Lecture 4 Flashcards
who is the father of pain medicine
John Bonica
John Bonica did two notable things
- published first textbook on pain titled ‘the managment of pain’
- founded the first multidisciplinary clinic
cancer patient treatment plans
curative , intent to cure, - palliative treatment - intent to make comfortable
vital sign is
something a paramedic or nurse is required to measure and record by law
pushback against which vital sign
fifth as the other four are objective but pain is subjective on how the patient feels
Evidence based medicine pyramid
personal opinion, expert opinion, case reports, case series, case control studies, cohort studies, randomized dcontrolled double blind studies, systematic reviews and meta-analyses
The Cochrane collaboration
is collaboration of many people who do meta-analyses for a living. thats wehre the ‘top-of-the-line’ meta-analyses is found
How do RCTs work
randomized controlled trials
common exclusion criteria for RCTs
having another condition that could mess with results
having pain score that is too low
not having pain fro long enough
age
already being on analgesics
parallel design
everyone only gets one of two or more treatments
crossover design
everyone gets both treatments; randomized to which treatment you get first and which you get second
advantages to crossover design
allows you to compare the two treatments in teh same person, giving more statistical power, need fewer people for it, and people tend to prefer this
disadvantage to crossover
carry-over effects
enriched design
give the drug to all of your samples and increase the dose until people either leave due to adverse effects or the drugs lack of efficiency ; all those who the drug worked on are now the main sample and those will be randomized to either stay on the dose or increase the dose without them knowing
y-axis vs x-ais for most common way of showing clinical trial results
y= measurement of pain
x= measure of time
primary outcome measure
the drug company had to decide before the study was run which measure they would use to identify if their drug worked or not
odd ratio (or relative risk)_
comes from cancer field
in numerator of odds ratio
you multiply the two factors that are in support of the relationship
in denominator of odds ratio
multiple two factors that go against hypothesis
odd ratio pt 2
then you divide the numerator by the denominator
Forset plots
way to plot all odds ratios of all RCTs on a topic
forest plots details
box is estimate and lines from either side are confidence intervals. the bigger the study the bigger the box is. if the numbers are negative, it favours the active group, if positive favours the placebo
the diamond on the bottom is the net average or median of all the results
L’Abbe plots
plot the percentage of patients with some outcome of the active treatment on one axis and the percentage of patients with some outcome of the placebo on other - diagonal line through graph; the side of the diagonal that most dots are on favoured the treatment
