Week 9 Flashcards
Secondary Research Evidence
- summarises the existing primary research
- if done well can take of the bias
- provides a summary that is balanced (it takes into account all the different studies and their results on the topic)
Secondary Research Evidence Types
LITERATURE REVIEW
- summary of exisiting knowledge on topic, gives a superficial understanding (can look like a fact sheet for a condition ie. symptoms, treatments etcs)
- it has BREDTH (wide range of information)
- DOESN’T HELP TO ANSWER A CLINICAL QUESTION
LIMITS
- lack of rigour (its doesn’t clarify the studies used to give info, could be bias
SYSTEMATIC REVIEW
- has a comprehensive and systematic methodology reducing bias and increasing RIGOUR
- has DEPTH
- it is a TRANSPARENT, COMPREHENSIVE AND REPRODUCIBLE PROCESS
- BEST FOR ANSWERING A CLINICAL QUESTION
why do we need it?
- increasing quantity of evidence, one systematic review is better than lots of articles
- open access to research
- synthesised info is less confusing than many articles with contradictions
**META ANALYSIS
an outcome of a systematic review
- it involves forming a question, looking for articles of studies addressing hypothesis and collating them to then analyse.
- it is a higher level analysis
- EVERY STUDY INVOLVED IN META-ANALYSIS HAS HOMOGENEITY (they should be similar in terms of PICO/PECOT; population, intervention, sample etc)
when meta- analysis is not possible, if there is heterogeneity use DESCRIPTIVE SYNTHESIS
LIMITS OF systematic reviews
- any research can be done poorly
- inappropriate grouping of studies (don’t have homogeneity)
- out of date (5 year expiry)
Heterogeneity (3 types)
meaning studies are not similar (there is variability)
CLINICAL
-variations that we see in patient population and in interventions used
METHODOLOGICAL
- the manner in which the studies are conducted and data is measured
STATISTICAL
- there will be random (chance) variations in the results due to clinical and methodological heterogeneity.
TESTS FOR HETEROGENEITY
- the heterogeneity test
- higgins I2 statistic
^these tests are just to know variability not if a meta analysis can be used
CLINICAL PRACTICE GUIDELINES
they are guidelines for clinicians that help decide how to manage a patient and gives all the information needed to know about a disease for clinician and patient
Aims of Clinical practice guidelines
- improve the quality of health care
- deal with a clinical condition
- can change the process of health care and improve the peoples chances of getting as well as possible
- offer recommendations for clinicians
What do you want in a clinical guidelines
CEEE
clinical utility
effectiveness
efficiency
evaluation
PROS and CONS of clinical guidelines
PRO’s
- based on a combination of scientific evidence, clinical expertise and patient values
- provides an overview of everything (like a proforma)
- saves time and improves decision thus outcome
CON’s
- not easy, takes a long time to develop
- evidence can be out of date
- conflict of interest issues
