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32 Cards in this Set
- Front
- Back
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Overall goal of EBM
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facilitate self-directed lifelong learning
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What is EBM?
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process of systematically finding, appraising, and integrating best Research Evidence with Clinical Expertise and Patient Values as the basis for CLINICAL DECISION MAKING
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Clinical Decision-Making in EBM are based on what 3 key elements?
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Clinical Expertise
Research Evidence Patient Preferences |
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What are the Four (5) fundamental Skills of EBM?
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Ask
Acquire Appraise Apply Assess |
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Three MODES of EBM
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Doers
Users Replicators |
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? practice all 4 of the fundamental skills of EBM (goal of this class)
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Doers
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? practice 3 of 4 of the fundamental skill of EBM (foregoing critical appraisal of the evidence)
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Users
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? practice 2 of 4 of the fundamental skills of EBM (foregoing acquiring and critically appraising the evidence and instead rely on "experts" who can be either authoritative [evidence base] or authoritarian [opinion-based]
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replicators
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Asking :: BACKGROUND questions
describe the process |
asks for GENERAL knowledge about a disorder
TWO essential components --a question root with a verb (who, what, where, when, how, why) --a disorder, or an aspect of a disorder |
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Asking clinically relevant questions :: FOREGROUND
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asks for SPECIFIC knowledge about a disorder
4 essential components (PICO) |
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In FOREGROUND QUESTIONS what is PICO?
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PATIENT / PROBLEM
--what is the type of patient / problem being addressed? INTERVENTION --what is the intervention / type of exposure being considered that the patient is experiencing (be it therapy / intervention, diagnostic, prognostic etc.)? COMPARISON (if relevant) --what is the comparison intervention / exposure in the control group, when relevant? OUTCOME --What are the clinical outcomes of interest |
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consider the ? iin establishing the clinical outcome of interest
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patient's perspective
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What is the difference between BACKGROUND and FOREGROUND questions?
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background = GENERAL knowledge
foreground = SPECIFIC KNOWLEDGE |
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whenb SKING the right clinically relevant questions--
begin by asking these 2 questions |
Is this a BACGROUND or FOREGROUND questions?
Specify the question type: is it one of therapy, diagnosis prognosis, etiology, prevention, disease manifestation, or self-improvement, etc |
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Foreground (OUTCOMES) questions: asks for specific knowledge in managing patients with a disorder---
use what source? |
EBM resources
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Bacground (MECHANISM) questions: asks for general knowledge about a disorder--
what source to use? |
Textbooks
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Prioritize these questions to answer:
most feasible to answer within the time available? most likely to encounter in your practice? most important issue for this patient now? most interesting to you? |
most important issue for the patient
most interesting to you most likely to encounter in practice most feasible to answer within the time you have available |
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What is the #1 reason why physicians CANNOT find answers to their questions?
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because they are NOT asking the right questions
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What are the top 3 resources for acquiring the evidence for BACKGROUND questions?
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MD Consult (med textbooks)
Micromedex (a drug database) Medline Plus (health information designed FOR PATIENTS) |
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Name the 3 General Medical Searches:
USUALLY UNRELIABLE!! |
Google Scholar
Wikipedia MEDPEDIA |
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What is the WEB-SITE EVALUATION FORM guidelines? (4)
--include point system!!! |
CONTENT
-reviewed for quality before posting -source of content clearly identified TIMELINESS -dates of post, revise and update are clearly listed -update within 6 monthes SPONSORSHIP AND FINANCIAL SUPPORT -relevant financial disclosures identified -financial support stated / linked on home page -no advertisement on home page -ads are on separate pages from content SCORING -trustworthy 7-8 pts -questionable trust 5-6pts -untrustworthy <5 pts |
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What are the 4S PYRAMID SOURCES OF EVIDENCE in acquiring evidence for FOREGROUND QUESTION?
(list from top to bottom) |
Systems
Synopses Summaries Studies |
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What are examples of SYNOPSES (pre-appraised and recommended)?
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ACP JOURNAL CLUB (best)
Clinical Evidence PIER |
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What are the examples for SUMMARIES (pre-appraised syntheses or review)?
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COCHRANE LIBRARY
UpToDate Specialty Web SItes -USPSTS -NCI -CDC -NIH -medline |
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What are the examples for STUDIES (peer reviewed published articles)?
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Pubmed
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True or False
Critical Appraisal-- --its in print therefore it is true --med literature will support one side of an arguement |
FALSE
--not everything in print is true --med literature will support both sides of argument |
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for each "Question Type" of articles, there are 3 key questions to ALWAYS ask
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Are the results of the study valid?
(bias?) What were the result? (size and precision of the effects?) Will the results help me in caring for my patients? (how do they apply? what is net impact of intervention?) |
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What are the 7 Question Type or Clinical Task of the Intervention?
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Therapy / Harm
Diagnosis Prognosis Etiology Prevention (or Screening) Clinical Manifestations of Disease Self-Imporvement |
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RESEARCH DESIGN ---name appropriate matching STUDY DESIGN
Therapy Diagnosis Screening |
Randomized Controlled Trial (therapy)
Cross-Sectional Study (diagnosis) Cross-Sectional Study (screening) |
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RESEARCH DESIGN ---name appropriate matching STUDY DESIGN
Prognosis Etiology (Causation) |
Cohort Study (prognosis)
Cohort Study (etiology) Case-control Study (etiology) |
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New Hierarchy of Evidence
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Pre-Appraised Sources (users)
Peer-Reviewed Studies (doers) Expert Opinion (replicators) |
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go over the hierarchy of evidence list!!
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go over the hierarchy of evidence list!!
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