Introduction into Evidence into Practice Flashcards
Define ‘evidence based practise’
achieving best possible Px management by integrating:
- best research evidence
- clinical expertise
- Px values
Is evidence based practice individualised
YES - about making best clinical decisions for each Px
What is the goal of evidence based practice?
achieve best management for each individual Px
EBP steps (6 A’s):
- Assess: question arises during Px care
- Ask: articulate all parts of question
- Acquire: find best quality evidence
- Appraise: evaluate evidence
- Apply: use clinical expertise to apply applicable evidence to Px values
- Audit
Is EBP interdisciplinary?
YES
What is step 1 of EBP and what does it involve?
- Assess:
- assess the Px
- prioritise questions that arise about their care
What is step 2 of EBP and what does it involve?
- Ask:
- form a clinical question
- use PICO
What principle can be used to formulate a clinical question?
PICO
What is PICO?
used to formulate a clinical question
- P: Patient/Population
- I: Intervention: what is the intervention/test you’re interested in?
- C: Control/Comparison: Is there an alternative strategy to compare to?
- O: Outcome: What are the consequences of the intervention you’re interested in?
Formulate a clinical question using PICO for the following scenario:
Elsie is a 68 year old female who comes to ask for your advice. Both her mother and father had macular degeneration and she is concerned about the prospect of developing the disease. Her friend has told her she should take vitamin supplements
- P (patient/population): elderly female with family Hx of AMD
- I (intervention): Vitamin supplements
- C (control): No vitamins
- O (outcome): decreasing risk of AMD
- question: Does taking vitamin supplements reduce risk of elderly female with family Hx of AMD from developing AMD compared to no vitamins
Types of questions:
- intervention
- diagnostic accuracy
- prognosis
- aetiology
- screening intervention
Define the following type of question - Intervention
What is the best treatment/therapy to deliver most benefit and cause least harm
Define the following type of question - Diagnostic Accuracy
How good is a test at differentiating b/w ppl with and without disease
Define the following type of question - Prognosis
progress of disease (gets better/worse/same?)
Define the following type of question - Aetiology
determines causal effect (cause of disease)
- factors associated with occurrence of disease?
Define the following type of question - Screening Intervention
is screening more effective than no screening or different screening?
Types of studies related to past/current/future
Past: cohort, case-control
Current: survey, cross-section
Future: randomised trial
(look at diagram in lecture)
Explain the following type of study- Randomised Control Trial
- experimental
- participants randomly divided into 2 (or more) groups
- each group receives different intervention
- measures effects of intervention
- FUTURE
Explain the following type of study- Cohort
- observational/longitudinal study
- study looking forward
- follow participants over time and measure differences
- participants with specific characteristics –> cohort
- looking at: what risk factors predict disease, aetiology, prognosis, diagnosis
Difference between cohort and case control study
Study looking forward –> cohort study
Study looking back –> case control study
Explain the following type of study- Case-control
- observational study
- study looking back
- participants with outcome already (e.g. disease) matched with participants with no outcome
- looking back to see risk factors
- risks, prognosis, diagnosis
Explain the following type of study- Cross-sectional
- observational study
- sample population at particular point in time and see who has the outcome
- how common is outcome?
- risk factors
- diagnosis
What study is experimental?
- randomised control trial
Evidence Hierarchy
systematic review > randomised control trial > non-randomised CT > Cohort (forward) > Case control (backward) > Cross section (present) > Qualitative > Expert opinion / Case reports
What is the highest quality evidence?
Systematic reviews- looks at randomised controls trials and presents them all
What is the lowest level of evidence?
Expert opinion - likely bias
Are case reports high quality evidence?
NO - lowest with expert opinion
- looking at single Px
Is hierarchy the same for all questions?
no- hierarchy is different for different questions
What is critical appraisal?
Process of analysing research evidence to measure its quality
What step do you integrate clinical expertise, Px values and best evidence
Apply
What step requires the most skill
Apply
What is the 6th step of EBP and what does it involve?
Audit
- evaluate your performance
What does hierarchy of evidence mean?
Ranking of different types of studies in terms of most quality and risk of bias
What step in EBP does CrowdCARE support?
Appraise
A study examining the causal effect of obesity on breast cancer is an example of what type of question?
aetiology (b/c causal)
A study examining use of aspirin to prevent stroke is example of what type of question?
intervention
Examining link b/w diet and morbidity in Px’s with colorectal cancer is example of what type of question?
Prognosis
Px’s have disease and looking at how diet affects disease progression
Examining use of leucocytes in abdominal fluid for diagnosis of appendicitis is example of what type of question?
Diagnostic Accuracy
CARE in crowd care stands for:
Critical
Appraisal of
Research
Evidence
