Introduction to the history, development and current status of evidence based medicine Flashcards
Definition of evidence based medicine
Translation of uncertainty into an answerable question
Involves a systematic retrieval and review of best evidence and results applied in clinical practice
Definition of context free scientific evidence
Research evidence for medical effectiveness
Definition of context sensitive scientific evidence
Evidence in clinical practise
Definition of colloquial evidence
Patient experience and views
Definition of Quality Adjusted Life Years
Measure of disease burden including quality and quantity of life to assess values of medical interventions
What is evidence based medicine
What evidence is critically appraised
What does this result in
Translation of uncertainty => answerable question
Systematic retrieval of best evidence
Critical appraisal of evidence for internal validity
- Systematic errors due to selective and information bias and confounders
- Quantitative aspects of diagnosis and treatment
- Clinical importance of results
- External validity/generalisability
Results applied to clinical practice
What are the 3 types of evidence needed
Why are they important
Context free scientific evidence
-Research evidence for medical efficacy
Context sensitive scientific evidence
-Evidence in clinical practise for medical effectiveness
Colloquial evidence
-Patient experience and views
All 3 are needed to produce EB guidance
How is evidence used in systematic reviews
What is the pathway for evidence based medicine
Define clinical/public health question
Identify evidence (from RCTs but not always possible)
Synthesise and assess body of evidence
Issue reccomendations
What are the 3 main problems with existing evidence
Too much evidence
-Can’t review everything
Selective lack of evidence
- Not all info about a study is published/accessable
- Therefore cannot make a decision on whether to introduce the intervention
Very little evidence on cost
-We need evidence of efficacy, effectiveness and cost effectiveness to make a judgement
What is a QALY
Measure of disease burden including quality and quantity of life to assess values of medical interventions
Does not consider cost
How would you weigh up the effectiveness and cost of new treatments
What is the most ideal new treatment
What are the common results of new treatments
How would you decide what new interventions to introduce
Plotted on cartesian plane
Ideal new treatment is highly effective and is cheaper/slightly more expensive than the current treatment
Quite often, new treatments are only fractionally more effective but very very costly
Threshold set by decision maker => value for money
What is NICE and why is it important
Provides national guidance on the promotion of good health and prevention and treatment of ill health
Decisions are made on a national level
Evidence is always being added, guidelines are constantly evolving.
What are the 4 benefits of NICE
Address inappropriate variations in practice and post code access to expensive treatments
Support clinicians with relevant new evidence
Assess cost effectiveness of new/existing treatments
Encourage innovation
Guidance is provided in 3 areas
What is the purpose of this
Public health
-Promotion and prevent ill health for all
Health technologies
-Use of meds, treatments, interventional procedures, diagnostics and devices
Clinical practise
-Appropriate treatment and care of specific diseases/conditions
