Lecture 2 - Week 1 - EBDM

Question 1

Why is EBDM important ?

Answer 1

• doctors make decisions constantly
• of the effect that decisions have on patients , families and society
• an understanding of decision making and the role of evidence can help improve medical practice

Question 2

Nature of decisions in medicine :

Answer 2

• they’re complex
• doctors generally use hypothetico- deductive reasoning when making diagnoses
• evidence from research can be used to inform decision making

Question 3

EBD

Answer 3

• Evidence from research
• clinical expertise
• patient preferences
• available resources

Question 4

Nature of evidence

Answer 4

Evidence is available from research studies
Different types of research study appropriate for different decisions

• cohort studies ; prognosis , causes )
• case control studies ( cause )
• Randomised controlled studies ( treatment interventions , benefits and harm and cost effectiveness )
  Qualitative approaches ( patients and/or practitioners perspectives)
• diagnostic and screening studies -(identification)
  Systematic reviews -(summary of evidence for a specific question)

Question 5

Why do we need EBDM

Answer 5

• limited time to read
• inadequacy of traditional sources of info ( textbooks out of date )
• disparity between Diagnostic skills / clinical judgement ; which increase over time ) and up to date knowledge / clinical performance ( which decrease over time )

Question 6

Solution …

Answer 6

Evidence based medicine (EBM )

Process of identifying and using most up to date and relevant evidence to inform decisions for individual patient problems.

Question 7

EBM - the process …

Answer 7

1- converting the need for info into an answerable question
2- identifying the best evidence to answer that question
3- critically appraising the evidence for its validity , impact and applicability.
4- Integrating critical appraisal with clinical expertise and the patients unique circumstances

5- evaluating our effectiveness and efficiency in carrying out steps 1-4 and seeking ways to improve them .

Question 8

Types of questions -1

Answer 8

1- background questions

• general knowledge about a disorder
• 2 essential complements
  
  • • a question root ( who , what , where , when )
  • • a disorder /aspect of a disorder

I.e what causes breast cancer

Question 9

Types of questions -2

Answer 9

• foreground questions.

Specific knowledge about managing patients with a disorder 
4/3 essential components 
  -- patient/problem 
  -- intervention 
  -- comparison intervention 
  -- Clinical outcome 

I.e in younger women with breast cancer Is mastectomy with chemo more effective than just mastectomy In reducing risk of cancer reoccurrence.
(PICC)

Question 10

Framework for asking questions:

Answer 10

1- population : women under age of 30 with breast lump

2- intervention : needle biopsy

3- comparison : ultrasound

4- Outcome : Accurate identification of breast cancer

PICO

Question 11

Structure

Answer 11

Identifying best evidence ( structured searches based on question )

Appraising the identified evidence

Integrating the evidence into decision making for the individual patient