Introduction to evidence-based practice Flashcards
Define evidence based medicine
The conscientious explicit and judicious use of best evidence in making decisions about care of individual patients
What is evidence based medicine the integration of?
is the integration of best research evidence with clinical expertise and patient values
What is the need for evidence based medicine?
- Change in disease levels
- Advancement of technology
- Different treatment philosophies
- Increased patient expectations
- Ethical and legal implication s
- Emphasis on cost effectiveness
- Resource constraints
What does evidence based dentistry integrate?
- The systemic assessments of clinical relevant scientific evidence relating to the patients oral and medical condition and history
- The dentists clinical expertise
- The patients treatment needs and preferences
What os evidence based dentistry?
The process of making decisions based on known evidence
What are the benefits of evidence based dentistry?
- Improves the effective use of research in clinical practice
- Uses resources more effective
- Relies on evidence rather than authority for clinical decision making
- Enables practitioner to monitor and develop performance
Go through the 5 step mode;
- ASK answerable questions
- FIND the best evidence
- APPRAISE the evidence for validity and clinical performance
- ACT on the evidence
- EVALUATE your performance
Where do you find the evidence?
- Medline/pubmed
- The Cochrane library
- Database of abstracts of reviews of effectiveness
- Clinical trial s
What do you check the you are appraising evidence?
- Validity
- Clinical importance
- Clinical relevance
What is validity?
It is the degree to which the results of the study are likely to be true, believable and free
What is bias?
Bias is any facto that could change the study results in a non random way
Name the 2 different types of validity
- Internal validity
2. External validity
What is internal validity
The extent to which the findings can sustain the conclusion
What is external validity?
The extent to which the conclusion can be generalised to a wider population
Name some biases that threaten internal validity
- Information/ observational bias
- Detection bias
- Observer bias
- Measuremtn bias
- Interview bias
- Recall bias
- Reporting bias
- bias due to confounding factors
Name some biases that threaten external validity
- Selection bias
- Sampling bias
- Non response bias
How do we grade the quality of evidence?
On a scale:
I, II1, II2, II3, III
What does it mean if the quality of evidence has been given a I
evidence is from at least one properly randomised controlled trials
What does it mean if the quality of evidence has been given a II1
Evidence is from well-designed controlled trials without randomisation
What does it mean if the quality of evidence has been given a II2
Evidence from well-designed cohort or case-controlled analytic studies, preferably from more than one centre or research group
What does it mean if the quality of evidence has been given a II3
Evidence from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments.
What does it mean if the quality of evidence has been given a III
The evidence is based on the opinion of respected authorities based on clinical experience, descriptive studies or reports of expert committee
How do we grade the type and strength of evidence?
It is graded on a scale of 1-5
What does it mean if the type and strength of evidence is given a grade of 1?
Theres string evidence from at least one published systematic review of
multiple well-designed randomised controlled trials
What does it mean if the type and strength of evidence is given a grade of 2?
Theres strong evidence from a t least one published properly designed randomised controlled trial of appropriate size and in an appropriate clinical setting
What does it mean if the type and strength of evidence is given a grade of 3?
Theres evidence from published wwell-designed trials without randomisation, single group pre, post, cohort, time series or matched case-controlled studies
What does it mean if the type and strength of evidence is given a grade of 4?
Theres evidence from well researched experimental studies from more than one centre or research group
What does it mean if the type and strength of evidence is given a grade of 1?
Theres Evidence of respected authorities, based on clinical experience, descriptive studies or reports of expert committee
What is the gold standard for clinical trials?
Doing a randomised controlled trial
What are randomised controlled trails the best at assessing?
The cause and effect relationship between treatment and outcomes
