Lecture 4 - Evidence-based practice

Question 1

Explain why is evidence-based practice (EBP) important?

Answer 1

EBP guides clinicians when deciding who to treat, when they should treat and how they should treat patients by using sound epidemiological evidence.

Question 2

So evidence based practise puts together the ___ _______ _______ evidence but it takes into account the ____ ____ of the health professional (e.g. doc, dentist, physiotherapist) and also patient’s ____ and _____.

Answer 2

So evidence based practise puts together the BEST AVAILABLE RESEARCH evidence but it takes into account the CLINICAL EXPERTISE of the health professional (e.g. doc, dentist, physiotherapist) and also patient’s VALUES and CHOICES.

Question 3

Key points from the 1st Scurvy example

1. What can be wrong?
2. What’s the best way to identify effective treatment?
3. ______ of evidence is important

Answer 3

1. “Expert opinion”
2. A trail
3. Dissemination

Question 4

Key points from 2nd example of Coronary heart disease:

1. Dangerous to rely on what studies to determine benefits of treatment?
2. Appeared that ____ ____ reduced risk of coronary heart disease but it actually increased it
3. Also, increase risk of _____ diseases

Answer 4

• Dangerous to rely on ANIMAL studies, observational studies, and trials of surrogate outcomes, to determine benefits of treatment
• Appeared that HORMONE THERAPY reduced risk of coronary heart disease, whereas it actually increases risk
• Also AVOIDABLE breast cancers, strokes, pulmonary emboli

Question 5

Key points from third example of ischaemic stroke

1. What lead to trials in humans where there was no benefit found?

Answer 5

1. Poor quality animal studies, enthusiasm for theoretical benefit of nimodipine led to trials in humans, no benefit found (usually supposed to be animals first and THEN humans but this happened simultaneously)

Question 6

Key points from 4th Measles example

• Clear to anyone with basic understanding of epidemiological methods that……..

• However, ______ in UK & elsewhere led to drop in _____ ______ and increase in _____ ______
(i.e. poor ‘evidence’ led to failure to provide beneficial ______ which, in turn, led to harm)

• Original research discredited, 2 researchers struck off
Medical Register (unethical behaviour & scientific fraud),
good quality research showed no link, but myth persists
4

Answer 6

• Clear to anyone with basic understanding of epidemiological methods that could not draw any conclusions re supposed relationship between MMR vaccine and autism from a case series (I mean, there were only 12 cases)

• However, adverse publicity in UK & elsewhere led to drop in immunisation rates and increase in measles cases
(i.e. poor ‘evidence’ led to failure to provide beneficial intervention which, in turn, led to harm)

• Original research discredited, 2 researchers struck off
Medical Register (unethical behaviour & scientific fraud),
good quality research showed no link, but myth persists
4

Question 7

Summary

1. ____ evidence is vital, otherwise danger that:

• _____ ____ are used
• give treatments for which the _____ outweigh the _____
• fail to provide ____ ____ ____
• provide ___ ____ ___ which may not be any _____ than existing less expensive alternatives

2. Cannot simply rely on:

• theories about ______ of treatment
• ______ opinion
• _____ studies
• _____ with ____ end points

3. Require evidence from _____-_____, well ______ and well-reported _____ _____ ___ which measure _____ ______ ______
4. Vital that health professionals……

Answer 7

1. Good evidence is vital, otherwise danger that:
   – Ineffective treatments are used
   – Give treatments for which the harms outweigh the benefits
   – Fail to provide existing effective treatments
   – Provide expensive new treatments which may not be any better than existing less expensive alternatives (waste $ which could be spent on other things)
2. • Cannot simply rely on:
   – Theories about effectiveness of treatments – Professional opinion
   – Animal studies
   – Trials with surrogate end points
3. Require evidence from well-designed, well- conducted, and well-reported randomised controlled trials which measure clinically meaningful outcomes
4. Vital that health professionals have a good understanding of epidemiological concepts!