Information: Quality not Quantity

Question 1

EBM

Answer 1

Evidence based medicine

Question 2

What is EBM ?

Answer 2

Use the best evidence in the scientific literature to provide the best care for an individual patient.

Question 3

3 principles of evidence based medicine

Answer 3

1. High quality health care rests on objective and clinically relevant information.
2. There is a hierarchy of evidence where some types are stronger than others.
3. Scientific data alone is not a sufficient basis for making clinical decisions.

Question 4

Early randomised clinical trial

Answer 4

Effectiveness of bloodletting

Question 5

Describe the 1st clinical trial

Answer 5

200-500 people
Divided into 2 groups by casting lots

Control group - no phlebotomy

Treatment group - as much bloodletting as appropriate

Efficacy assessed by the number of funerals in each group.

Question 6

Standardised mortality ratio

Answer 6

expected deaths

NB - assumes the 2 populations are equal in terms of age and sex

Question 7

NNT

Answer 7

Number needed to treat

Question 8

What is meant by NNT ?

Answer 8

The number of patients who need to be treated in order for one person to benefit.

The larger the NNT the less the benefit.

Question 9

What is the ideal NNT ?

Answer 9

Ideally NNT is 1.

Everyone who is treated benefits.

Question 10

Evidence pyramid

Answer 10

Systematic reviews and meta-analyses
Randomised controlled double blind studies

Cohort studies
Case control studies
Cross-sectional studies
Case study, series or report

Read it in a textbook
Somebody told me

Question 11

Simplest rules to choosing a starting point

Answer 11

Questions found in systematic reviews/ meta-analyses

Clinical practice guidelines

Question 12

What is a systematic review ?

Answer 12

It attempts to identify, appraise and synthesise all the empirical evidence that meets pre-specified eligibility criteria to answer a given research question.

Question 13

What do researchers conducting systematic reviews use ?

Answer 13

Explicit methods aimed at minimising bias, in order to produce more reliable findings.

Question 14

Trial identification

Answer 14

Identified 4 electronic databases :

• Medline
• Human nutrition
• EMBASE
• Allied and Alternative medicine

Question 15

Why are systematic reviews viewed as gold standard ?

Answer 15

Avoidance and/or the minimisation of bias

Question 16

What is a meta-analysis ?

Answer 16

A meta-analysis is when results of the individual studies are combined to produce an overall statistic.

Question 17

Aims of meta-analysis

Answer 17

To provide a precise estimate of the effects of an intervention and to reduce uncertainty.

Question 18

What is a point estimate ?

Answer 18

(Usually the mean)

Indicates the magnitude of the effect of the experimental intervention compared to the control intervention.

Question 19

Confidence interval

Answer 19

Uncertainty of point estimate.

A range of values within which we can be reasonably sure that the turn effect actually lies.

Question 20

Narrow confidence interval

Answer 20

Higher level of confidence in results

Question 21

Wider confidence interval

Answer 21

Lower level of confidence in results

Question 22

How to answer a clinical question ?

Answer 22

Systematic reviews or meta-analysis

NICE and SIGN guidelines

Then, only use primary research literature.

Question 23

NICE

Answer 23

National Institute for Health and Care Excellence

Est. as a special health authority in April 1999

Question 24

What did NICE do ?

Answer 24

Development and implementation of evidence based guidelines for appropriate clinical practice, public health and social care.

Question 25

What is MEDLINE ?

Answer 25

‘THE’ medical publications database which can be accessed through :

• PubMed
• Ovid