Evidence-based Clincial Decision Making Flashcards
What is evidence-base healthcare?
Best research evidence + clinical expertise + px unique values and circumstance
What is the 5 step process of EBHC?
1) Formulate a clinical question
2) Search the best evidence available
3) Critically appraise the evidence (validity, relevance and applicability)
4) Apply the evidence in practice
5) Auditing evidence based decisions to determine effectives
What frame work is best to formulate a clinical question + what does it stand for?
PICO
Patient
Intervention
Comparison (placebo)
Outcome
What are four useful resources for searching for evidence?
- TRIP database
- NHS evidence
- Cochrane library - effectiveness of interventions
- Pubmed - biomedical literature, primary evidence
What should you think about when searching for evidence?
What your search terms are
What two word are used to combine search terms when searching for evidence?
The use of “AND” and “OR”
What is the best level of evidence?
Systematic reviews
What is the second best level of evidence?
RCTs
What is the penultimate best level of evidence?
Controlled clinical trials
What is the last level of evidence?
Uncontrolled data
What two points must you consider to critically appraise the evidence?
- Validity (risk of bias) - is it randomised? Concealment? Are all px accounted for
- Clinical important - magnitude of treatment effect and how precise the estimate of the treatment effect
What is a relative measure to measure the magnitude of treatment effect?
Relative risk ratio
What is the relative risk (RR) ratio?
The ratio of the probability of an event in the intervention group compared to the probability of an event in the control group
What does a RR of 1 indicate?
There is no difference in risk between the two groups
What are two absolute measures to measure magnitude of treatment effect?
- Absolute risk reduction
- Number needed to treat
What is the absolute risk reduction?
The difference in risk of an event in the treated group and control group
What is the number needed to treat?
The number of px who need to be treated to achieve one additional bad or good outcome
*becoming popular method of reporting effectiveness of treatments in clinical trials and can apply to efficacy of a treatment or prevention
How is the number needed to treat (NNT) calculated ?
NNT= 100/ARR (%) and is rounded to nearest whole number
ARR is the absolute risk ratio
What are some consideration you need to make when applying the evidence?
Is your px similar to px in the trial?
How much of the study effect can you expect ?
Is the intervention realistic?
What are the alternative?
Is the treatment acceptable to your px?
