Week 3: Evidence Based Medicine Flashcards

1
Q

What is evidence based medicine?

A
  1. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of idinvidual patients
  2. 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.
  3. It does not advocate “cook-book” medicine or reduce the practice of medicine to following an algorithm
  4. It does not advocate replacing clinical expertise with external evidence, but rather integrating them
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2
Q

What are EBM Practitioners?

A
  1. Write a precise question
  2. Search for the best evidence
  3. Appraise validity
  4. Integrate the clinical appraisal
  5. Evaluate the results
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3
Q

How do we develop a clinical question?

A

PICO
1. Patient/population
2. Intervention
3. Comparison
4. Outcomes

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4
Q

What are guidelines?

A

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

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5
Q

What are the arguments against EBM?

A
  1. Leads to cook-book med
  2. Cult status
  3. Authoritative
  4. Crave certainty
  5. Release on empiricism
  6. Narrow definition of evidence
  7. Limited usefulness for individual patients
  8. Threats to doctor autonomy
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6
Q

What are clinical guidelines?

A

Statements that include recommendations intended to optimize patient care

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7
Q

What makes up clinical guidelines?

A
  1. Informed by systemic review
  2. Assessment of benefits and harms of alternative options
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8
Q

What make guidelines trustworthy?

A
  1. Based on systematic review
  2. Developed by a panel of experts
  3. Considers important patient subgroups and preferences
  4. Transparent, no biases and distortions
  5. Provide clear explanations of evidence and recommendations
  6. Reconsidered and revised
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9
Q

What is validity?

A

Accuracy

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10
Q

What is reliability?

A

Precision

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11
Q

What is clinical applicability?

A

Practice guidelines should be as inclusive of appropriately defined patient populations as scientific and clinical evidence and expert judgment permit

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12
Q

What is clinical flexibility?

A

Identify exceptions to their recommendations

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13
Q

What is clarity?

A

Practice guidelines should not use unambiguous language, define terms precisely, and use logical, easy-to-follow modes of presentation

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14
Q

What is multidisciplinary process?

A

Practice guidelines should be developed by a process that includes participation by representatives of key affected groups

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15
Q

What is scheduled review?

A

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

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16
Q

What is documentation?

A

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

17
Q

What are the IOM attributes of CPG?

A
  1. Validity
  2. Reliability/Reproducibiloity
  3. Clinical applicability
  4. Clinical flexibility
  5. Clarity
  6. Multidisciplinary Process
  7. Scheduled review
  8. Documentation
18
Q

What is GRADE?

A

A system of rating quality of evidence and strength of recommendations in systematic reviews and clinical practice guidelines

19
Q

What is the purpose for GRADE?

A

Provides a transparent and structured process for developing and presenting evidence summaries for systematic reviews and CPG. Guidelines for guidelines

20
Q

What are the components of GRADE?

A

Grading of Recommendations Assessment, Development and Evaluation.

21
Q

What are the domains of GRADE?

A
  1. Study limitations (study design)
  2. Inconsistency of results
  3. Indirectness of the evidence
  4. Imprecision
  5. Publication bias
22
Q

What is AGREE II?

A

Appraisal of Guidelines Research and Evaluation

Standard for assessing the methodological quality of practice guidelines

23
Q

What are the domains of AGREE II?

A
  1. Scope and purpose
  2. Stakeholder Involvement
  3. Rigor of development
  4. Clarity of presentation
  5. Applicability
  6. Editorial independence
24
Q

What is PRISMA?

A

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