Evidence-based Practice

Question 1

What argument is evidence based healthcare is based on?

Answer 1

That health science delivery should be based on the best available evidence

Question 2

What is best evidence?

Answer 2

Findings of rigorously conducted research

Evidence of effectiveness and cost-effectiveness

Question 3

Why has evidence-based healthcare been developed?

Answer 3

1. Ineffective and inappropriate interventions waste resources that could be used more effectively
2. Variations in treatment create inequities
3. Care that is non-evidence based are likely to cause harm
4. Practices are influenced too much by:
   - professional opinion
   - clinical fashion
   - historical practice and precedent
   - organisational and social culture

Question 4

What kicked off evidence-based healthcare?

Answer 4

Cochrane called for register of all RCTS
The first was a register of all RCTSs in obs and gynae producing systematic reviews and meta analyses of data and evidence produced by the RCTS

Question 5

What was the problem with a systematic review of seven RCTS comparing cheap corticosteroid treatment for pregnant women at risk of giving birth prematurely versus placebo?

Answer 5

Reduction in likelihood of death of baby due to complications 30-50%

But no systematic review was published until 10 years after so tens of thousands of babies suffered/died/needed more expensive treatment that would have been necessary

Question 6

Define evidence practice

Answer 6

The integration of individual clinical expertise with the best available external clinical evidence from systematic research

Question 7

Where does evidence from systematic research come from?

Answer 7

Systematic reviews and meta analyses

Question 8

Why are systematic reviews needed?

Answer 8

• they may help clinical uncertainty
• they may highlight gaps in research/poor quality research
• the traditional ‘narrative’ of research may be biased and subjective

Question 9

List 5 ways in which systemic reviews may be useful to clinicians.

Answer 9

• they save time - for clinicians to locate studies themselves
• they can be relatively easily be converted into guidelines and recommendations
• they offer authoritative and up to date conclusions
• by integrating findings they offer quality control and increased certainty
• they may also possibly reduce a delay between research discoveries and the implementation of their ideas

Question 10

What are some limitations of evidence-based practice?

Answer 10

• aggregate, population-based outcomes may not work for the individual
• a clinician also needs to maintain professional responsibility/authority
• the research itself may be too challenging and expensive
• it is impossible to do evidence-based research for every single intervention/condition
• it requires ‘good faith’ on account of the pharmaceutical companies who may have conducted the research