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28 terms

Clinical Procedures II Test I: EBM

STUDY
PLAY
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