Definition by David Sackett - ANSWER - evidence-based medicine = explicit and
conscientious attempts to find the best available research evidence to assit health
professionals in making the best decisions for their patients
Purpose of evidence based practice - ANSWER - to support clinical decision-making
- formalized process of using a set of methods for finding and implementing the best
clinical information in clinical practice
- want to cause the gap between what is known and what is practiced to improve patient
care
Pateint values + research evidence + clinical expertise + practice context = EBP
Integration of information - ANSWER - integrate research evidence with patient input
Research contribution - ANSWER - research enriches clinical decision-making by
providing additional insights and perspectives to inform healthcare choices
Why do we need Evidence Based Decision Making - ANSWER 1. Variations in practice =
Most people have reasons for why they do things the way that they do
- we want to be able to back these practices up with evidence and standardize care
2. Slow translation of research into practice = We want to stay current and make sure
patients have the best possible care as soon as it is available
- and we want to discontinue ineffective/outdated care
,3. Managing information overload = not all sources are accurate
- want to be able to decipher what is useful
4. Changing educational requirements = Evidence-based decision-making is now a
requirement in many programs
ex. dentistry, dental hygiene, medicine, etc.
5 A's - ANSWER 1. Ask a question
2. Access the information
3. Appraise the articles found
5. Apply the information
6. Audit = evaluate steps 1-4
Step 1 - ANSWER = create an answerable clinical question
ex. a question about intervention, diagnosis, prognosis, patients concerns
Step 2 - ANSWER = Find the best evidence to answer your clinical question
- use appropriate resources
- be able to efficiently search online resources
Step 3 - ANSWER = appraise the evidence for its validity, impact and applicability
1. internal validity = refers to whether the evidence is trust worth
2. impact = clinical importance/impact of the evidence
3. applicability = research has to relate to the patient/situation
Step 5 - ANSWER = evaluate the effectiveness of steps 1-4
- think of ways to improve for next time
Foreground questions - ANSWER - answers a pointed question about a specific disease
or population
- often investigates comparisons (two treatment approaches or diagnostic tests)
ex. is chlorohexidine effective in geriatric patients for treating mouth ulcers
ex. PICO question
Background question - ANSWER - answers a general knowledge question about a
disease condition or process
ex. what is hypodontia
PICO(T) - ANSWER P = population/patient/problem
I = intervention or issue of interest
C = comparison
O = outcome
T = time
History of PICO - ANSWER - framework was originally developed for medicine as a way
to address knowledge gaps during patient encounters
- PICO = become the most widely used question framework for evidence-based practice
, Patient/population - ANSWER - who is the patient
- age, sex, race
- primary problem
- health status
Intervention - ANSWER - what do you plan on doing for the patient
- diagnostic test
- medication
- procedure/treatment
Comparison - ANSWER - what alternative are you considering
- another test, medication or procedure
Outcomes - ANSWER - what do you wish to accomplish
- accurate diagnosis
- relieve or improve symptoms
- maintain function
Time - ANSWER = time
- optional
- sometimes needed
- the time it takes for the intervention to achieve the outcome
- time over which populations are observed for the outcome to occur
**Prognosis Qs always need time
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