HIEBP - evidence based practise Flashcards
what is the hierarchy of evidence?
meta-analysis = statistical integration of evidence from multiple studies that address a common research question.
what is an RCT?
- experiment to reduce bias when testing the effectiveness of new treatments
- random allocation of subjects to two or more groups
- treat them differently, compare them with respect to a measured response
- the experimental group—receives the intervention being assessed
- the control group—receives an alternative treatment, such as a placebo
- the groups are monitored to determine the effectiveness of the experiment
what is the definition of NICE
National Institute for Health and Care Excellence
what does the NICE do?
- Independent organisation funded by the Department of Health
- Provides national guidance on the promotion of good health, prevention
- Established in 1999 as a NHS Special Authority.
- In 2013 it become the National Institute for Health and Care Excellence
- It left the NHS to become an on departmental public body.
what is implementation science?
the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services
what is evidence-based practise?
- Translation of uncertainty to an answerable question and includes critical questioning, study design and levels of evidence
- Systematic retrieval of the best evidence available
- Critical appraisal of evidence for internal validity that can be broken down into aspects
What happens after you have defined what the evidence you need is?
- Potentially unmanageable volume of evidence
- Evidence needs rationalizing
- Evidence has to be compatible with the clinical situations in which I find myself
which 3 places provide solutions to unmanageable volumes of evidence, and evidence that needs rationalising
Clinical Guidelines
National Institute of Health and Care Excellence
BMJ Clinical Guideline Concise and similar
Outline clinical guidelines in context of evidence-based practice.
- Made the volume of research manageable for the individual clinician
- Resolved clinicians’ disagreement on appropriate management
- Brought resources to develop guidelines
- Expertise became available - specialist, generalist, the patient and public
- Adminstrative resource included to handle large volumes of research evidence
What are some sources of guidelines?
Professional Societies and Associations – British Thoracic Society, European Respiratory Society, Medical Royal Colleges
Stakeholder Associations - Asthma + Lung UK
Government supported national bodies – SIGN, NICE
4 reasons why we need the NICE?
- Address inappropriate variations in clinical practice and “post-code” access to expensive treatments
- Support clinicians to keep up to date with relevant new evidence
- Assess the “value” (cost effectiveness) of new and existing treatments
- Encourage innovation
what is the definition of QALYs
Quality Adjusted Life Years
What are QALYs assessed by?
- QALYS are assessed by health economists
- They combine the outcome measure in years of quality of life gained and the cost of that gain.
what is the learning health system?
integrated AI in the electronic record
what is the EPR
Patient’s demographic data, biometric data, disease and treatment data, presenting history and examination data
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Clinician’s action: – proposed diagnosis, proposed investigation; proposed treatment
