HIEBP introduction and overview

Question 1

What is evidence-based practice?

Answer 1

“Evidence-based medicine is the conscientious explicit and judicious use of evidence in making decisions about the care of individual patients”

• Reasearch
• Randomised controlled trials
• Evidence-based Practice
• Implentation science
• National Institute of health and care excellence

Question 2

Major change in medical evidence

Answer 2

Among the major changes in medicine:
* Introduction of computers
* Establishment of the electronic patient record
* Authority and experience replaced by Evidence-Based Medicine

Question 3

What are the stages of evidence development

Answer 3

• Definition of need
• Hierarchy of need – minor irritation to life threatening event
• Anecdotal reports
• Early experiments
  High quality evidence
• Multidisciplinary review
• Guideline endorsement
• Implementation

NICE REGULATES THIS

Question 4

How do we synthesise information into evidence?

Answer 4

• Collecting, categorizing, sifting, testing, summarizing
• Hypothesis generating and testing
• Replicating experiments
• Randomised controlled Trials - gold standard of evidence medicine

Question 5

What is the RCT?

Answer 5

RCT – The randomized controlled trial
* experiment to reduce bias when testing the effectiveness of new treatments
* random allocation of subjects to two or more groups
treat them differently, comparing 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

Question 6

What is the Hierachy of evidence?

Answer 6

Expert opinion < case report < case-control studies < cohort studies < RCTs < systematic reviews (figure out if RCT conclusions are true) < meta-analyses (strongest)

Question 7

Where can you find the Evidence Guidelines?

Answer 7

NICE - The National Institute for Health and Care Excellence
* independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
* Has provided guidance for evidence-based practice

Question 8

What is big data?
How is it used in health?

Answer 8

Data that contains a large variety, in increasing volumes and with more velocity
More complex and from new sources.
* Traditional processing software can’t process them.
* Can be used to predict treatment responses and new diagnostic/prognostic models etc

Question 9

What is implementation science?

Answer 9

Study of ways to improve systemic uptake of evidence-based practice into routine practice and policy to improve health services
* Linear path: you know what works and want to integrate it
* Cycle: putting adapted knowledge into practice, assess barriers and then tailor
interventions, evaluate outcomes, repeat

Question 10

What is Pharmacogenomics?

Answer 10

How do genes affect a person’s response to particular drugs?

Can we identify biomarkers that point to the greater efficacy of particular drugs for the particular patient?

It is not clear if this approach will lead to a radical shift in the practice of medicine in the near future

Big Data, computer algorithms, artificial intelligence, machine learning, hold out the hope that precision medicine will be possible.

Question 11

What is Precision medicine?

Answer 11

Treating individuals not the group
Pharmacogenomics: how genes affect drug response and identifying biomarkers.
Looking specifically at the patient, thier genetic makeup