Introduction to Evidence-Based Medicine and Clinical Epidemiology

Question 1

Evidence based medicine requires the integration of the

Answer 1

best research evidence with out clinical expertise and out patient’s unique values and circumstances.

Question 2

best research evidence is

Answer 2

clinically relevant research

Question 3

clinical expertise is

Answer 3

the ability to use our clinical skills and past experience to solve patient problems.

Question 4

patient values mean

Answer 4

the preferences, concerns, expectations and circumstances each patient brings to the clinical encounter.

Question 5

patient circumstances means

Answer 5

the clinical state of a patient and the clinical setting.

Question 6

definition of epidemiology

Answer 6

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.

Question 7

evidence based medicine (EBM) is the

Answer 7

conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

Question 8

The practice of EBM involves 5 steps

Answer 8

1. asking answerable questions
2. finding the best evidence
3. critically appraising the evidence
4. acting on the evidence
5. evaluating (reflecting on) one’s performance.

Question 9

SORT

Answer 9

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.

Question 10

GRADE

Answer 10

Grading of Recommendations, Assessment, Development and Evaluation working group.

Ranges from high to very low.

Question 11

the term evidence-based medicine (EBM) was first published by

Answer 11

Guyatt in 1991.

Question 12

According to Sackett, EBM has been defined as

Answer 12

the integration of best research evidence with clinical expertise and patient values.

Question 13

the 3 main components of EBM are

Answer 13

research evidence
clinical experience
patient values

and can be visualized with a Venn diagram.

Question 14

EBM was originally intended to

Answer 14

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.

Question 15

An evidence-based physician should be able to

Answer 15

find, critically evaluate and apply research findings to the clinical setting.

Question 16

As the years since medical school graduation increase, the knowledge of hypertension care

Answer 16

decreases

Question 17

common limitations and misperceptions of EBM

Answer 17

need to develop new skills
limited time and resources
paucity of evidence that EBM works

Question 18

misperceptions of EBM

Answer 18

denigrates clinical expertise
ignores patients' values and preferences
cost cutting tool
limited to clinical research
absence of evidence from randomized trials

Question 19

skills needed for evidence based medicine

Answer 19

fundamental knowledge of clinical research

ability to find peer-reviewed research

ability to critically evaluate research

knowledge to apply these findings to everyday practice.

Question 20

steps to make research more accessible

Answer 20

become familiar with the research process
develop basic strategies for reviewing literature
read relevant journals
avoid trends
evaluate and enhance your clinical decision making.

Question 21

strongest study

Answer 21

quantative systematic review (meta analysis)

Question 22

weakest study

Answer 22

anecdoes

Question 23

order of evidence, from strongest to weakest

Answer 23

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

Question 24

the ___ is considered the gold standard for judging whether a treatment does more good than harm.

Answer 24

the randomized controlled trial (RCT) is considered the gold standard for judging whether a treatment does more good than harm.

Question 25

cohort studies are

Answer 25

prospective (planning for future data collection)

Question 26

case reports are

Answer 26

retrospective (going back in time for data collection)

Question 27

which has more control of the data when collected in the future (prospective or retrospective)?

Answer 27

prospective

Question 28

best evidence/study for therapy

Answer 28

systematic review of RCTs or RCT.

Question 29

best evidence/study for harm or etiology

Answer 29

observational study - cohort or case control.

Question 30

best evidence/study for prognosis

Answer 30

observational study - cohort or case control

Question 31

best evidence/study for diagnosis

Answer 31

blind comparison to gold standard

Question 32

background questions have two components:

Answer 32

question root

aspect of the disorder

Question 33

foreground questions have 4 components

Answer 33

patient or problem of interest
main intervention (dx, tx, progonostic fx)
comparison interventions
clinical outcomes of interest

Question 34

foreground questions are generally

Answer 34

detailed information with a patient focus. It is made using an evidence-based process.

Question 35

when our experience of a specific condition is limited, we tend to ask more

Answer 35

background questions.

Question 36

As our experience grows, we should and tend to as

Answer 36

more foreground questions.

Question 37

4 parts of a clinical question (PICO)

Answer 37

P - patient and problem
I - intervention (treatment, test, prognostic factor, etiology)
C- comparison
O - outcome

Question 38

PICO in action

Answer 38

P - in a child with frequent febrile seizures
I - would anticonvulsant therapy
C - compared to no treatment
O - result in seizure reduction?