CLINICAL DECISION MAKING

Question 1

Clinical decision making common problems? 4

Answer 1

-lack of understanding current evidence
-lack of time to appraise current evidence
-follow colleagues advice
-create patterns to common situations

Question 2

Factors affecting clinical decision making? 4

Answer 2

-evidence
-PT
-prescriber
-environment (knowing the organisational approach to decision making processes)

Question 3

Dual theory explained?

Answer 3

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.

Question 4

System 1 explained?

Answer 4

Based on pattern recognition.
-fast
-automatic
-intuitive

Question 5

System 2 explained?

Answer 5

Based on deliberate analytical approach.
-slow
-conscious
-logical

Question 6

Core skills in Clinical decision making? 5

Answer 6

-pattern recognition
-critical thinking
-EBM
-team work/sharing
-reflection

Question 7

What to consider when making a good clinical decision? 3

Answer 7

-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

Question 8

3 source of Evidence based practice?

Answer 8

-individual clinical expertise
-pt values and expectations
-best current research evidence

Question 9

EBM definition

Answer 9

Practice to enable clinical decision making that focuses on:
-critical thinking
-reliable evidence
-relevant evidence

Question 10

4 stages of EBM?

Answer 10

-PICO
-evidence of hierarchy
-critical appraisal
-integrate evidence to treatment

Question 11

PICO

Answer 11

Framework used to identify clinical questions
-partecipant
-intervention
-comparison
-outcome of interest

Question 12

Hierarchy of evidence?

Answer 12

Systems used to rank different type of studies and provide guidelines on best research evidence available to the clinical question

Question 13

Appraisal of evidence? 3

Answer 13

Looks into the study and focuses on t
Its:
-significance
-validity
-generalisability

Question 14

Integrate evidence to treatment explained?

Answer 14

Best research evidence is integrated with the it’s values and preferences and with the clinical expertise of the prescriber

Question 15

Type of studies? 5

Answer 15

-case series
-case-control
-cohort studies
-RCT (randomised controlled studies)
-meta-analysis

Question 16

NNT definition?
Formula

Answer 16

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

Question 17

NNH definition?

Answer 17

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

Question 18

Relative risk formula?

Answer 18

RR= ART : ARC

Question 19

Relative risk reduction (RRR) formula?

Answer 19

RRR= (ARC -ART) : ARC

Question 20

Absolute risk definition and formula

Answer 20

Number of events (negative and positive) : number of people in the group (either control or treatment)

Question 21

When communicating risk and advantages? 4

Answer 21

-use natural frequency than %
-personalise risk and benefit
-use a positive and negative frame
-present risks over a period of time

Question 22

Challenges to applying research evidence to pt? 2

Answer 22

-guidelines often refer to single condition
-pt values and expectation might differ from the values and preferences explored in the best evidence available

Question 23

When starting a new treatment a prescribed should ? 4

Answer 23

-choose a rational and economic treatment
-start with lowest effective dose, shortest period
-benefits> risks
-pt agreement to the treatment

Question 24

Factors influencing prescribing? 5

Answer 24

-pt
-relatives
-media
-pharmaceutical companies
-prescribers

Question 25

Eminence based practice definition?

Answer 25

Refers to the practice where a clinician follows specialist advise rather than best evidence available.

Question 26

Reasons why clinician doesn’t follow guidelines? 3

Answer 26

-lack of capability
-lack of motivation
-organisational barriers

Question 27

How to reduce influence from pharmaceutical companies? 2

Answer 27

-be aware of the impact the pharmaceutical companies have in clinical decision making
-reduce exposure to promotion