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5112 > Principles of EBP and asking EBP questions > Flashcards

Principles of EBP and asking EBP questions Flashcards

1
Q

PPCP

A

Outer: Collect, Assess, Plan, Implement, Follow up/monitor
Inner: Communicate, Collaborate, Document
EBP occurs in all parts of the PPCP

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2
Q

Where does EBP go in a SOAP note?

A

Assessment

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3
Q

Definition of EBP

A

Decision making and patient care integrated with research: “conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual pts”

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4
Q

Three things EBP does

A
  1. emphasized the use of evidence from medical literature
  2. requires searching and critical appraisal skills
  3. minimizes the impact of intuition, personal observations, and expert authority
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5
Q

Factors that impact EBP decisions

A
  1. Patient values and characteristics
  2. Clinical expertise
  3. Best evidence
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6
Q

Highest strength of evidence

A

systematic reviews of randomized controlled trials

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7
Q

Lowest strength of evidence

A

Unsystematic clinical observations

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8
Q

The 5 A’s in EBP

A 
Ask
Acquire
Appraise 
Apply
Act
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9
Q

Define the 5 A’s

A
  1. Ask and frame the question
  2. Acquire the evidence
  3. Appraise the evidence
  4. Apply and integrate the evidence with our clinical expertise and pt values and circumstances
  5. Act to implement your plan, assess your own performance
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10
Q

Two types of questions

A

Foreground

Background

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11
Q

What do background questions consist of

A

general knowledge about a medical condition or drug therapy
two parts:
1. a question root with a verb (who, what, where, why, how)
2. A disorder or an aspect of a disease or drug

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12
Q

Specialized background questions

A 
DDI - detailed
OTC meds
IV drugs
Compounding
Natural products
Peds
Geriatrics
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13
Q

Where to find background answers

A

Textbooks

Tertiary resources

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14
Q

Examples of background evidence resources or therapeutics texts

A

micromedics, lexicomp, clinical pharmacology, up to date, PDR, Red Book, etc

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15
Q

Where to find info on IV drug compatibility/stability

A

Trissel’s (Gold standard)

King’s

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16
Q

Info on Drug compounding

A

Remington

17
Q

Info on Pregnancy and Lacation

A

Brigg’s (Gold Standard)
Micromedex
Lexicomp

18
Q

Info on DDI

A

Hansten and Horn
Micromedex
Lexicomp

19
Q

Info on natural/herbal products

A

Natural medicines

20
Q

Info on pediatrics

A

Harriet Lane

21
Q

Info on Geriatrics

A

Merck Manual of Geriatrics

Geriatric Dosing Handbook

22
Q

Other background info sources

A 
Applied Therapeutics by Koda-Kimble
Pharmacotheraphy by DiPiro
Harrisons Internal medicine
Current Medical Diagnosis and Tx
DynaMed
UpToDate
23
Q

Physical assessment resource

A

Bates’ Guide to Physical Examination

24
Q

What is a foreground question

A
  1. refers to questions related to the management of pts, which may be changing with new evidence
  2. asks for specific knowledge about managing pts with disorders
  3. in most cases, one needs to understand the background info before addressing foreground questions
25
Q

What do foreground questions ask

A
  1. for specific knowledge about managing pts with disorders

2. asked in a specific format

26
Q

Ask EBP questions in what format

A

PICO

27
Q

P in PICO

A

Patient or population

start with broad pt and narrow

28
Q

I in PICO

A

Interventions or exposures

29
Q

C in PICO

A

comparators

30
Q

O in PICO

A

outcomes important to the pt

31
Q

Common types of foreground questions

A

Therapy
Harm
Diagnosis
Prognosis

32
Q

Therapy questions

A
  • determine the effect of different tx on improving pt function or avoiding adverse events
  • generally RCT are preferred
33
Q

Harm questions

A
  • determine the effect of potentially harmful agents
  • for potentially harmful exposures, an RCT is not practical or ethical
  • observational studies are used, although weaker than RCT
34
Q

Diagnosis questions

A
  • establish the characteristics of a diagnostic tool

- conducted by comparing the new diagnostic tool with the gold standard

35
Q

Prognosis questions

A
  • estimate the future course of a pts disease
  • typically identify a group of pts with or without factors that modify their prognosis
  • follow pts to determine if they develop the target outcome
36
Q

How does PICO support critical appraisal

A
  • validity
  • O = importance
    P = applicability
  • focus on clinical outcomes
37
Q

The 5 D’s (patient important outcomes of disease)

A 
Death
Disease 
Discomfort 
Disability 
Dissatisfaction 
Prevent, cure, and reduce all but death
38
Q

Surrogate endpoint

A

Substitute for a clinically meaningful end point; biomarker; direct measure of how a pt feels, functions, or survives. Predicts effect of therapy

39
Q

Is lowered BP a surrogate endpoint or clinical outcome

A

Surrogate endpoint

Clinical outcome would be: death, MI, stroke, etc

5112 (12 decks)

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