Introduction to Evidence-Based Medicine and Clinical Epidemiology Flashcards
Evidence based medicine requires the integration of the
best research evidence with out clinical expertise and out patient’s unique values and circumstances.
best research evidence is
clinically relevant research
clinical expertise is
the ability to use our clinical skills and past experience to solve patient problems.
patient values mean
the preferences, concerns, expectations and circumstances each patient brings to the clinical encounter.
patient circumstances means
the clinical state of a patient and the clinical setting.
definition of epidemiology
the scientific study of the distribution and determinants of health related states or events in specified populations, and the application of resulting knowledge to the prevention and control of health problems.
evidence based medicine (EBM) is the
conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.
The practice of EBM involves 5 steps
- asking answerable questions
- finding the best evidence
- critically appraising the evidence
- acting on the evidence
- evaluating (reflecting on) one’s performance.
SORT
Strength of Recommendation Taxonomy.
Strength of recommendation goes from A - C (A is the best, C is the worst). Grades are assigned based on quality and consistency of available evidence.
GRADE
Grading of Recommendations, Assessment, Development and Evaluation working group.
Ranges from high to very low.
the term evidence-based medicine (EBM) was first published by
Guyatt in 1991.
According to Sackett, EBM has been defined as
the integration of best research evidence with clinical expertise and patient values.
the 3 main components of EBM are
research evidence
clinical experience
patient values
and can be visualized with a Venn diagram.
EBM was originally intended to
aid the clinician in providing the best patient care possible by utilizing all of the available evidence (research) as part of the clinical decision-making process.
However it has become evidence based policy making.
An evidence-based physician should be able to
find, critically evaluate and apply research findings to the clinical setting.
As the years since medical school graduation increase, the knowledge of hypertension care
decreases
common limitations and misperceptions of EBM
need to develop new skills
limited time and resources
paucity of evidence that EBM works
misperceptions of EBM
denigrates clinical expertise ignores patients' values and preferences cost cutting tool limited to clinical research absence of evidence from randomized trials
skills needed for evidence based medicine
fundamental knowledge of clinical research
ability to find peer-reviewed research
ability to critically evaluate research
knowledge to apply these findings to everyday practice.
steps to make research more accessible
become familiar with the research process
develop basic strategies for reviewing literature
read relevant journals
avoid trends
evaluate and enhance your clinical decision making.
strongest study
quantative systematic review (meta analysis)
weakest study
anecdoes
order of evidence, from strongest to weakest
meta-analysis (quantitative systematic review) qualitative systmatic review randomized controlled trial cohort study before/after study cross-sectional study single subject tine series case series case report clinical hunches anecdotes
the ___ is considered the gold standard for judging whether a treatment does more good than harm.
the randomized controlled trial (RCT) is considered the gold standard for judging whether a treatment does more good than harm.
cohort studies are
prospective (planning for future data collection)
case reports are
retrospective (going back in time for data collection)
which has more control of the data when collected in the future (prospective or retrospective)?
prospective
best evidence/study for therapy
systematic review of RCTs or RCT.
best evidence/study for harm or etiology
observational study - cohort or case control.
best evidence/study for prognosis
observational study - cohort or case control
best evidence/study for diagnosis
blind comparison to gold standard
background questions have two components:
question root
aspect of the disorder
foreground questions have 4 components
patient or problem of interest main intervention (dx, tx, progonostic fx) comparison interventions clinical outcomes of interest
foreground questions are generally
detailed information with a patient focus. It is made using an evidence-based process.
when our experience of a specific condition is limited, we tend to ask more
background questions.
As our experience grows, we should and tend to as
more foreground questions.
4 parts of a clinical question (PICO)
P - patient and problem
I - intervention (treatment, test, prognostic factor, etiology)
C- comparison
O - outcome
PICO in action
P - in a child with frequent febrile seizures
I - would anticonvulsant therapy
C - compared to no treatment
O - result in seizure reduction?
