Evidence into practise

Question 1

What are guidelines?

Answer 1

Reccommendations to optimise patient care. They focus on prevention, social care, patient safety and procedures.

Question 2

What are the bodies for publishing guidance?

Answer 2

NICE (National Institute for Healh and Care excellence
World Health Organisation
Scottish Intercollegiates Guideline Network
Royal Colleges
European Associations
UK Health Security Agency (Replacing Puublic Health England

Question 3

Why are guidelines important?

Answer 3

To achieve equity and use evidence based care.

Question 4

What is the limitations of evidence based care?

Answer 4

Due to the volume of medical articles published, there is a failure to translate research findings into medical practise.

Question 5

How are guidelines made?

Answer 5

Based on evidence such as Systematic reviews. Should have both a formal and transparent process of the context of its creations, use the best relialable evidence and update regularly. It should have a transparent process and consider patient subgroups and preferences. Developed by multidisciplinary expert panel.

Question 6

What are protocols?

Answer 6

Sequence of activities to adhere for managing a clinical condition. Provides concise instructions for specific situations and simpler than guideline.

Question 7

What are the benefits of protocol?

Answer 7

Accountability, consensus for care, increased autonomy and clear framework.

Question 8

What is a good protocol?

Answer 8

Clarity, fits with guidelines, specific referral criteria and clear lines of accountability

Question 9

What are the drawbacks of protocol?

Answer 9

Restricts clinical discretion and individual care management, reduce need for qualified staff, issues with compliance and it requires regular review

Question 10

How does systematic reviwws inform guidelines and protocols?

Answer 10

Part of the formation of guidelines where evidence is reviewed. The relevant clinical questions in a guideline are answered by systematic review.

Question 11

What is a traditional non-systematic review?

Answer 11

Written by field experts that provide overview of a topic

Question 12

What is a systematic review?

Answer 12

Addresses a specific question by evaluating and interpreting all available relevant research evidence. It aims to be rigorous and comprehensive and be transparent, replicable and open to criticism.

Question 13

What is the process of systematic review?

Answer 13

Review question
Define eligibility criteria and method
Search for studies- use appropriate strategy, check reference list of recent systematic reviews and relevant sources for unpublished data
Apply eligibility criteria
Collect data and appraise quality
Analysis and synthesis
Conclusion

Question 14

How are questions reviewed?

Answer 14

For population, intervention, comparator, outcomes and study designs

Question 15

What are relevant literature databased?

Answer 15

Medline and embase, Cochrane, NICE, Pubmed, BMJ

Question 16

How do guidelines and protocols fit into evidence based care?

Answer 16

Quality of evidence strengthens guideline reccommendations. Guidelines draw from results of many systematic reviews.

Question 17

Why are there issues with guidance compliance?

Answer 17

Guidelines may be out of date or guidelines may be conflicting for patients with multi-morbidities. Clinicians may have a lack of knowledge about guidelines or fail to take agree responsibility for using the guideline.

Question 18

What is a synthesis?

Answer 18

Collates, combines and summarises the findings of individual studies included in the systematic review which can be a meta analysis that is quantitative. If this is not possible, then a narrative synthesis is made.

Question 19

What is narrative synthesis?

Answer 19

Used when meta analysis is not possible- summary in words of multiple papers obtained in systematic review

Question 20

What is a meta analysis?

Answer 20

Quantitative summary of the systematic review.

Question 21

What is the quality issues in literature?

Answer 21

Statistical flaws, bias, fraud, applicability, quality of reporting, quality of intervention, choice of outcome measure and appropriate study design.

Question 22

What is the gold standard for intervention effectivity?

Answer 22

Randomised control trials. They create comparable groups for causal relation. Balance all factors to reduce skewed comparison. However, they can have highly controlled settings or selection of unrepresented populations.

Question 23

Which other factors inform guidelines?

Answer 23

Best available evidence, value for money and social value

Question 24

What is a forest plot?

Answer 24

Summarises data findings from multiple papers by identifying a common statistic in a single image. Especially useful for systematic reviews when analysing data with different conclusions and statistics.