Intro To Ebm

Front 1

evidence

Back 1

-Information that helps answer a question we have, related to some aspect of patient care

Front 2

essential EBM skills

Back 2

1. Convert the need for info. into an answerable question
2. Efficiently track down information
3. Appraise information
a) how valid is it?
b) and how important was it?
4. Apply to patient at hand. Combining info with:
a. Clinical expertise
b. Patient’s unique circumstances
c. The system within which we operate

Front 3

how to go about framing the clinical question-novice

Back 3

1. What is the disease?
2. How do I diagnose it?
3. What is the prognosis?
4. What are the pathophysiologic underpinnings?

Front 4

how to go about framing the clinical questions- expert

Back 4

1. Given a positive test result what is the likelihood my patient has the disease?
2. What re the risks vs. benefits of a particular RX for my patient?
3. What is my patient’s prognosis?

Front 5

Foreground questions- PICO

Back 5

1. particular Patients
2. Interventions
3. Comparisons
4. Outcomes of interest (benefits, harm costs)
example: Do sertoninergic agents decrease weight, morbidity, and mortality in obese adults compared to weight loss programs alone?
P = obese pts; I = serotonergic agents; C = other wt loss programs w/out meds; O = difference in outcome of wt and how well/ long they live

Front 6

characteristics of well-built clinical questions

Back 6

1. directly relevant to the problem
2. focused, clearly formulated, sufficiently SPECIFIC to ensure a clear answer
3. ARTICULATED to facilitate searching medical database for an answer

Front 7

type of clinical questions: what are you concerned about?

Back 7

1. clinical findings
2. etiology
3. differential dx
4. prognosis
5. diagnostic tests
6. therapy
7. prevention

Front 8

clinical question triage

Back 8

-o several good questions and try to prioritize them based on urgency, patient information need; potential help/harm, generalizability, teaching utility, time constraints, personal education

Front 9

example: pt with suspected DVT: background questions

Back 9

1. whats a DVt?
2. why do people with DVT develop swelling months later?
3. how do DVTs form?
(look at chart and pico questions)

Front 10

match the resources to the question: know what you're looking for!

Back 10

General background questions: textbooks/websites that are well-referenced and current or “books” that have monthly/quarterly updates; review articles in reputable journals
Focused foreground (PICO) questions: current research-based info; start with prefiltered evidence based resources, find original articles if none exist

Front 11

not everything thats sats its "evidence based" actually is...look for texts and websites that...

Back 11

1. are revised at least 1/yr
2. select and appraise evidence in an explicit way
3. o Cite evidence in support of declarations about clinical care: readers can thus get to original sources for details and can also easily determine the date of publication of evidence cited to support a given claim.

Front 12

secondary studies

Back 12

-arose from a desire to look at the "big picture" (i.e. all studies on a topic_
1. systemic review
2. meta-analysis

Front 13

systemic reviews

Back 13

-usually focus on a clinical topic to answer a specific pt-care question
-Look at ALL the available research in a field and attempt to synthesize all the results into an overall conclusion
-Difficult to know that you have ALL the research in a field

Front 14

meta analysis

Back 14

-a systemic review that ALSO includes a statistical analysis of systemically combined data from all the identified studies
-The most important issue is that, since each study is different, the data sets are not always comparable.
-Meta-Analysis can vastly increase the power of a conclusion, because the combined sample sizes are larger than that of the individual studies.

Front 15

evidence-based secondary sources

Back 15

-written by reviewers who use explicit and rigorous methods to identify, critically appraise, and synthesize relavant studies from the published medical research

Front 16

clinical decision suport systems

Back 16

-(few exist) – you have the patient in the ICU, the data from the patient (BP, respiratory rate etc.) would be in the computer and it would be constantly going back and forth looking for the most current info out there and letting you know what the best way to treat

Front 17

synopses

Back 17

-(provide a bottom line) (they collect all the evidence and tell you what they think you should be doing, say “this test is not as good as this test”)
ex. British Medical Journal, American College of Physicians, UptoDate

Front 18

syntheses

Back 18

databasees of systemic reviews
ex. Cochrane Library, Pub Med Clinical Queries

Front 19

primary studies

Back 19

-Pub Med, CINAHL

Front 20

Clinical Evidence

Back 20

-updated monthly
-designed to inform treatment decision (whats the best diagnostic test)
-tells you about their methods-
-do a summary about different therapys and rate how good that intervention is based on the kinds of evidence they found

Front 21

UpToDate

Back 21

-answers both background questions and then moves to most current literature about how to make a good diagnoses and appropriate therapies
-doesnt just look at evidence, also get opinions from authors

Front 22

The Cochrane Library

Back 22

-Collect info and let you read it in a synthesized formate but don’t tell you what to do
-Collection of systematic reviews

Front 23

PubMed Clinical Queries

Back 23

-meant to move towards EBM approach; lets you pick etiology, diagnosis, prognosis, therapy and narrow or broaden your search