Evidence-Based Medicine, Reviews, and Confidence Intervals (Exam 2)

What does this refer to

• Limitations

  • Collection of high-quality evidence was limited by bias and lack of blinding as MDs made observations about interventions and outcomes of their own patients.

• Difficulty with carrying forward

  • Scurvy

  • Handwashing

• Early pioneers of EBM

  • Drs Sackett, Guyatt, Chalmers, Feinstein, and Cochrane

History of Evidence-Based Medicine (EBM)

What does this refer to

1. Ask a clinical question

2. Search For evidence

3. Evaluating the evidence

4. Applying the evidence

5. Evaluation of the process

Process of evidence-based medicine

What step of evidence-based medicine is the following

• PICO

  • Population or patient

  • Intervention

  • Comparison

  • Outcome

Step 1 Ask a clinical question

What step of evidence-based medicine is the following

• Starts with identifying the type of evidence of interest

• Filtered

• Unfiltered

• Use keyword search narrowing for relevancy through Systematic Review

• Lump and critique by similarities if applicable

Step 2. Search for evidence

What does this refer to

• _____-has already been reviewed and synthesized by experts.

  • UpToDate, CATs, etc… Full list on pg 121 table 11.2 in “A Guide to Clinical Practice…” textbook.

Filtered

What does this refer to

• ________-primary evidence original research articles. Same table for full examples.

Unfiltered

What step of evidence-based medicine is the following

• Consider the outcome measurement

• Validity

• Bias, confounding error, Loss to follow up

Step 3 Evaluating the evidence

What does this refer to

• Cohort

• Case-Control

• Cross-sectional

Observational study designs

What does this refer to

• Identify the best evidence

• Combine it with clinical judgement

• Discuss with the patient for informed consent

Step 4 Applying the evidence

What does this refer to

• Consider the outcome of the patients in your practice

• Was the treatment effective for them, better or worse than expected or informed

• Continuous process.

Step 5 Evaluating your process

What does this refer to

Investigation

What does this refer to

• Using a single data point as a way to describe the larger group. For example: using the sample mean x to estimate the population average.

• You calculate the mean HgA1C in your clinic over a week of patients and use that exact number to estimate the average HgA1C of your entire patient panel.

Point estimate

What does this refer to

• Using a range of values of which has a high probability to contain the true average of a population instead of a calculated exact number.

Interval estimate

What does this refer to

• Range of numbers at a stated percentage of probability that the population average lies within.

  • Example 95% CI(p-1.96 X SE, p+1.96 X SE)

• 90%-1.645

• 95%-1.96

• 99%-2.58

Confidence Interval

What does this refer to

Calculating Confidence Interval(You want to know if offering a Saturday yoga class would be cost effective for the practice)

What does this refer to

• Univariate analysis

  • Data is using one variable for descriptive statistical analysis.

  • Not looking for cause or relationship

  • Ways of looking at descriptive statistics’ distribution

    • Mean, median, quartile, skew, (looking for patterns)

Analysis

What does this refer to

Multivariate Analysis uses statistical tools to analyze more than just a single variable.

What does this refer to

• ____________ is a is a literature review focused on a single question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question.

Systematic review

What does this refer to

• __________ is a survey in which the results of all of the included studies are similar enough statistically that the results are combined and analyzed as if they were one study.

Meta-analysis

What does this refer to

• What evidence is currently out there? What is your research question?

  • Who could benefit?

  • How could you impact public health?

• Provided background information is necessary to engage the reader?

  • Background information

  • Keywords

  • Limitations

Introduction

What does this refer to

• How can you set up research to support or reject your question?

  • Choose research method

  • Chose research design

Methods

What does this refer to

• How can you set up everyday practice to deliver best care?

• EBM

Going forward