EBM 2

Pregunta	Respuesta
Define EBM	1. the conscientious, explicit, and judicious use of current best evidence in making clinical decisions about the care of the individual patients. 2. The practice of EBM means integrating individual clinical experience with the best available external clinical evidence from systematic research.
Aside from current evidence based. EBM incorporates two important aspects which are ---------?	1. clinical experience 2. patient values
List factors that are part of patient values and circumstances.	1. individualized preferences, concerns, expectations 2. financial resources of the patient.
Key skills require to successfully practice EBM are -----?	1. developing a structured clinical question 2. formulating a systematic search strategy to obtain the best available evidence 3. evaluating the literature properly 4. comprehending the study results 5. incorporating evidence into patient care.
patient-oriented evidence that matters (POEM) focuses include ------- ?	1. “quality of life, 2. improving function 3. staying independent 4. overall mortality, and 5. cost-effectiveness
List the six steps of applying the evidence-based medicine (EBM) process.	1. Create an answerable clinical question. 2. Find the best evidence. 3. Critically appraise the evidence. 4. Integrate evidence with clinical judgment/expertise and patient preferences.* 5. Implement intervention or apply the evidence. 6. Evaluate the effectiveness of the intervention.
Internal validity describes ---------?	degree to which the intervention or treatment contributes to the results
External validity describes --------- ?	1. describes the generalizability of the results to a population (or patient) of interest 2. External validity is the extent to which the results apply to the population of interest
List the four components of a well-formulated question:	PICO: 1. patient (or problem) 2. intervention (drug the pt is on) 3. comparison (or control) [alternative drug] 4. outcome [ effect or result expected]
What is PICO use for?	PICO search strategy results in a well-built, searchable question that is relevant to the patient and specific for the clinical situation.
Define Experimental studies/designs + Examples.	1. Experimental studies contain at least two groups in which members of one group receive active therapy and members of the other group may receive the standard of care or placebo. 2. Researchers measure effects of therapy on predetermined outcomes. 3. Example is RCT
What is the major advantage of RCT designs?	controls for known and unknown confounders.
How is systematic error or error by chance in RCT is checked/reduced?	Randomization = limits selection bias
RCT designs can be affected by cofounder, define cofounder.	Confounders are independent factors related to both the outcome and treatment
In RCT, how do you limit cofounders?	Use Inclusion and exclusion criteria.
In RCT, what is the use of randomization?	To limit selection bias
In RCT, what is the use of blinding?	To limit Hawthorne effect
In RCT what is Hawthorne effect?	is a type of bias in which patients respond to therapy (either control or treatment) because they are being studied
In RCT, what is a placebo effect?	is a type of Hawthorne effect in which patients respond favorably to placebo.
In RCT, what element is assessed?	Efficacy
Explain observational studies	1. participants may be assigned to groups, but are not assigned a treatment or therapy. 2. Researchers observe participants for the desired outcome. 3. assess drug effectiveness.
Identify factors that determine the internal validity of experimental and observational trials	1. Confounding [inclusion and exclusion] 2. duration of therapy 3. dosage 4. primary outcome 5. surrogate outcomes
In RCT, what is a noninferiority study?	1. a study that permits researchers to randomize patients to receive active drug or the drug considered as the gold standard. 2. Researchers design the study to show that the new treatment is not inferior to the standard treatment. 3. In doing so, a noninferiority margin is established a priori.
Explain observational studies	1. Results from observational studies answer questions about treatment, prognosis, and harm and shed light on questions about therapy, specifically under real-world conditions and not ideal conditions, as set forth in the RCT. 2. Results from observational studies only draw associations between therapy and outcome rather than cause and effect between treatment and disease.
List Xteristics of case-control	1. Identify RF 1st w/ an event of disease 2. often used in studying rare diseases. 3. could have confounders (like RCT) 4. Outcome is measure in OR 5. It is only retrospective 6. watch out for selection bias and recall bias 7. Patient's outcome is known before the study.
In case-control, how do you minimize confounding?	match cases to controls based on patient characteristics such as age, sex, and comorbidities
In case-control, factors that influence internal validity includes --------?	1. Selection bias 2. recall bias
Xteristics of cohort includes-----?	1. researchers follow a group of people (a cohort), of which some have the exposure of interest and some do not. 2. Can be retrospective or prospective

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