Evidence based Practice

Question 1

Process of evidence based practice?

Answer 1

• Translation of uncertainty to an answerable question and includes critical questioning, study design and levels of evidence
• Systematic retrieval of the best evidence available

Question 2

What are the different aspects of critical apraisal of evidence?

Answer 2

Critical appraisal of evidence for internal validity that can be broken down into aspects regarding:
* Systematic errors as a result of selection bias, information bias and confounding
* Quantitative aspects of diagnosis and treatment
* The effect size and aspects regarding its precision
* Clinical importance of results
* External validity or generalisability
* Application of results in practice

Question 3

How to assess evidence for clinical decision making?

Answer 3

1. Medical effectiveness research (context free scientific evidence)
2. Social science oriented research (context-specific scientific evidence)
3. Expertise, views, and realities of stakeholders (colloquial evidence)

Question 4

Purpose of NICE?

Answer 4

• Address inappropriate variations in clinical practice and “post-code” access to expensive treatments
• Support clinicians to keep up to date with relevant new evidence
• Assess the “value (cost effectiveness) of new and existing treatments
• Encourage innovation

Question 5

What are the core principles of NICE?

Answer 5

• Comprehensive Evidence Base
• Expert In put
• Public Patient and Carer Involvement
  Independent Advisory Committees
• Genuine Consultation
• Regular Review
• Open and Transparent Process

Question 6

What is the impact of too much evidence?

Answer 6

• Volume, especially of clinical guidelines becomes unmanageable
• Statistically significant benefits may not be clinically important
• The evidence may not apply to people with complex multimorbidity and becomes unintelligible
• There needs to be continuing rationalization

Question 7

What is QALY?
How does QALY factor in?

Answer 7

QALYs – Quality Adjusted Life Years
QALYS are assessed by health economists
They combine the outcome measure in years of quality of life gained and the cost of that gain.

Question 8

What are Clinical Guidlines

Answer 8

• Made the volume of research manageable for the individual clinician
• Resolved clinicians’ disagreement on appropriate management
• Brought resources to develop guidelines
• Expertise became available–specialist, generalist, the patient and public
• Adminstrative resource included to handle large volumes of research evidence

Question 9

What are the source of guidelines?

Answer 9

• Specialist Societies and Associations – British Thoracic Society, European Respiratory Society
• Stakeholder Associations - Asthma + Lung UK
• Professional Associations - Royal College of Physicians, Royal College of General Practitioners
• National Bodies – SIGN, NICE

Question 10

What is the risk of duplication with evidence based studies?

Answer 10

• NICE
• GOLD COPD
• British Thoracic Society
• European Respiratory Society
• American Thoracic Society

All produce independent guidelines and some participants sit on two or three committees