Principles of EBP and medicine information

Question 1

Define EBP

Answer 1

Process of systematically reviewing, appraising, and using clinical research findings to aid delivery of optimum clinical care. Assist in clinical decision making.

Question 2

Appreciate the need for EBP

Answer 2

Need for current, unbiased, critically examined relevant data about drugs and diagnostics in a patient or situation.

Question 3

5A’s - steps involved in provision of EBP

Answer 3

Ask a question - convert to PICO - patient, intervention/exposure, compare, outcome.
e.g., patients’ w/ MI, does early treatment with a statin compared to placebo decrease CVD mortality?

Access the evidence – PICO, secondary resources, primary database, text words, filter for type of study.

Appraise the evidence – RAMmBO. Representative of patient? Allocation of intervention randomised or comparable group? Maintance- treated equally and compliant? Measurement (study outcome) blind or objective?

Apply the information – integrate evidence w/ clinical expertise, patient values and circumstances, and information.

Audit – evaluate effectiveness and efficiency of steps used. Improve for next time. Am I searching efficienty? Is it a well-formulated clinical question?

Question 4

Appreciate the relevance of EBP to healthcare professionals and its limitations:

Answer 4

Effective care to improve patient outcome, accountability, minimise waste.

Criticism: heavy reliance of quantitative research, limited availability of research, capturing complexity and rapidly evolving practise, nature of evidence.

Question 5

Define etiology

Answer 5

Cause of disease and their modes of operation. Can use case-control or cohort study

Question 6

Define diagnosis

Answer 6

signs, symptoms or tests for diagnosing a disorder. Use diagnostic validation study.

Question 7

Define prognosis

Answer 7

probable course of disease over time. Use inception cohort study

Question 8

Define therapy

Answer 8

selection of effective treatments which meet patient values. Use RCT.

Question 9

Define quality of life

Answer 9

what will be the quality of life? Use qualitative study.

Question 10

Tertiary examples, pro’s, cons

Answer 10

textbooks, electronic books, databases, published review articles.
- Pros: condensed overview of a topic, background info, readable and indexed
- Cons: not up to date, poorly referenced, subject to opinion, bias, and evaluation
- E.g. AMH, APF, eTG, Briggs, Stockley’s drug interactions.

Question 11

Secondary examples, pros, cons

Answer 11

resources that index or abstract literature from biomedical journals, systemically locate primary or tertiary resources
- Pros: rapid access to primary, high standard, complex searches, natural language, broaden search, how often an article is cited.
- Cons: lag time, need access to primary, scope dependent, need training.
- E.g. Medline, embase, google scholar.

Question 12

Primary pros, cons, e.g.

Answer 12

original scientific or clinical studies, most current, source of info for secondary and tertiary, critically appraise and analyse article is possible.
- Pros: most up to date, original
- Cons: flaws in study method, bias (sponsors), invalid findings
- E.g. lancet, British medical journal.

Question 13

Identify and discuss steps of a systematic approach to answer drug and health information queries:

Answer 13

Step 1 – receive enquiry and obtain demographics
Step 2 – obtain background info
Step 3 – classify the question
Step 4 – systematically search for info
Step 5 – evaluate, analyse, and synthesise info found
Step 6 – provide response
Step 7 – follow-up and document