Unit 2 - Introduction

Question 1

what is the integration of EBM?

Answer 1

best research evidence + clinical expertise + patient values

Question 2

describe the 6 steps of EBM

Answer 2

1. Ask - focused, answerable clinical questiosn derived from care of patients
2. Reflect - on what you already know about the question
3. Search - available databases for evidence to answer your question
4. Appraise - the evidence you find for its validity, results, and relevance
5. Apply - evidence to your patient, taking into account their preferences/values
6. Assess - how you did on the first 5 steps

Question 3

explain disease oriented evidence

Answer 3

focused on numbers, tests, and biomolecules

• outcomes of pathophysiology, pharmacology, etiology
• intermediate outcome, surrogate marker
• requires assumptions

Question 4

what are DOEs VS POEMs for antiarrhythmics?

Answer 4

DOE: antiarrhythmics reduce ventricular tachycardia in post-MI patients
POEM: patients routinely prescribed class I antiarrhythmics were more likely to die overall

Question 5

what are DOEs VS POEMs for gemfibrozil?

Answer 5

DOE: gemfibrozil lowers cholesterol
POEM: gemfibrozil increases mortality

Question 6

what are DOEs VS POEMs for Ca-channel blockers?

Answer 6

DOE: CCB lower BP
POEM: somem types of CCB increase stroke and mortality

Question 7

what are DOEs VS POEMs for PSA?

Answer 7

DOE: PSA detects prostate cancer early
POEM: not known whether PSA screening reduces morbidity or mortality

Question 8

what are DOEs VS POEMs for DEXA scan?

Answer 8

POE: DEXA scan identifies osteoporosis
POEM: limited data demonstrating bone density scans prevent symptomatic fractures, and no data that they prolong life

Question 9

in “background VS foreground questions”, what are background questions?

Answer 9

Stem (what is, who is at risk, what are causes) + Content (disease in question)

• use these when you don’t know enough about a topic to ask a foreground question
• good for “refreshing”, but sources that best answer these questions aren’t the most current

Question 10

in “background VS foreground questions”, what are foreground questions?

Answer 10

specific and focused as PICO
Patients/Population
Intervention/exposure
Comparison
Outcome

Question 11

what are some cases where foreground PICO questions can be asked?

Answer 11

therapy
harm/etiology
diagnosis
prognosis