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Flashcards in Modalities Ch. 3 Deck (31)
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1

difference between EBM and EBP

EBP applies EBM

2

overarching goal of EBP

use best evidence possible to improve patient care

3

Evidence-Based vs. Patient-Centered Medicine

Powerful, different, somewhat contradictory philosophies

4

EBM

approaches patient care from a biomedical perspective
based solely on scientific facts
is a doctor-oriented, disease-centered model
aims to improve quality by standardizing medical, through clinical guidelines of best practice
patients treated as a group
_____

5

best practices

philosophy of action
specific techniques, methods, activities, or processes
good guidelines apply to only 80% of patients
a given best practice only applies to a specific condition or circumstance
-may be modified or adapted for similar circumstances

6

protocols

a plan or set of specific steps to be followed
a strict process for monitoring and caring for specific conditions
often provides a practical, step-by-step framework for implementing guidelines

7

patient-centered medicine

a humanistic, biophychosocial approach
focus on patient participation in clinical decision making, using in-depth patient communication to understand patients' complaints, unique needs, and who they are
moves care from clinician control to_______
patients are experts in the experience of their symptoms
patients differ, even with same S/S

8

benefits of EBP and PCM

EBP
-increased quality of care
-proven to work
PCM
-patient-specific (not cookie cuter)
-empowers the patient

9

detriments of EBP and PCM

EBP
-less personal
-might not work for everybody
-doesn't account for patient differences
PCM
-giving patients too much control/power without knowledge
-can negate the expertise of the clinician

10

who one is best?

not either-or, but both
both are needed and must be integrated
-external clinical evidence can inform, but can never replace, individual clinical expertise

11

components of EBP

defining a clinically relevant question
searching for the best evidence
appraising the quality of the evidence
applying the evidence to clinical practice
evaluating the process

12

clinically relevant questions

what's the best course of action?

13

components of clinical questions

patient population
intervention/treatment
outcome of interest

14

searching for the best evidence

technology is a blessing

15

what is evidence

anything used to establish a fact, or give a reason to believe something
seek "facts"

16

sources of medical evidence

tradition
experience
research
theory

17

types of research

laboratory
observational
clinical trials

18

laboratory

controlled
looks at
-physiological processes
-tissue response to intervention

19

laboratory pros and cons

pros
-easy to control
cons
-limited by tissue type (healthy, animals)

20

observational

observations in a natural environment
prospective or retrospective (before/after data collection)

21

observation pros and cons

pros
-natural
cons
-uncontrolled

22

clinical trials

observation + lab

23

clinical trials pros and cons

pros
-well controlled
-natural setting

24

narrowing the focus of your search

patient group
intervention
outcome
use studies within last 5-10 years

25

quality of evidence

there is a direct correlation between the quality of evidence and the quality of healthcare

26

levels of evidence

1. systematic reviews or meta-analyses or randomized controlled trials and high-quality, single, randomized controlled trials
2. well-designed cohort studies (observation)
3. case-control studies
-comparison of two patients
4. case series and poor-quality cohort and case-control studies
5. expert opinion, based not on critical appraisal, but on reasoning from physiology, bench research, or underlying principles

27

quality of evidence

relates to the credibility, clinical significance, and applicability of evidence
-how confident are you that it represents the "truth"
-can you trust the results?

28

things to consider when applying the intervention

what are the goals?
evidence
patient preference

29

clinical outcomes

end results of specific health care practices and interventions

30

examples of clinical outcome measures

objective measurements (ROM, strength)
patient-based assessments (questionnaires, pain scales)