Evidence in Clinical Practice Flashcards
What is the best source of evidence to support clinical practice?
Clinical guidelines
If clinical guidelines are not found, what is the next best source of evidence to support clinical practice?
Evidence summaries
If evidence summaries are not found, what is the next best source of evidence to support clinical practice?
Systematic reviews
If systematic reviews are not found, what is the next best source of evidence to support clinical practice?
Primary research
Why are secondary sources of information used over primary sources, when looking for evidence to support clinical practice?
A single study is rarely enough to provide robust, unbiased evidence to influence a guideline change
What is an example of a clinical guideline source?
NICE
What is an example of an evidence summary source?
BMJ
What is an example of a systematic review source?
Cochran Library
When searching for a primary source, what can be used to target the right type of study?
Methodological filters in a bibliographic database
How do clinical guidelines go a step further than evidence summaries?
They develop recommendations for clinical practice from available evidence and expert opinion
What drives the systematic literature reviews which help form clinical guidelines?
Need for information, regardless of the type or quality of evidence
Give four characteristics of clinical guidelines which make them the highest quality source of evidence for supporting clinical practice
They include a systematic review of evidence, including economic analysis
They consider several clinical questions, so the entire disease management pathway is covered
The guidelines evaluate confidence and certainty of the evidence
They engage stakeholders about whom the guidelines concern
What is the GRADE tool used for?
To assess confidence in the results of evidence summaries, when forming clinical guidelines
What information does the GRADE table present?
The number, type and quality of studies for each clinical outcome
Why must each clinical outcome be considered separately when using the GRADE tool?
Because the quality of evidence can vary for different clinical outcomes
What are the five domains which make up the GRADE tool?
Risk of bias
Imprecision
Inconsistency
Indirectness
Publication bias
How is the rating of each domain determined in the GRADE tool?
According to how close the size of the effect estimated by the evidence is to the trust effect seen in practice
How is risk of bias assessed in the GRADE tool?
Using the evidence hierarchy and critical appraisal of individual studies used
How is imprecision assessed in the GRADE tool?
Based on the width of confidence intervals
How is inconsistency assessed in the GRADE tool?
Based on the similarity between the results of individual studies
Whether confidence intervals overlap or not
How is indirectness assessed in the GRADE tool?
Based on the applicability of evidence to the population
Base on the setting of interest
How is publication bias assessed in the GRADE tool?
Based on the potential effect that excluding studies from the review would have on the estimate of the effect
When evidence is turned into recommendations, who is input required from?
MDT guideline group
Stakeholders
When evidence is turned into recommendations, what does the strength of recommendation depend on?
Strength and certainty of evidence
Size of the effect relative to adverse effects
The cost of the intervention, both monetary and training hours
Whether patient preferences are in agreement or not
