Ev Based Practice Flashcards
LO2: disc diffics of gett ev into prac.
-critiques of EBP- practical arnd poss of EBP. Philosoph arnd desirabil of EBP.
Practical- imposs maint sys revs across all specialities. Chall and expens to dissem and implem findings. RCTs not always feasible. Choice of outcomes biomedical and may infl which intervens are trialled and funded. Reqs faith of pharm comps.
Philosoph- not align with drs modes of reasoning (probab vs deterministic causality). Pop lev outcomes not work for indiv. Create unrefl rule followers. Ligitimises rationing and undermine dr pt rel. prof responsib and autonomy.
-many ineffec pracs contin desp EBM well estab. Some effec pracs not implem.
Dr not know ev so poor dissem. Dr not use use ev due to eg habit, org cult, prof judgem. Org sys cant support innov due to managers. Comiss decis refl diff priorities eg pt view. Resource not av to implem change.
-policies that help- care and qual comiss, and NICE. NHS orgs legal oblig to foll NICE. Reluc to fund things for which ev is poor.
LO1: offer critic perspec on rise of EBM movem.
- health service should be based on best av ev= findings of rigor research. Ev of effectiven and cost effec. Innapp intervens waste resource and cause var in tx so inequity. Prev prac infl too much by prof opin, clinic fashion, hx prac and precedent, org and soc cult. Clinicians used to persist with ineffec interven, fail use more effec, tol huge var in prac. Eg prophylactic lidocaine dur MI mor eharmf than placebo. Lack of use of MgSO4 for eclamptic seizure though proven benef. Cochrane set out princips 72, criticised lack of acc for research. Called for regist all RCTs, sys revs and meta anal. Eg no sys rev for corticoster tx for mum vs premat birth til 89. 89 effec care in preg and childbirth CDROM.
- EBP defin- invs integ of indiv expertise with the best av external clinic ev from sys research.
- sys rev- needed as narrative lit revs bias and subjec, not show how studies id’d, qual of studies var, sys rev addresses clinic uncert and highlight gaps in research and poor qual research. Sys rev offer integ qual contr and incr cert. Authoritative, generalisable and up to date conclus. Save time for clinicians. Aid disocvery implem. Prev bias. Eas conv to guidelines. But Drs need to access and appraise.
- assess qual of ev- critic apprais tools eg CASP.
- sources of ev- medical journals, EBP journals. Cochrane lib. NHS centre for revs and dissem. NIHR health tech assessm prog.
