Steps of EBVM

Question 1

Steps of EBVM

Answer 1

1.Convert info into answerable questions

2. Track down evidence to answer them
3. Critically appraise the evidence for validity
4. Apply the results to clinical practice
5. Evaluate performance

Question 2

A’s of EBVM

Answer 2

-Ask- questions
-Acquire- evidence
-Appraise- quality of evidence
-Apply- implement the evidence
-Assess- evaluate impact of implementation

Question 3

Do all 5 steps always need to be used?

Answer 3

No, clinicians often use 3 basic strategies:
1.Appraising mode
2. Searching mode
3. Replicating mode

Question 4

Appraising mode

Answer 4

-used with conditions that we commonly encounter, when we need to be “up to the minute” and sure of what we are doing

-put time into both searching, critically appraising

Question 5

Searching mode

Answer 5

-used with conditions we encounter less often
-clinicians seek out critical appraisals already performed by others

-Skips critical appraisal
-Searching step is restricted to sources that have already been critically appraised

Question 6

Replicating mode

Answer 6

-blindly seek, accept, and apply the recommendations received from authorities

**common; but need to think about whether the experts are also working in replicating mode?

Question 7

Types of clinical questions

Answer 7

1. Background questions
   -5 W’s; ask for general knowledge about disorder
2. Foreground questions
   -specific knowledge about managing patients

Question 8

Different questions asked in clinical practice

Answer 8

1. Treatment- Which treatment is best with helping the disease?
2. Prognosis and incidence- Does sex affect survival rate of retrievers with disease?
3. Etiology and risk- What are the risks of general anesthesia in ferrets?
4. Diagnosis- Which diagnostic test is most reliable for diagnosing specific disease?
5. Prevalence- What is the prevalence of heartworm infections in dogs in Sask?

Question 9

What is needed to make a good question?

Answer 9

PICO
-patient/population or problem
-intervention or treatment/exposure, prognostic factor
-comparison between the intervention or exposure
-Outcome of interest

Question 10

Searching mode as a time saver?

Answer 10

• Focus on critically appraised topics (CAT) or Best evidence topic (BET) because although meta-analysis and systemic reviews are great, there is too much to go through and not enough time

Question 11

Characteristics of a Critically appraised topic (CAT)

Answer 11

-Fast
-Fewer methods
-Increased risk of bias
-Possibly incomplete

Question 12

Characteristics of systemic review/meta-analysis

Answer 12

-Slow
-More explicit methods
-Decreased risk of bias
-Comprehensive

Question 13

Vet resources of searching mode

Answer 13

-Best BETS for Vet (BETs)
-Vet evidence journal (Knowledge summaries)
-Banfield Pet Hospital (CATs)
-Clinical evidence in Equine practice online collection (systemic reviews and CATs)

Question 14

Library resources for searching mode

Answer 14

-Medline
-CAB international: VetMed

Question 15

Free online databases for searching

Answer 15

• google scholar
  -pubmed
  -national library of medicine

Question 16

EBVM websites

Answer 16

-Evidence based vet med
-RCVS knowledge
-Centre for evidence based vet med

Question 17

Why appraise?

Answer 17

• many poor quality studies get published in reputable and non reputable journals (predatory journals- target individuals that need to publish)

Question 18

Predatory publishing

Answer 18

-open access publishing business model
-charge publishing fees to authors
-often involves lack of peer review/editorial oversight
-often mimic journal name of legitimate journal