validity
3. Appraising the results

Question 26

What are the steps for applying evidence?

Answer 26

1. Assessing applicability
2. Individualizing the results
3. Sharing the decision

Question 27

What are the levels of processing evidence?

Answer 27

1. Primary studies
2. Systematic reviews
3. Clinical guidelines

Question 28

What is a systemic review?

Answer 28

a study type that assesses the results of all studies addressing a research question & provides a summary estimate of effects across studies

Question 29

What are clinical guidelines?

Answer 29

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”