When Evidence is not implemented?

Question 1

What is effectiveness?

Answer 1

the degree to which something is successful in producing a desired
result
* best tested in medicine with a ‘real’ world trial

Question 2

What is efficacy?

Answer 2

the power or ability to produce an effect
* best tested in medicine with a randomized controlled trial

Question 3

What is the Efficacy - effectiveness gap?

Answer 3

The efficacy-effectiveness gap describes the differences in outcomes between patients treated in RCTs and those treated in the ‘real world’
* In an RCT everything is arranged to represent the ideal
* In real world trials the experiment is much more messy because the restrictions on participants is much less.

Question 4

How do Randomised Controlled Trials work?

Answer 4

experiment to reduce bias when testing treatment efficacy
random allocation of subjects to two or more groups, treat them differently, compare the response
* The Experimental Group: receives the intervention, eg a drug
* The Control Group: receives an alternative perhaps a placebo

the groups are monitored to determine the efficacy of the experiment

Question 5

Strengths of Randomised Controlled Trials?

Answer 5

• Accurate unbiased measurement of treatment effect
• high degree of internal validity
• Strict eligibility criteria - homogenous study population Accurate measurement of treatment effect
• reduce inter-patient variability.

Question 6

Limits of Randomised Controlled Trials?

Answer 6

• Not good representation of patients treated in the real world setting
• Most marked among patients with advanced age or greater comorbidities

Question 7

What is an alternate to RCTs?

Answer 7

Real World Trials
* Less restrictive recruitment criteria
* Ensure that people with previous ineligible characteristics are matched on both sides of the trial

Question 8

Problems with the prescribing of antibiotics?

Answer 8

• Questionable effectiveness in respiratory infections
• Associated with increasing resistance in bacteria
• Associated with 50,000 preventable deaths in people admitted to hospital
• Can be costly
• Associated with side effects

Question 9

Areas of implementation

Answer 9

• Individual clician
• Local groups
• Professional groups
• Organisation
• Region
• Society

Question 10

What are the obstacles to implementation?

Answer 10

• Lack of experience in the executors of the implementation plan
• Inadequate planning
• Disorganised work culture
• Poor readiness to change
• Poor team structure
• Lack of necessary resources
• Lack of leadership
• Lack of commitment
• Lack of prioritisation

Question 11

How are NICE guidelines established?

Answer 11