Irving slides- quiz 2 Flashcards
What is EBM?
combination of individual clinical expertise and the most up to date research to make informed clinical decisions regarding a patient’s individual care
Who was the founding father of EDM?
Archibald Cochrane
Prior to the Cochrane database that allows for better access to literature, the literature was described as what?
fragmented; meaningful conversations across disciplines was difficult
What are the 3 pieces of the EBM venn diagram?
individual clinical expertise, best external evidence, patient factors
What are the 5 steps (the 5 A’s) of EBM?
- ask a clinically relevant question
- acquire the evidence
- appraise the evidence
- apply the evidence
- assess your performance
What is the ACO?
accountable care organization; groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients
What goes up when we are practicing EBM?
quality of care
EBM wants to reduce cost by doing what four things?
- eliminating waste
- preventing complications
- preventing medical errors
- reducing readmissions
Why does EBM aim to improve prognostication?
if we can do a better job to anticipate disease trajectory, we can do a better job to anticipate what will happen and what we should do
forecasting is equal to what?
prognosis
Evidence comes from places like journals, clinical trials, books, etc. and is filtered through a funnel to create what?
evidence based guidelines that can be used to inform practice, but must be individualized to a particular patient scenario
When considering if the evidence applies to the patient, what four things should be considered?
- demographics
- confounding factors
- benefits
- risks
What are the demographics?
how closely does the study subjects (evidence) match the patient(s)
what are confounding factors?
an extra variable that you did not account for that can affect the results of a study
what are some examples of confounding factors?
- co-morbidities
- dietary influences
- drug interactions
- genetics
What does it mean to weigh the benefits vs. the risks?
have to consider how the patient will benefit and if the intervention will help the patient meet their goals and if these benefits outweigh the potential harm to the patient
Long term use of PPI’s can lead to what?
cognitive impairment, problems with gut microbiome, loss of bone density, increase pneumonia risks, and other nutrition problems
Why is autism diagnosed more often in boys than girls?
initially only boys were studied so it was thought that only boys could have autism; girls also may have a higher social intelligence at a young age and can mimic behavior
why did the 95 year old lady with CAD and hx of MI in the example in class keep experiencing falls?
from taking lovastatin which can cause musculoskeletal issues in the long term
In the teeth brushing article in class, brushing elderly patient’s teeth at least twice a day was thought to help reduce the risk of what?
pneumonia by preventing aspiration of bacteria from the teeth into the lungs
In the azithromycin article regarding COPD discussed in class, what was the main benefit observed?
people taking azithromycin experienced less COPD exacerbations
what were some of the adverse events seen from taking azithromycin for COPD exacerbations?
- macrolide resistance
- hearing impairment
in the example in class where the 88 year old lady taking coumadin for a fib was experiencing frequent falls, why was she switched to aspirin instead of continuing coumadin?
coumadin can put older patients at a higher risk for hemorrhage and the dose should be adjusted as they age; with the lady’s fall history, her risk of falling and developing a hemorrhage was greater than the risk of her having a stroke several years from now, so she was switched to aspirin to still thin her blood without the increased risk for hemorrhage
