University of Pittsburgh EBP 1 Midterm Exam Study Guide.

EBP Midterm Exam:



Lecture 1: What is EBP

 Basic Concept:
o Integration of best research evidence with clinical expertise and patient values
 Goals:
o Questions dependency on knowledge gained from authority and tradition
o Improves clinical performance
o Puts patient at the center of care by emphasizing outcomes that matter to them such as
symptoms, morbidity, mortality, QOL and cost
 Why use EBP?
o Decrease wide variation in current clinical practice
o Use good and relevant clinical examples
o Improve efficiency in the clinical decision making which will maximize successful
outcomes
 Defining evidence:
o Not non-peer reviewed information
o Evidence is not theory
o Evidence is data from clinical research performed on patients
 5 Step Process of incorporating EBP into clinical practice:
o Develop an answerable question
 Background
 Foreground—ask for specific question a clinician has about a pt.’s problem





o Search for the best evidence to answer the question
 Determine which database will be the most useful
 Medline—largest general biomedical research database, available
through OVID or pubmed
 Cumulative index to nursing and allied health—contains literature
related to nursing and allied health professions. Access under “more
resources databases” on Pitt Health Sciences library website

,  Cochrane Database—database of systematic reviews. Includes
systematic reviews of trials of health care interventions
 PTNow.org—clinical summaries and clinician’s quick takes

 Identify search terms to enter the database
 0.





 Use the database features to streamline the search
 Be prepared to reformulate the question
 Aim for the highest quality of evidence available
o Critically appraise the evidence
o Integrate clinical appraisal with clinical expertise and patient’s values
o Evaluate the effectiveness and efficacy of initial 4 steps and seek improvement for next
time
 Best Evidence available:
o Primary source: direct evidence concerning a topic under investigation
 Generally articles that appear in peer-reviewed journals and are found by
searching medline or pubmed
o Secondary Sources: summaries or analyses of the evidence derived from and based on
primary sources.
 PEDro
 PIER
 Cochrane Library
 Hierarchy of Evidence:

, o
o Systematic Reviews:
 Summary of the literature that uses explicit methods to:
 Systematically search
 Critically appraise
 Synthesize the world-wide literature
 May or may not use statistical procedures to combine the results of individual
studies
 Called meta-analysis with studies are combined statistically to estimate overall
effect
o Clinical Guidelines:
 Summary of current best practice for management of specific conditions
 Often created by professional societies
 Grades of recommendations based on level of evidence supporting the
recommendation
 Grade A – Supported by at least 1 & preferably more level I RCT
 Grade B – Supported by at least 1 level II RCT or prospective
comparative study
 Grade C – Supported by only level III, IV or V evidence
o Diagnosis Studies:
 Optimal design is a prospective cohort study
 Independent and blind comparison of diagnostic test with reference
standard
o All subjects underwent both tests
o Results of diagnostic test did not influence decision to perform
reference standard
o Prognosis Studies:
 Optimal design is a prospective cohort study
 1 or more groups that have not experienced the outcome of interest
 Monitor over time