EBM Flashcards
(40 cards)
What is the aim of EBM
apply the best available evidence gained from the scientific method to clinical decision making, or
integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances
What are the four things that are integrated in EBM
Best research evidence
Clinical expertise
Patient values
Patient circumstances
What was the coldfx controversy
Was an over the counter cold remedy that purposefully misled consumers into believing it worked even though it was shown to be inneffective
Traces of EBm origin can be found where
ancient Greece
Who is Avicenna? What did they create
Avicenna (c. 980 - 1037), also known as Ibn Sina, was a Persian philosopher and physician.
He was the first to recognize the concept of infectious diseases and introduced quarantine
to control their spread. He introduced clinical pharmacology and experimental medicine
Created the Canon of Medicine, which was used for centuries afterwards
Who is Dr. Archie Cochran? What was his book?
Through his book “Effectiveness and Efficiency: Random Reflections on
Health Services” (1972) and subsequent advocacy, caused increasing awareness and
acceptance of the concepts behind evidence-based practice
First to used EBM
The methodologies used to determine “best evidence” were largely established by
the McMaster University research group led by
David Sackett and Gordon Guyatt
Guyatt coined the term “evidence based”
5 reasons why EMB is gaining popularity
1- Need for valid and quantitative information in variety of medical practice aspects
* 2- The shortcomings and inadequacy of traditional references such as text books, medical journals
* 3- The gap and disparity between our diagnostic skills and clinical judgment.
* 4- We are too busy and not having enough time per patient for finding and adopting this evidence
* 5-The gap between evidence and practice (Knowledge-to-practice gap) lead to variations in practice and quality of care
How do we practice EBM
Step 1- Formulate a question (converting the need for information into an answerable question).
* Step 2- Search for answer (tracking down the best evidence with which to answer the question).
* Step 3- Critically appraise (critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in our clinical practice).
* Step 4- Adopt and integrate (integrating the critical appraisal with our clinical expertise and with our patient’s unique biology, values and circumstances).
* Step 5- Evaluate the end results and yourself (evaluating your effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them).
Which steps are “using mode”, “doing mode”, and “replicating mode”
What are background questions? What are the two essential components?
What are foreground questions? What are the four essential components?
As you gain experience how are background and foreground questions balanced
As you gain experience, foreground questions increase
Cognitive resonance
The knowledge we already have about our patient predicament leads to mental reinforcing and emotional responses
Cognitive Dissonance
Our patient’s condition brings us to a point that we confront
what we do not know and we need to know (knowledge gap
awareness). Powerful motivators of learning. Turning the “
negative space” of knowledge gap to the “ positive space” of
well-structured clinical Q
We do not know what we don’t know leads to an _______ _________
undisturbed ignorance
Central issues in clinical work, where clinical questions often arise (10 things)
How can EBM be practiced in real time
Capturing or saving: using shorthand
Scheduling: by when we need to have our Qs answered
Selecting: which one or few of the many Qs should be pursued
How many questions do you usually need
one or two
7 ways well-formulated questions can help
- They help us focus our scarce learning time on evidence that is directly relevant to our patients’ clinical needs.
- They help us focus our scarce learning time on evidence that directly addresses our particular knowledge needs.
- They can suggest high-yield search strategies.
- They suggest the forms that useful answers might take.
- they can help us to communicate more clearly with our colleagues.
- When teaching, they can help our learners to better understand the content of what we teach
- When our questions get answered, our knowledge grows, our curiosity is reinforced, our cognitive resonance is restored, and we can become better, faster, and happier clinicians
What is an educational prescription
Specifies the clinical problem that generated the questions
States the question in all its key elements
It specifies who is responsible for answering it.
It reminds everyone of the deadline for answering it
reminds everyone of the steps of searching, critically appraising, and relating the answer back to the patient
How to find
current best evidence and have current best
evidence find us
Should sort evidence into pre-appraised and non-pre-appraised
2 step screening test for whether a text is likely to be evidence based and up-to-date. Should it be used if it fails these screens
1-A text that provides recommendations for patient care must have “in line” references to evidence that supports each of its key recommendations about the diagnosis, treatment, or prognosis of patients.
2-If the text does indicate exact references for its
recommendations, check the date of publication of the references; if the most recent is more than 2–3 years old, you will need to check whether more recent studies require a change in recommendation. Texts that fail these two screens should be used for background reading only, no matter how eminent their authors
No
What is the 6S hierarchy of organization of pre-appraised evidence
