Evidence-Based Practice

Question 1

what values do we need to have for evidenced based practice?

Answer 1

patient values and choices, clinical expertise, best available evidence

Question 2

describe why we need to use evidence based practice?

Answer 2

• research provides the evidence to guide your practice
• evidence is evolving, you need to know how to evaluate it

Question 3

what is the heirarchy of evidence?

Answer 3

• No evidence ranking system of decision tool can be used thou a healthy dose of judgement and thought

Heirarchy of evidence (the higher up the better it is):
1. systematic reviews and meta analysis of RCTs
2. RCTs
3. cohort studies
4. case control studies
5. cross-sectional surveys
6. case studies
7. ideas, expert opinions, editorials
8. anecdotal
- unfortunately, anecdotes often seem to have the most influence on people’s opinions

Question 4

How do we appraise the evidence?

Answer 4

Don’t accept the results of an RCT just because it is an RNCT
- was it done well?
- are the findings applicable to your patient/population?
- are the outcomes meaningful to your patient?
- cure, improved survival, fewer symptoms, better quality of life

Question 5

How do we use all the evidence?

Answer 5

Don’t reject the results of an observational study simply because it is an observational study
- what is the best study design to answer a particular question?
- appraise the methods and realists of the studies addressing the question

Question 6

What are the best study types used for epidemiological questions?

Answer 6

How common is a disease? Who is most likely to get it?
- cross-sectional or cohort studies of incidence and prevalence
What are the causes of the disease?
- Cohort or case-control studies

Question 7

What are the best study types used for clinical questions?

Answer 7

Diagnostic tests:
If the test is positive - does this mean the disease is present?
If the test is negative - does this mean no disease?
- Diagnostic accuracy studies (cross-sectional)
What is the natural history of the condition? And what happens if you do nothing?
- cohort studies (case series) of people with the condition
- can have ethical issues

Question 8

What are the best study types used for treatment questions?

Answer 8

What is the best treatment?
- does it cure the disease?
- does it improve survival or other outcomes?
- RCTs (intervention studies)
What are the harms of the treatment?
- Common harms may show up in RCTs
- Rare or long-term harm - usually case-control or cohorts

Question 9

Why it is important to have good evidence for interventions?

Answer 9

• because when things are suggested without evidence it can impact people and the population massively (potentially win a negative way)
• in the example of SIDs, thousands of babies dies because of a recommendation which was not supported by evidence
• in the example of measles, the population had outbreaks of measles that impacted many even though there wasn’t any evidence about the MMS vaccine causing autism

Question 10

Summary of evidence based practice, and the hard things about achieving it

Answer 10

Good evidence is vital otherwise:
- ineffective treatments are used
- give treatments for which the harms outweigh the benefits
- fail to provide effective interventions
- new expensive treatments may be no better than older cheaper ones

BUT
It can be difficult to communicate the evidence
- adverts backed by dubious scientific claims
- endorsements by prominent people
- scare and conspiracy theories
- the values that people pace on individual stories may lead people to ignore objective evidence