CLINICAL DECISION MAKING Flashcards
Clinical decision making common problems? 4
-lack of understanding current evidence
-lack of time to appraise current evidence
-follow colleagues advice
-create patterns to common situations
Factors affecting clinical decision making? 4
-evidence
-PT
-prescriber
-environment (knowing the organisational approach to decision making processes)
Dual theory explained?
Theory adapted from psychology literature. Describes how a clinician think through a pt’s case. Identifies two systems that work together to enable clinical decision making.
System 1 explained?
Based on pattern recognition.
-fast
-automatic
-intuitive
System 2 explained?
Based on deliberate analytical approach.
-slow
-conscious
-logical
Core skills in Clinical decision making? 5
-pattern recognition
-critical thinking
-EBM
-team work/sharing
-reflection
What to consider when making a good clinical decision? 3
-encourage appropriate use of System 1 and 2
-increase understanding of processes and common sources of error in clinical decision making
-be aware of ethical obligations
3 source of Evidence based practice?
-individual clinical expertise
-pt values and expectations
-best current research evidence
EBM definition
Practice to enable clinical decision making that focuses on:
-critical thinking
-reliable evidence
-relevant evidence
4 stages of EBM?
-PICO
-evidence of hierarchy
-critical appraisal
-integrate evidence to treatment
PICO
Framework used to identify clinical questions
-partecipant
-intervention
-comparison
-outcome of interest
Hierarchy of evidence?
Systems used to rank different type of studies and provide guidelines on best research evidence available to the clinical question
Appraisal of evidence? 3
Looks into the study and focuses on t
Its:
-significance
-validity
-generalisability
Integrate evidence to treatment explained?
Best research evidence is integrated with the it’s values and preferences and with the clinical expertise of the prescriber
Type of studies? 5
-case series
-case-control
-cohort studies
-RCT (randomised controlled studies)
-meta-analysis
NNT definition?
Formula
Average number of people treated over a period of time to either prevent a negative outcome (disease) or to achieve a desired outcome (reduce a risk factor)
1 : ARR
ARR= ARC-ART
NNH definition?
Average Number of people that need to be exposed to a specific risk in order for a patient to experience an ADR
NNH= 1:ARI
ARI= ART- ARC
Relative risk formula?
RR= ART : ARC
Relative risk reduction (RRR) formula?
RRR= (ARC -ART) : ARC
Absolute risk definition and formula
Number of events (negative and positive) : number of people in the group (either control or treatment)
When communicating risk and advantages? 4
-use natural frequency than %
-personalise risk and benefit
-use a positive and negative frame
-present risks over a period of time
Challenges to applying research evidence to pt? 2
-guidelines often refer to single condition
-pt values and expectation might differ from the values and preferences explored in the best evidence available
When starting a new treatment a prescribed should ? 4
-choose a rational and economic treatment
-start with lowest effective dose, shortest period
-benefits> risks
-pt agreement to the treatment
Factors influencing prescribing? 5
-pt
-relatives
-media
-pharmaceutical companies
-prescribers
