Exam 1 Material Flashcards
(67 cards)
what is the definition of EBM (evidence-based medicine)
- The integration of best research evidence with clinical expertise and patient values
- The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients
Who is the “father of EBM”
David Sackett
Inductive reasoning is ______ to _______
specific observation to general conclusion
Deductive reasoning is ______ to ______
general observation to specific conclusion
Approximately ___% of patients are seen only 1 time
48%
Approximately ___% of patients are seen >2 times
25%
What is the relationship between quality of health care and clinical experience?
As clinical expertise increases, quality of care decreases
Statistically better outcomes came from ______ clinicians when working on patients using manual therapy
less experienced clinicians (and uncertified) had better clinical outcomes when providing manual therapy
what are the two fundamental principles of EBP
- There is a hierarchy of evidence
- The evidence is never enough (have to include other things)
When discussing the hierarchy of evidence, which has the most bias control (highly controlled) and therefore leads to the most confidence in results
Experimental designs
When discussing the hierarchy of evidence, which has the least bias control which has the least confidence in results
Case report/anecdote
In order from highest to lowest bias control, what is the order of the hierarchy of evidence
experimental designs
quasi-experimental designs
non-experimental designs
case report/anecdote
The great majority of our clinical decisions will be made from the ____ level of evidence
Lowest
-Even though there is a hierarchy, people still use clinical experience, expert opinion, and mechanism- based reasoning to make decisions
What does the quote “absence of evidence is not evidence of absence” mean?
Just because there are no studies of something does not mean there is evidence that it is wrong or doesn’t work
-using skills that your expertise is telling you works is fine until there is evidence against it
Generally research evidence is based on ____.
Means
-recognize that there are outliers and it doesn’t necessarily represent each individual patient
What is the general sequence of the EBP method?
- Acknowledge there’s something I don’t know
- Formulate a foreground question (PICO)
- Efficiently search online databases
- Select “best available evidence”
- Critically appraise evidence
- Integrate evidence with clinical practice
- Self-evaluation: “How am I doing as an evidence based practitioner ?”
Background questions
-Focused on the medical aspects of the situation
-ex. “what is the most commonly injured ligament in the knee?”
Foreground questions
-Help clinicians make decisions about specific PT management
-ex. “In a patient with a ruptured ACL, is proprioceptive training as effective as surgery for returning to sport?”
-PICO format
What does PICO stand for
P= patient/problem
I= Intervention, exposure, or test
C=Comparison (don’t always have to have a comparison)
O=Outcome
What is the function/point of PICO?
It is the format to ask foreground questions
what is the formula for usefulness
Usefulness= (validity x relevance)/ work
Which sources are considered “pre-processed” and what does it mean
-Pre-processed means that someone else has already graded the quality (takes less work)
-Systematic reviews (cochrane, DARE)
-Critically Appraised Topics (CATS, Clinical evidence database, FPIN clinical inquiries)
-Specialty specific POEMs
-Critically appraised individual articles (ACP Journal club)
Which sources take the most work
Journal articles (MEDLINE, & other databases)
Which sources take the least work
Systematic reviews
(Cochrane, DARE)
