Lec 9- Evidence based healthcare

Question 1

What is evidence-based medicines

Answer 1

• EBP is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient
• It means integrating individual clinical expertise with the best available external clinical evidence from systematic research

Question 2

EBP- 3 components

Answer 2

• Evidence
• Expertise
• Patient’s values and preferences

Question 3

Evidence to answer questions

Answer 3

• Does thalidomide cause congenital malformations
• Should I use it to treat my patients

Question 4

EBM process

Question 5

EBM question format

Answer 5

• P- Population
• I- intervention
• C- Comparator
• O- Outcome

Question 6

Levels of Evidence

Answer 6

Question 7

Evidence problems

Answer 7

• Is it reliable
• Now focuses on small benefits
• Too much of it

Question 8

Ways to cheat on statistical tests

Answer 8

• Throw all data in the computer and report all results p<0.005 (data dredging)
• If the two groups are different and this benefits the intervention group, forget to adjust
• Ignore all drop-outs, only analyse subjects that complete treatment
• If outliers (Unusual results) are messing up the results then get rid of them. On the other hand, if they make the results better, keep them in
• If you gain significance early; stop the trial. If you almost gain significance; extend the trial
• If the whole group isn’t significant, look for sub-groups that are

Question 9

Evidence overload

Answer 9

Question 10

Whats a clinician meant to do

Answer 10

• We surveyed one acute medical take in our hospital
• In a relatively quiet take, we saw 18 patients with a total of 44 diagnoses
• The guidlines that the on-call physician should have read remembered and applied correctly for those conditions came to 3679 pages
• This number included only by NICE as well as major societies from the last 3 years
• If it takes 2 minutes to read each page, the physisianwill spend 122 hours reasing

Answer 11

Question 12

Midlines

Answer 12

• Clinicians rarely accessed, appraised and used explicit evidence directly from research or other formal sources; rare expections were where they might consult such sources after dealing with a case that had particularly challenged them

Question 13

Personal stratergies for improved performance

Answer 13

• Heighten our metacognition
  
  • Step back from the problem to:
    
    • Reflect on the thinking
    • Reflect on the affective process
• Decrease reliance on memory
  
  • Use cognition aids (but use them wisely)
  • Decision support, mnemonics, guidelines, algorithms
• Try to make tasks easier
  
  • e.g. calculate drug doses