Download as PDF, PPTX
More Related Content
Similar to FINDING THE EVIDENCE (1).pdf
FINDING THE EVIDENCE (1).pdf
- 1.
- 17. •A good answerablequestion will help us focus on evidence that is relevant to a patient’s clinical needs, (or your own knowledge needs). •They can suggest high yield search strategies •They can suggest the forms that useful answers might take (i.e. what is best research design to answer our question) THE QUESTION - WHY IS IT SO IMPORTANT?
- 18. FRAMEWORK TO Patient/Problem Intervention Comparison Outcome In aman with depressive symptoms… …Is cognitive behavioural therapy… …compared with fluoxetine… …better at improving depressive symptoms?
- 19. CLINICAL QUESTIONS • Background- “What is it?” • General information on a condition or disease • Foreground – “What do I do for this patient?” • Patient • Intervention/Investigation • Comparison Intervention/Investigation • Outcome (Patient-Oriented)
- 26. Framework to Patient/Problem Intervention Comparison Outcome In aman with depressive symptoms… …Is cognitive behavioural therapy… …compared with fluoxetine… …better at improving depressive symptoms?
- 27.
- 38.
- 39. Steps in theEvidence-Based Process are: (Citrome, & Ketter, 2009)
- 40. FSU College ofMedicine 40 Constructing A Clinical Question P patient I intervention C comparison O outcome Who? What? Alternative Intervention? Outcomes “How would I describe a group of patients similar to this particular patient?” ”Which treatment, test or other intervention?” “Compared to what other treatment, test, or perhaps compared to doing nothing” What is the patient oriented outcome – better prognosis? Higher rate of cure? Etc.?”
- 41. FSU College ofMedicine 41 Examples P I C O Kids with acute otitis media -2-4 y/o Antibiotics No treatment except acetaminophen for pain/fever No pain after two days? Adult with microhematuria IVP CT scan Diagnostic accuracy (Predictive value or likelihood ratio) Adult patients <70 TIA No TIA Rates of CVA within 90 days Healthy adolescents Routine scoliosis screen No screening – evaluate only if problems Pain, disability, need for intervention
- 42. FSU College ofMedicine 42 Types of Questions Best Answered by EBM Resource • Therapy Question – In patients with migraine headaches without auras, is Depakote more effective than Inderal for prophylaxis of headaches? • Prognosis Question – In diabetic patients with foot ulcers, is the diagnosis of osteomyelitis with MRI as predictive of healing as an audible pulse on Doppler examination? • Diagnosis Question – In geriatric patients with suspected carotid stenosis, is duplex ultrasound as good as magnetic resonance angiography in detecting significant carotid stenosis? • Harm Question – For pregnant patients, does the consumption of large amounts of coffee, (compared to non-coffee drinkers) increase the rate of spontaneous abortion?
- 43.
- 44. 44 Drilling Down forInformation Grandage KK, Slawson DC, Shaughnessy AF. When less is more: a practical approach to searching for evidence-based answers. J Med Libr Assoc. 2002 Jul;90(3):298-304.
- 45. FSU College ofMedicine 45 EBM Hunting Tools A high-quality Hunting tool employs a transparent process that • Searches multiple EBM databases (several foraging tools) • Organizes results to make them easy to find • Provides levels of evidence (Slawson, et al)
- 46. FSU College ofMedicine 46 EBM Pyramid 5, C MEDLINE InfoRetriever DynaMed
- 47. • Biomedical journalliterature PubMed Database • Published by: The National Library of Medicine • International scope
- 48. Accessing PubMed • Freelyavailable over the Internet • Also through library’s home page @ www.pubmed.gov
- 49. tool that searchesfor evidence-based literature PubMed’s Clinical Queries
- 50. Diagnosis Therapy Etiology (cause) Prognosis(prediction of probable outcome) Clinical Queries Searchable by:
- 51.
- 52.
- 53. Results for Therapyand Broad Scope Change to Narrow Scope
- 54. Click See all(7542)
- 55.
- 56. Click on thearticle title you wish to read