Evidence Based Medicine- Follen

Define evidence-based medicine (EBM)

• objective

• “the integration of best research evidence w/ clinical expertise and patient values”

• incorporates evidence along w/ clinical experience and patient preferences into the decision-making process

Define evidence:

• findings from clinical research, especially from patient-centered research, that are relevant to patient care

Clinical expertise definition:

• using clinical skills and previous experience to evaluate evidence and the patient’s health status and experiences

Patient values and preferences definition:

• collection of goals, expectations, predispositions, and beliefs that individuals have for certain decisions and their potential outcomes

__________________________________ refers to the setting as primary, secondary, or tertiary care in which care is provided

clinical circumstances

Identify steps involved in EBM

• objective

1. asking an appropriate/ answerable question

2. finding evidence

3. appraising evidence

4. applying evidence to practice

What method is used to ask an answerable question??? (aka step 1 of EBM)

PICO method

• P- patient, population, program, or problem

• I- intervention

• C- comparison

• O- outcome

In the second step of EBM, you are finding evidence. Which of the following would you NOT use to find evidence:

a. PubMed

b. Cochrane

c. Google

d. SCOPUS

c

The third step of EBM is appraising (aka assessing) evidence. What are the main points in appraising information?

• assessing internal validity

• assessing freedom from bias, reliability, usefulness bias the hierarchy of evidence

Basically: checking the info so that it’s reliable

Identify the hierarchy of evidence

• objective

• a pyramid that categorizes evidence from least- most reliable

• used in step 3 of EBM, when you are appraising evidence

• use the photo attached for the hierarchy

The 4th step of EBM is applying evidence. What must you pay critical attention to when apply evidence?

• external validity

• clinical significance

• patient’s goals

• shared decision-making

Discuss strengths (advantages) of EBM

• objective

• attempts to find and incorporate interventions that work

• provides guidance on how to keep up with new literature

• improves critical thinking skills

• can create communication btwn professional

Discuss disadvantages of EBM

• objective

• focuses on WHETHER an intervention works, not HOW it might work

• requires knowledge, skills, and support mechanisms to practice it efficiently

  • aka students might struggle/ lack clinical role models to practice EBM

• some have dismissed EBM as “cookbook medicine” and a threat to autonomy

  • bad if you think this way- EBM is necessary

• many important questions do not yet have answers

What is the purpose of the MAARIE framework?

• objective

• kinda an FYI

• The basis for a step-by-step approach to reading the clinical research literature.

• Another tool practitioners can use for EBM

What does the MAARIE framework stand for?

• objective

MAARIE stands for:

M- methods

A- assignment

A- assessment

R- results

I- interpretation

E- extrapolation

What makes up the “M” or “Methods” of the MAARIE framework?

• PURPOSE

  • hypotheses

• POPULATION

  • who’s being studied

• STUDY SAMPLE

  • sample size/statistical power

    • Ex: how many ppl in study and control group

What makes up the “A” or “Assignment” of the MAARIE framework?

• Allocation(assignment) of participants to study and control groups

  • basically, placing the participants in their groups

    • includes how they were assigned, why, etc.

What makes up the “A” or “Assessment” of the MAARIE framework?

• measurement of outcomes or end points in the study and control groups

  • primary, secondary, and safety endpoints

  • statistical analysis methods

  • do NOT include study results here

What makes up the “R” or “Results” of the MAARIE framework?

• comparison of outcomes in the study and control groups

  • did we achieve our endpoints?

What makes up the “I” or “Interpretation” of the MAARIE framework?

• meaning of the results for THOSE INCLUDED IN THE INVESTIGATION

  • authors conclusions

  • limitations, strengths, bias, etc.

What makes up the “E” or “Extrapolation” of the MAARIE framework?

• meaning of the results for THOSE NOT INCLUDED IN THE INVESTIGATION

Identify the components within the MAARIE framework

• objective

• basically a summary of all the cards above^

“MAARIE”

M- methods: the purpose, population, and study sample for investigation

A- assignment: allocation of participants to study and control groups

A- assessment: measurement of outcomes or end points in the study and control groups

R- results: comparison of outcomes in the study and control groups)

I- interpretation: meaning of the results for those included in the investigation)

E- extrapolation: meaning of the results for those not included in the investigation)

PRACTICE:

Which of the following does the “I” stand for in the MAARIE Framework?

a. Investigational

b. Intentional

c. Interpretation

d. Interpersonal

c

PRACTICE:

Which of the following is NOT a disadvantage of EBM?

a. it does not provide guidance on how to best keep up w/ new literature

b. focuses on whether an intervention works, no how it might work

c. requires skills, knowledge, and support to practice

d. some have dismissed EBM as “cookbook medicine” and a threat to autonomy

a

PRACTICE:

In what component of the MAARIE framework do we measure the primary, secondary, and safety endpoints?

a. Results

b. Assessment

c. Assignment

d. Interpretation

b

PRACTICE:

Which of the following correctly places the steps in practicing EBM in the correct order?

a. applying evidence, appraising evidence, finding evidence, asking an appropriate question

b. asking an appropriate question, appraising evidence, finding evidence, applying evidence

c. finding evidence, appraising evidence, asking an appropriate question, applying evidence

d. asking an appropriate question, finding evidence, appraising evidence, applying evidence

d

PRACTICE:

Which method is used to ask an answerable question?

a. PICO

b. MAARIE

c. RICO

d. EBM

a

PRACTICE:

T/F Extrapolation is the meaning of the results for those included in the investigation.

F- Extrapolation is for those NOT INCLUDED

PRACTICE:

Based on the hierarchy of evidence, which of the following is the most reliable? Which is the least reliable?

a. case studies

b. expert opinion

c. cohort studies

d. systematic reviews

most reliable- d. systematic review

least reliable- b. expert opinion