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15 Cards in this Set
- Front
- Back
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What is EBP?
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1) The integration of best research evidence with clinical expertise and patient values
2) The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients |
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Why is EBP not ALL about the evidence?
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It's more of an integration between best research evidence, clinical expertise, and patient values
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What is the general sequence in the EBP method?
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1) Acknowledge there's something I don't know
2) Formulate a foreground question (PICO) 3) Efficiently search online databases 4) Select "best available evidence" 5) Critically appraise evidence 6) Integrate evidence with clinical practice & patient values 7) Periodically evaluate myself: how am I doing as an evidence-based practitioner? |
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What are the different sources for clinical decision making?
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1) Tradition & authority
2) Trial and error 3) Logical reasoning 4) Scientific method |
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What is the primary advantage of using the scientific method for clinical decision making?
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It is designed to reduce bias (especially compared to the other approaches)
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What are the 4 domains of clinical practice?
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1) Diagnosis
-- Accuracy & precision of diagnostic tests including hx and PE 2) Prognosis -- Power of prognostic markers 3) Therapy -- Efficacy of therapeutic, rehabilitative, and preventive regimens 4) Harm -- The potential for harm with our treatments |
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What does the clinician need most, theory or evidence?
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Evidence!
- Justifications for treatment based on applied work (on patients) designed to answer the question IF something works (where theory answers WHY something should work) |
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If given 2 pieces of evidence, one categorized as level 5 and the other as level 1b, which do we prefer?
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Level 1b
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BUT in the absence of higher-order evidence, do we prefer evidence based on tradition or level 5?
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Level 5
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What are the 2 fundamental principles of EBP?
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1) The evidence is never enough
- Patient values and expectations - Your own clinical expertise - Benefits and risk - Inconvenience - Costs 2) There is a hierarchy of evidence |
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What is the hierarchy of evidence (e.g. which kinds of trials are at the top and which are at the bottom)?
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Strongest to weakest:
1) N-of-1 RCT (more for medical and pharmacological practice) 2) Systematic review of RCT 3) Single RCT 4) Systematic review of observational studies 5) Physiologic or other lab studies 6) Unsystematic clinical observations (expert opinion) |
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Why are higher levels of study (based on the hierarchy of evidence) better than lower levels?
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They allow you to have increased confidence in the conclusions drawn from the study
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What kinds of questions do novice practitioners tend to use? Give some examples.
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Background questions (questions regarding the general features of specific conditions)
E.g. What is stenosis? What are the anatomical conditions of the low back of someone with spinal stenosis? |
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What kinds of questions do expert clinicians use? Give some examples.
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Foreground questions (what EBP model focuses on - PICO)
E.g. What is the effectiveness of WFE for lumbar stenosis? How probable is it that someone with Type II Diabetes will develop peripheral neuropathy by the age of 50? |
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What does PICO stand for?
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P - patient population
I - interventions or exposures C - comparison intervention(s) O - outcome(s) *Sometimes it is a 3-part question (excluding "C") |
