Term
| what is the definition of evidence based medicine |
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Definition
| concencious and judicious use of current best evidence in making decisions about patient indivigual care |
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Term
| what is the fancy definition for how one practices evidence based medicine |
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Definition
| combine study results with clinical judgement and patient preferences |
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Term
| what does evidence based medicine lead to |
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Definition
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Term
| explain the example about how catheters in the hospital used evidence based medicine and the result |
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Definition
| we used to put them in everyone this led to infections, they used a bacterial agent to get rid of the infections which led to resistance. studies were done saying this is stupid and we don't do it as often anymore and now bacteria are weaker, people are healthier, overall improved quality of care |
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Term
| what is evidence based medicine considered "cookbook medicine", what is the flaw |
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Definition
| because if you follow the rules how can they sue you? people will still find a way but it is less likley |
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Term
| where do the protocols in evidence based medicine come from |
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Definition
| socities and expert pannels |
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Term
| what are the reasons for development of evidence based medicine |
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Definition
| to cope with information overload, cost control, public is impatient for the best diagnosis and treatment |
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Term
| in the reasons for evidence based medicine, what does it mean by information overload |
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Definition
| physicians are faced with increases in biomedical journals and textbooks and cannot keep up with them due to quantity and time. most dont meet the minimum standards of apprasal anyways, they are inadequate and misleading |
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Term
| in the reasons for evidence based medicine, what does it mean by it being driven by increased health care costs |
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Definition
| costs are increasing and cost control is needed to limit it, we need to make the best use of limited resources |
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Term
| in the reasons for evidence based medicine, what does it mean by public impatience |
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Definition
| the public is more educated and can find stuff more easily, they want the best diagnosis and therapy, dont want to wait, quality isnt important |
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Term
| what things ranked higher than quality in the eyes of patients |
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Definition
| convience, coverage, access, health plans |
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Term
| what is the goal of evidence based medicine |
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Definition
| make the best clinical decisions, appropirate, efficient, and effective |
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Term
| how can we improve the quality of catr |
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Definition
| clinical practive guidelines, care maps, outcome measures (what changes have you made to improve) |
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Term
| what are the steps of evidence based medicine |
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Definition
1. decide what information is needed
2. make a question that can be answered with research
3. search published literature
4. decide which studies are valid and appropirate
5. apply to patient
6. re-evaluate |
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Term
| what are the integrated care pathways |
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Definition
| pathways of care, care maps, and collaborative care pathways |
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Term
| why do we have clinical pathways, what does it include |
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Definition
| provide guidance for each stage in the management of a patient: treatments, interventions. includes progress and outcome detials |
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Term
| what are clinical practice guidelines |
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Definition
| systematically developed statments to assist practitioner and patient decisions about appropirate healthcare for specific clinical circumstances |
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Term
| what can make better quaility guidelines |
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Definition
| greater strength in evidence |
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Term
| what does it mean when we say clinical practice guidelines provide an agreement with how patients should be treated |
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Definition
| provides them with a greater consistance of care, helps patients make more informed choices, influences public policy by drawing attention to deficiencies |
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Term
| how do some people thik about clinical pathways |
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Definition
| viewed as algorithms, not really practive guidelines |
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Term
| what does it mean when people say they view clinical pathways as algorithms |
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Definition
| offers a flow chart format of the decisions to be made |
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Term
| what does it mean when people say they view clinical pathways are not really practice guidelines |
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Definition
| utilized by a multidiciplinary team, ahve a focus on the quaility and coordination of care |
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Term
| what are the components of clinical pathways |
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Definition
| timeline, categories of care or activities/interventions, intermediate and long term outcome criteria, variance record |
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Term
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Definition
| a critical pathway document not that much different than a clinical pathway, it is a grid you can follow to improve care |
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Term
| what does the care map measure |
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Definition
| readily obtained outcomes |
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Term
| what does a care map reflect |
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Definition
| the progress of a pathway |
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Term
| how is a care map set up, physically |
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Definition
| formulated as a grid with categories of care given specific time segments |
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Term
| what do care maps rely on, why |
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Definition
| quaility evidence, it needs to evaluate if it is optomizing the process and improving efficiency of care |
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Term
| what is the assessment of outcomes, what does it provide |
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Definition
| a guide to effectiveness of care that provides information for further assessment of the initial appropirateness of care |
