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