Modalities Ch. 3

Question 1

difference between EBM and EBP

Answer 1

EBP applies EBM

Question 2

overarching goal of EBP

Answer 2

use best evidence possible to improve patient care

Question 3

Evidence-Based vs. Patient-Centered Medicine

Answer 3

Powerful, different, somewhat contradictory philosophies

Question 4

EBM

Answer 4

approaches patient care from a biomedical perspective
based solely on scientific facts
is a doctor-oriented, disease-centered model
aims to improve quality by standardizing medical, through clinical guidelines of best practice
patients treated as a group
_____

Question 5

best practices

Answer 5

philosophy of action
specific techniques, methods, activities, or processes
good guidelines apply to only 80% of patients
a given best practice only applies to a specific condition or circumstance
-may be modified or adapted for similar circumstances

Question 6

protocols

Answer 6

a plan or set of specific steps to be followed
a strict process for monitoring and caring for specific conditions
often provides a practical, step-by-step framework for implementing guidelines

Question 7

patient-centered medicine

Answer 7

a humanistic, biophychosocial approach
focus on patient participation in clinical decision making, using in-depth patient communication to understand patients’ complaints, unique needs, and who they are
moves care from clinician control to_______
patients are experts in the experience of their symptoms
patients differ, even with same S/S

Question 8

benefits of EBP and PCM

Answer 8

EBP
-increased quality of care
-proven to work
PCM
-patient-specific (not cookie cuter)
-empowers the patient

Question 9

detriments of EBP and PCM

Answer 9

EBP
-less personal
-might not work for everybody
-doesn’t account for patient differences
PCM
-giving patients too much control/power without knowledge
-can negate the expertise of the clinician

Question 10

who one is best?

Answer 10

not either-or, but both
both are needed and must be integrated
-external clinical evidence can inform, but can never replace, individual clinical expertise

Question 11

components of EBP

Answer 11

defining a clinically relevant question
searching for the best evidence
appraising the quality of the evidence
applying the evidence to clinical practice
evaluating the process

Question 12

clinically relevant questions

Answer 12

what’s the best course of action?

Question 13

components of clinical questions

Answer 13

patient population
intervention/treatment
outcome of interest

Question 14

searching for the best evidence

Answer 14

technology is a blessing

Question 15

what is evidence

Answer 15

anything used to establish a fact, or give a reason to believe something
seek “facts”

Question 16

sources of medical evidence

Answer 16

tradition
experience
research
theory

Question 17

types of research

Answer 17

laboratory
observational
clinical trials

Question 18

laboratory

Answer 18

controlled
looks at
-physiological processes
-tissue response to intervention

Question 19

laboratory pros and cons

Answer 19

pros
-easy to control
cons
-limited by tissue type (healthy, animals)

Question 20

observational

Answer 20

observations in a natural environment

prospective or retrospective (before/after data collection)

Question 21

observation pros and cons

Answer 21

pros
-natural
cons
-uncontrolled

Question 22

clinical trials

Answer 22

observation + lab

Question 23

clinical trials pros and cons

Answer 23

pros

• well controlled
• natural setting

Question 24

narrowing the focus of your search

Answer 24

patient group
intervention
outcome
use studies within last 5-10 years

Question 25

quality of evidence

Answer 25

there is a direct correlation between the quality of evidence and the quality of healthcare

Question 26

levels of evidence

Answer 26

1. systematic reviews or meta-analyses or randomized controlled trials and high-quality, single, randomized controlled trials
2. well-designed cohort studies (observation)
3. case-control studies
   - comparison of two patients
4. case series and poor-quality cohort and case-control studies
5. expert opinion, based not on critical appraisal, but on reasoning from physiology, bench research, or underlying principles

Question 27

quality of evidence

Answer 27

relates to the credibility, clinical significance, and applicability of evidence

• how confident are you that it represents the “truth”
• can you trust the results?

Question 28

things to consider when applying the intervention

Answer 28

what are the goals?
evidence
patient preference

Question 29

clinical outcomes

Answer 29

end results of specific health care practices and interventions

Question 30

examples of clinical outcome measures

Answer 30

objective measurements (ROM, strength)
patient-based assessments (questionnaires, pain scales)

Question 31

how to integrate EBP and PCM

Answer 31

adjust evidence-based intervention based on the patient
-determined by
--patient progress
--outcome measures
communication
-what?
-why?