HaDSoc 2.1- Evidence based practice

Question 1

Who is the main figure in the history of evidence based practice?

Answer 1

Archie Cochrane

Question 2

What did Cochrane do?

Answer 2

Call for a register of all RCT’s

Question 3

Why do we need evidence based practice?

Answer 3

• practice should be based on the best available evidence
• need to be sure interventions are effective and cost effective
• it’s wasteful to do inappropriate/ineffective interventions
• variations in healthcare lead to inequities

Question 4

How was the first analysis distributed?

Answer 4

Via CD-ROM for easy updating

Question 5

How did people respond to the first systematic review?

Answer 5

at first with hostility, and suspicion.

Question 6

What’s the standard definition of evidence based practice?

Answer 6

it involves the integration of individual clinical expertise with external clinical evidence from systematic research.

Question 7

What is a systematic review?

Answer 7

an overview of primary studies that used explicit and reproducible methods.
Brings together many different studies

Question 8

What is a meta-analysis?

Answer 8

a quantitative synthesis of the results of 2 or more studies that addressed the same hypothesis.
Brings studies together to produce a single number

Question 9

how are systematic reviews and meta-analyses linked?

Answer 9

a meta-analysis is a type of systematic review.

Question 10

Why do we need systematic reviews?

Answer 10

• primary literature may be biased
• the quality of primary studies may be poor
• they can highlight gaps in research
• They increase certainty and ensure quality
• they save clinicians from having to locate and appraise studies themselves
• reduce delay between findings and implementation
• can be converted into guidelines

Question 11

How do you assess the quality of evidence?

Answer 11

Using a critical appraisal tool, which suggests things to look for and questions to ask`

Question 12

Where can you find the evidence?

Answer 12

Medical journals, eg BMJ, the Cochrane library

Question 13

What are the 2 main groups of criticisms of EPB?

Answer 13

practical criticisms

philosophical criticisms

Question 14

What are some practical criticisms of EPB?

Answer 14

• may not be possible to create and maintain reviews across all specialities
• can be difficult to disseminate
• favours biomedical outcomes, which are what are often tested
• needs good faith of pharmaceutical companies (less likely to see studies of a medication not working)

Question 15

What are some philosophical criticism of EBP?

Answer 15

• may create rule-followers
• population outcome doesnt mean it’ll benefit an individual
• lose sight of where professional responsibility/accountability takes over from evidence,

Question 16

What are some problems with getting evidence into practice?

Answer 16

• dissemination may be ineffective so doctors dont know about evidence
• doctors may chose not to follow (tradition, habit, professional judgement)
• organisations may not be able to impliement eg not have enough staff or training for certain methods
• resources may not be available (finance, human)