Key EBP and DI concepts

What is the definition of evidence based practice?

The use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients

What is the modified systematic approach to DIQs?

1. identify and obtain information about the requester

2. obtain background information

3. determine and categorize the ultimate question

4. develop and conduct an efficient search strategy

5. evaluate and analyze

6. formulate and provide a response

7. conduct follow up and document

What is a background question?

-broad in scope

-answer is generally accepted knowledge

-tertiary references

(Ex: what dosage forms does semaglutide come in?)

What is a foreground question?

-narrow in scope

-answer may require examination of new or conflicting evidence

-primary and secondary references

(Ex: is ozempic or victoza better?)

What is the PICO method to determine the ultimate questions?

P = patient, population, predicament, or problem

I = intervention, exposure, test or other agent

C = comparison intervention, exposure, test, etc

O = outcomes of clinical importance, including time when relevant

What is a tertiary source?

-generally accepted/compiled/summarized infomation

-Ex: textbooks, online DI databases (Lexicomp), clinical practice guidelines, review articles (in journlas)

What is a secondary source?

-searchable database to help locate primary and tertiary resources

-provides reference information and abstracts

-Ex: PubMed, EBSCO, Medline, Ovid technologies, First Search

What is a primary source?

-direct source material

-Ex: original research studies (randomized controlled trials, clinical trials), case reports, conference notes, poster

How many resources should you use to answer any question?

Two

What tertiary resource do you use for general drug information?

Package insert, Lexicomp, Micromedex, Clinical Pharmacology

What tertiary resource do you use for disease state general overviews?

Dynamed

What tertiary resource do you use for pediatric information?

Harriet Lane, Teddy Bear Book, Lexi-peds, Neofax

What tertiary resource do you use for pregnancy information?

Briggs

What tertiary resource do you use for lactation information?

LactMed, Hale's

What tertiary resource do you use for IV compatibility?

Trissel's, King Guide

What tertiary resource do you use for herbals?

Natural Medicines

What tertiary resource do you use for international drug equivalency?

Index Nominum

What tertiary resource do you use for pharmacogenomics?

PharmGKB, CPIC

What is the orange book used for?

Therapeutic equivalence

What is the yellow book used for?

Travel immunizations

What is the pink book used for?

General immunizations

What is the purple book used for?

Biologics and biosimilars

What is the red book used for?

Drug pricing and pediatric infectious diseases

What is the definition of clinical practice guidelines?

Statements that include recommendations intended to optimize patient care that are informed by a systemic review of evidence and an assessment of the benefits and harms of alternative care options

What is a meta-analysis?

Combines results of multiple studies into a single statistical analysis of results

What are randomized controlled trials?

Experimental studies that compare participants who are assigned to either the intervention or control group

What are cohort studies?

Observational studies that take a cohort/group of people who have something in common and compares to those that don't share commonality to determine occurrence of outcome

What are case controlled studies?

Observational studies where patients who have a specific outcome status (case group) are compared with people who don't (control group)

What are case reports/case series?

Descriptive study that includes a collection of reports on treatment of individual patient(s)

What should be in the introduction of a DIQ?

-brief overview or summary of background information

-introduce ultimate question without writing it in question form or saying "this DIQ will tell you"

-1 paragraph

What should be in the body of a DIQ?

-analysis of supportive literature (not just summary)

-must include primary literature if available

-include pertinent information from studies

-1-2 supportive paragraphs

What should be in the conclusion of a DIQ?

-a conclusion/recommendation based on only the presented information

-should correspond with objective state in the introduction

-avoid using pronouns

-avoid mentioning the person you are writing to

-consider key follow up/monitoring/education points

How should in-text citations be used?

-numbered in order of appearance

-immediately after punctuation (w/o a space)

-superscripted

-can cite every single sentence that references the resource or cite the first and last sentence that references the resource

What are preferred references to cite for drug information?

Package insert

What are preferred references to cite for disease information?

Clinical practice guidelines

What resources should never be cited?

-Dynamed/UptoDate

-class notes

-WebMD

-RxPrep/UWorld

-artificial intelligence

What is an AMA citation?

Authors last name first initial, Title. Approved abbreviation of journal. year;volume:pages. doi

How should authors be cited?

-If 6 or less total authors, cite all authors

-If more than 6 authors, cite the first 3, then et al.

How should an article title be cited?

Only capitalize the first letter and the rest are lowercase (no matter how it shows on the article)

How should the journal or approved abbreviation be cited?

Italicized