Week 3: Evidence Based Medicine Flashcards
What is evidence based medicine?
- The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of idinvidual patients
- A philosophy of medical practice advocating making individual patient care decisions based on the best available evidence integrated with the practitioner’s own clinical expertise and the individual patient’s circumstances and preferences.
- It does not advocate “cook-book” medicine or reduce the practice of medicine to following an algorithm
- It does not advocate replacing clinical expertise with external evidence, but rather integrating them
What are EBM Practitioners?
- Write a precise question
- Search for the best evidence
- Appraise validity
- Integrate the clinical appraisal
- Evaluate the results
How do we develop a clinical question?
PICO
1. Patient/population
2. Intervention
3. Comparison
4. Outcomes
What are guidelines?
Statements that include recommendations intended to optimize patient care
They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options
What are the arguments against EBM?
- Leads to cook-book med
- Cult status
- Authoritative
- Crave certainty
- Release on empiricism
- Narrow definition of evidence
- Limited usefulness for individual patients
- Threats to doctor autonomy
What are clinical guidelines?
Statements that include recommendations intended to optimize patient care
What makes up clinical guidelines?
- Informed by systemic review
- Assessment of benefits and harms of alternative options
What make guidelines trustworthy?
- Based on systematic review
- Developed by a panel of experts
- Considers important patient subgroups and preferences
- Transparent, no biases and distortions
- Provide clear explanations of evidence and recommendations
- Reconsidered and revised
What is validity?
Accuracy
What is reliability?
Precision
What is clinical applicability?
Practice guidelines should be as inclusive of appropriately defined patient populations as scientific and clinical evidence and expert judgment permit
What is clinical flexibility?
Identify exceptions to their recommendations
What is clarity?
Practice guidelines should not use unambiguous language, define terms precisely, and use logical, easy-to-follow modes of presentation
What is multidisciplinary process?
Practice guidelines should be developed by a process that includes participation by representatives of key affected groups
What is scheduled review?
Practice guidelines should include statements about when they should be reviewed to determine whether revisions are warranted, given new clinical evidence or changing professional consensus
What is documentation?
The procedures followed in developing guidelines, the participants involved, the evidence used, the assumptions and rationales accepted, and the analytic methods employed should be meticulously documented and described
What are the IOM attributes of CPG?
- Validity
- Reliability/Reproducibiloity
- Clinical applicability
- Clinical flexibility
- Clarity
- Multidisciplinary Process
- Scheduled review
- Documentation
What is GRADE?
A system of rating quality of evidence and strength of recommendations in systematic reviews and clinical practice guidelines
What is the purpose for GRADE?
Provides a transparent and structured process for developing and presenting evidence summaries for systematic reviews and CPG. Guidelines for guidelines
What are the components of GRADE?
Grading of Recommendations Assessment, Development and Evaluation.
What are the domains of GRADE?
- Study limitations (study design)
- Inconsistency of results
- Indirectness of the evidence
- Imprecision
- Publication bias
What is AGREE II?
Appraisal of Guidelines Research and Evaluation
Standard for assessing the methodological quality of practice guidelines
What are the domains of AGREE II?
- Scope and purpose
- Stakeholder Involvement
- Rigor of development
- Clarity of presentation
- Applicability
- Editorial independence
What is PRISMA?
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
An evidence based minimum set of items for reporting in systematic reviews and meta-analyses
Methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the findings
