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EBM Flashcards

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1
Q

What is the definition of Evidence-Based Medicine (EBM)?

A

The conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients.

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2
Q

What are the three core principles of EBM?

A
  1. Best available evidence
  2. Clinical expertise
  3. Patient values and preferences
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3
Q

What are the 5 steps of EBM (The 5 A’s)?

A
  1. Ask an answerable question
  2. Acquire the best evidence
  3. Appraise the evidence
  4. Apply the evidence
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4
Q

What is clinical expertise in EBM?

A

The proficiency and judgment that clinicians acquire through experience and practice to effectively diagnose and provide care suited to individual patients.

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5
Q

Name a few health regulators in Australia involved in clinical expertise.

A

AHPRA, FSANZ, TGA

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6
Q

What are patient values in the context of EBM?

A

Unique preferences, concerns, and expectations that must be integrated into clinical decisions to best serve the patient.

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7
Q

What are some weak sources of medical advice?

A

Testimonials, media reports, traditions, anecdotal experience

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8
Q

What types of studies represent the highest quality evidence?

A

1`. Systematic Reviews
2. Randomised Controlled Trials
3. Cohort Studies
4. Case-Control Studies
5. Case Series and Reports

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9
Q

List common biases affecting published medical research.

A

Publication bias, language bias (Tower of Babel), database bias, citation bias, multiple publication bias

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10
Q

What is the purpose of clinical guidelines?

A

To help clinicians make informed decisions quickly, standardize care, and improve quality and safety of healthcare.

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11
Q

What is the role of the TGA?

A

To regulate therapeutic goods in Australia including medicines and medical devices. Does not regulate food unless it makes therapeutic claims.

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12
Q

What is the ‘food-medicine interface’ in regulation?

A

The overlap where products may be classified as either food or medicine based on presentation, claims, and form (e.g., powders, capsules).

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13
Q

What was the issue with Neurofolin?

A

It was promoted as managing depression without strong evidence, raising concerns about misleading advertising and classification under TGA.

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14
Q

What are common barriers to applying EBM?

A

Resistance to change, inaccessibility of new evidence, high volume of data, cost/time of implementation, conflicting traditional beliefs.

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15
Q

What are the three pillars of Evidence-Based Medicine (EBM)?

A
  1. Best available evidence
  2. Clinical expertise
  3. Patient values and preferences
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16
Q

What are the 5 A’s of EBM?

A
  1. Ask
  2. Access
  3. Appraise
  4. Apply
  5. Assess
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17
Q

What are the five types of clinical questions in EBM?

A
  1. Diagnosis
  2. Therapy
  3. Prognosis
  4. Aetiology/Harm
  5. Prevention
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18
Q

What is the purpose of a structured search strategy?

A

To ensure comprehensive, reproducible, and unbiased literature retrieval.

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19
Q

List four sources of research reporting.

A
  1. Peer-reviewed journals
  2. Conference abstracts
  3. Government reports
  4. Grey literature
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20
Q

What is the journal Impact Factor?

A

The average number of citations to articles published in a journal over the past two years.

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21
Q

What are quartile rankings in journal impact?

A

Q1 = top 25% of journals in a field, Q4 = bottom 25%

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22
Q

List three indicators of article-level impact.

A
  1. Citation count
  2. Field-weighted citation impact
  3. Social and media mentions
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23
Q

What is the h-index used for?

Study These Flashcards
A

To measure an author’s productivity and citation impact.

24
Q

Give three signs of a predatory journal.

Study These Flashcards
A
  1. Charges submission fee
  2. Editorial board is not listed
  3. Low-quality or inconsistent website
25
What are tools to assess journal and author impact?
Web of Science, Scopus, Google Scholar, InCites, SCImago (SJR), SNIP
26
What is the goal of critical appraisal in EBM?
To evaluate the quality, trustworthiness, and relevance of research for clinical application.
27
What are three types of validity in critical appraisal?
Internal validity, external validity, and reliability.
28
Name three types of bias to look for in RCTs.
Selection bias, reporting bias, and performance bias.
29
What is internal validity?
The degree to which a study accurately answers the research question, free from bias.
30
What are three sources to access critical appraisal checklists?
CASP, SIGN, CEBMH.
31
What are the steps in conducting a systematic review?
Formulate a question → Develop protocol → Literature search → Assess studies → Extract data → Synthesize → Interpret results.
32
What is the function of a forest plot in meta-analysis?
Displays individual study effects, confidence intervals, and the pooled average effect.
33
What is the role of a funnel plot?
To visually assess publication bias in meta-analyses.
34
Name three pros and three cons of systematic reviews.
Pros: Condensed, objective, reproducible. Cons: Time-consuming, conflicting findings, aggregation errors.
35
What does heterogeneity in a meta-analysis refer to?
Differences between studies in population, methodology, or statistical findings.
36
What is the purpose of clinical reasoning?
To systematically collect, interpret, and act on clinical information for patient care.
37
Name 3 cognitive biases in diagnosis.
Premature closure, anchoring, confirmation bias.
38
What are the formulas for LR+ and LR-?
LR+ = Sensitivity / (1 - Specificity), LR- = (1 - Sensitivity) / Specificity
39
What does SpPin mean?
Highly specific test, when positive, rules disease IN.
40
What does SnNout mean?
Highly sensitive test, when negative, rules disease OUT
41
What is pre-test probability based on?
Clinical experience, disease prevalence, and initial presentation.
42
How is post-test probability calculated from LR?
Use pre-test odds × LR → convert to post-test probability.
43
Why are predictive values affected by prevalence?
Because they depend on the base rate of disease in the population.
44
What is a nomogram used for?
To convert pre-test probability and likelihood ratios into post-test probability visually.
45
Give an example of over-reliance on testing.
Ordering a coronary angiogram when pre-test probability is too low (e.g., 3%), leading to little diagnostic gain.
46
What are Clinical Practice Guidelines (CPGs)?
Evidence-based statements with recommendations to assist clinical decision-making.
47
List 5 characteristics of high-quality CPGs.
Evidence-based, current, transparent, state COIs, freely available, funded and endorsed.
48
Why are CPGs necessary in clinical practice?
They reduce variation, guide care when evidence is overwhelming, and improve safety and efficiency.
49
What is the GRADE system used for?
Assessing quality and strength of evidence in guidelines.
50
What are common challenges in developing CPGs?
Conflicts of interest, limited resources, lack of transparency, and conflicting views.
51
How can guideline development be improved?
Patient involvement, clear presentation, cost analysis, and independent editorial control.
52
What change did the latest BP guidelines recommend?
Lower threshold from 140/90 to 130/80 to encourage early lifestyle intervention.
53
Give one example where a hospital guideline is essential.
Cord prolapse case → Royal Women’s Hospital guideline.
54
Where can you find CPGs for children with infections?
Royal Children’s Hospital clinical guide.
55
What should you tell a patient asking about PSA testing?
Refer to RACGP guidelines and explain risks/benefits based on evidence.
56
What does NICE recommend regarding PRP injections for knee OA?
Limited evidence → only under research/audit settings.

med 2100 (8 decks)

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