Clinical Procedures II Test I: EBM

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

EBM

providers need _________therapies to offer pts.

proven

application of the best ______ available in medicine to the patient in your office with a particular medical problem

evidence

in the past when an answer was unknown you went to ______

the eldest provider for the answer (the most experienced)

Now when the answer is unknown we consult _______ to determine what decision is associated with the best clinical outcome

medical evidence (the best proven)

what are the 3 components to EBM

clinical problem solving, medical information systems, and critical appraisal of medical literature

good questions, epidemiology, and statistics are used in

clinical problem solving

up to date, pubmed, cochrane, etc. are examples of

medical information systems

statistics, epidemiology, knowledge of study design and level of evidence represent the

critical appraisal of medical lit

why EBM

too many pts., too many problems, too many journals, info overload, no time, read only what your familiar with, avoid difficult issues

truth is a probablility statement.....

that what we do for pts. Does more good than harm

deductive way to find out what is true

EBM

the focus is on outcomes that work not _______

what ought to work

The five A's

Ask, access, appraise, apply, assess

ask is

formulate and ask a question

access is

access the information

appraise is

critically appraise the evidence

apply is

apply the evidence

assess is

assess the usefulness of the information in practice

the 6 steps in EBM

create a clinical question (PICO), search the medical lit, find the study that will answer your question and note the effect size, perform a critical appraisal of the study to determine validity, determine if/how results will help your pt (external validity), evaluate the result in your pts.

evidence packaging began in the

UK

CAT

critically appraised topic

DOE

disease oriented evidence

POEM

patient oriented evidence that matters

JCB

journal club bank

DOE vs POEM

some studies may only review the disease but may irrelevant to your pt., some studies directly matter to your pts.

improves decision making confidence, help communication, decreases time wading through lit, fosters focused productive reading, lessens lag time for applying and finding research, dovetails with tech such as pda's and databases

advantages of EBM

requires commitment, time, effort, not everyone is equally skilled at data searches, not everyone can afford resources, not everyone is equally skilled at appraising literature, better know and choose reliable filters, there is a risk of misinterpretation

disadvantages of EBM

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