Questions and Answers
What does an evidence pyramid depict?
The evidential strength of different research designs.
What is the importance of follow-ups after treatment?
To check on the resolution of the disease or disorder, identify complications, and evaluate the effectiveness of the therapy plan.
What is the SOAP format used for in medical evaluation?
To structure the evaluation process into Subjective, Objective, Assessment, and Plan.
What does EBM stand for?
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Which of the following are steps in the five A's of Evidence-Based Practice?
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What does PICO format stand for in the context of EBM?
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The P in PICO format stands for ________.
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Evidence alone is sufficient to make a clinical decision.
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What is the goal of EBM?
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Study Notes
Evidence-Based Medicine (EBM)
- EBM combines the practitioner's clinical expertise, patient's desires, and values with the conscientious use of current best evidence from clinical literature to improve clinical decision-making.
- EBM is the clinical judgment to make the best possible healthcare decision for patients.
The Five A's of Evidence-Based Practice
- ASSESS: Assess the patient to identify the information needed, gather information, and research further.
- ASK: Ask a focused clinical question using the PICO format (Patient, Intervention, Comparison, Outcome).
- ACQUIRE: Acquire the best available evidence to answer the question using various resources (e.g., databases, journals).
- APPRAISE: Appraise the quality of the evidence with regard to validity, importance, and applicability to the patient or patients of interest.
- APPLY: Apply the new information to patient care, considering whether the treatment benefits are worth the potential harms and costs.
Examples of EBM in Practice
- Example 1: A 37-year-old female patient with alcoholic hepatitis, where the goal is to reduce mortality using pentoxifylline therapy.
- PICO format: P - patient with alcoholic hepatitis, I - pentoxifylline, C - (none), O - reduced mortality
- Example 2: A 30-year-old pregnant woman with severe hypertension, where the goal is to improve symptoms and reduce teratogenic effects using Nifedipine or Captopril.
- PICO format: P - 30-year-old pregnant woman with severe hypertension, I - Nifedipine, C - Captopril, O - improve symptoms and reduce teratogenic effects
Resources for Evidence Acquisition
- National Guideline Clearinghouse (NGC): A database providing comprehensive evidence-based clinical practice guidelines.
- TRIP Database: A database devoted to evidence-based medicine, searchable by medical images, evidence-based medicine, and patient leaflets.
- ACP Journal Club: A journal reviewing over 100 internal medicine journals to publish short summaries of high-quality articles.
- British Medical Journal (BMJ): A database providing a comprehensive collection of journals from other online databases.
- Cochrane Review: A database providing high-quality evidence-based reviews addressing well-researched clinical questions.
- Essential Evidence Plus: A database assisting health care professionals in facilitating evidence-based decision-making.
- UpToDate: A database containing thousands of chapters on basic pathophysiology and current treatment recommendations for diseases of interest.
- PubMed: A database maintained by the National Library of Medicine, containing millions of biomedical citations from other databases.
Conducting the Search
- Use BOOLEAN SEARCH to combine individual words or terms using Boolean operators (“AND”, “OR”, and “NOT”) to produce more results.
- Example searches: "Alcoholic Hepatitis AND Pentoxifylline AND Mortality" or "Pregnant with severe hypertension OR Nifedipine OR Captopril OR improve symptoms"
Appraising the Evidence
- Research the evidence may be appraised with regard to three main areas: validity, importance, and applicability to the patient or patients of interest.
- Use trusted resources that have been prescreened/reviewed by EBM experts.
Applying Evidence to Patient Care
- Ask if the evidence can be applied to the current problem.
- Consider whether the treatment benefits are worth the potential harms and costs.
- Evaluate whether all clinically important outcomes were considered.
Evaluating Performance
- Follow up on the patient to check on the resolution of the disease or disorder and to see if there are complications encountered when applying the intervention.
- Conduct a case study to contribute to the ever-growing reservoir of medical information.
Evidence Pyramid
- A visual depiction of the evidential strength of different research designs.
- Strong research designs (e.g., systematic reviews, meta-analysis) are at the top of the pyramid.
- Weak research designs (e.g., observational research, expert opinion) are at the bottom of the pyramid.
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Description
Test your understanding of Evidence-Based Medicine, combining clinical expertise with current best evidence to improve clinical decision-making. Learn the Five A's of Evidence-Based Practice.