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Term
| what does the assessment of outcome suggest, what is it assessing |
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Definition
| review and updating of the clinical practice guidelines |
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Term
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Definition
| the ability of a procedure or test to achieve the desired clinical purpose under controlled circumstances of a controlled group of patients |
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Term
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Definition
| the treatment effect must be demonstrated in a larger population verifying its value in the situation of usual clinical practice |
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Term
| what questions should be asked in clinical apprasal |
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Definition
was the assignment of patients to treat randomized
was the follow up complete
how were those who withdrew or dropped out of the study handled
was the study properly blinded
were the study groups similar when the trial began (age, gender, race, procession)
were all groups treated equally apart from medication or the procedure being tested
can the results be applied to my practice
were all the clinically important outcomes considered
is the treatment benifits worth the risk / cost
will the treatment bring harm |
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Term
| what are the types of studies, begin with most broad |
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Definition
| animal, case series, case control, cohort, randomized controlled trial, systematic review, meta-analysis |
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Term
| what is a systematic review |
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Definition
| concise summary of the best available evidence from primary studies using explicit, rigrous, and reproductable methods to find critically review, and synthezise the evidence |
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Term
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Definition
| uses statistical methods to combine multiple studies of similar design into a statistical combination of data |
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Term
| what is consort stand for |
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Definition
| consolidated standards of reporting trials |
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Term
| what is the purpose of consort |
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Definition
| to eliminate bias and move away from narrative and selective form of review used by researchers, people were not collaborating |
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Term
| give examples of a studies that resulted in consort being formed, tell the story |
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Definition
Linus Pauling a nobel prize winnder said vitamin c helps us live longer and have a better life using 2 studies, but many more studies said it didnt. utilization of vitamin c went up dramatically.
vaccinations are linked to autism in children prevented vaccinations.
antibody induction through vaccination and do not give immunity, antibodies are needed to protect against disease, induction through macrophage production. |
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Term
| what did AT Still develope the osteopathic principals on |
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Definition
| anatomical and physological principals |
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Term
| what is the main reason for the growth of osteopathy |
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Definition
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Term
| tell the story about how AT Still first did some osteopathic medicine |
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Definition
| people didnt do a lot of research back then and opium was perscribed a lot because it made people feel good, Still didnt like it and began to do OMT. over time the pharmacy got better drugs and osteopathy didnt take off just yet |
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Term
| what were the main drugs of the early pharmacy |
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Definition
| opium, mercurials, alcohol, cinchona (quinine) |
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Term
| what were the challenges in the development of osteopathic medicine |
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Definition
| growth of the pharmaceutical industry, regulation of safety and efficacy of new drugs leading to randomized controlled studies, traditional epidemiologic research methods for public health began to apply to clinical populations, growth and availbility of computers and support software made health based databases, eventual demonstration of cost effectiveness |
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Term
| what are the challenges in osteopathic research |
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Definition
| DOs were physicians not researchers, research money shifted to pharmacy, development of penicillin, randomized controlled studies, OMT was only studied by DOs |
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Term
| describe the challenges that the research in kirksville had |
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Definition
| there was no research to demonstrate the effectiveness of the osteopathic methods, they did early studies on neuromscular relationships, not sustanied and expanded over time, scarcity of basic mechanistic and traditional research |
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Term
| what are some of the advances in osteopathic research |
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Definition
| low back pain, meta-analysis advances |
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Term
| what are the meta-analysis advances in osteopathic research |
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Definition
| omt affords greater pain reduction than active placebo control treatments, effects of omt are comparable reguardless of wethere treatment is provided by a fully lisenced DO in the IS or uK, effects of omt increase over time |
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Term
| why do some critisize the promotion of OMT |
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Definition
| percieved lack of evidence regaarding efficacy, belief in efficacy in OMT is based on more faith than evidence |
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Term
| what information combats the critics of the promotion of OMT |
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Definition
| same criticims can be said about elegant case controlled studies: non-pharacological interventions, specific surgical procedures, psychotherapeutic inerventions. no one tool fixes everything |
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Term
| what are some of the existing trials in osteopathic research |
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Definition
| NIH, osteopathic heratige foundations, osteopathic research center |
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Term
| what are some of the things the osteopathic research center are working on |
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Definition
| multi-center osteopathic pneumonia study in the elderly, omt in low back pain in military, omt to treat carpal tunnel, multicenter osteopathic otitis media study |
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Term
| what are some of things the agency for health care policy and research are working on, what are the results |
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Definition
| research on spinal manipulation for low back pain including DOs, DCs, and physical therapists, most of the treatments favored OMT vs the control studies |
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