SLIDE 1 Clinical decision making
Evidence based practice
Sarah Dean
with thanks to
Stuart Logan, Paul Glasziou, Rod Jackson & Mark Perry
SLIDE 2 Aims of the afternoon
Discuss the role of empirical evidence in clinical practice Think about the quality of evidence we use Why & how to structure focussed questions Give you a couple of short cuts to useful evidence Practise critical appraisal of research Think about how to apply evidence to practice
SLIDE 3 Clinical Decision Making (CDM): Using evidence to improve practice
Adapted from: Sackett DL, Rosenberg MC, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312: 71-72.
SLIDE 4 The “best” evidence depends
Level Treatment Prognosis Diagnosis I Systematic Review of … Systematic Review of … Systematic Review of … II Randomised trial Inception Cohort Cross sectional III
SLIDE 5 Hierarchy of reliability (for treatment interventions!)
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SLIDE 6
The demand for EBP
The existence of a research-practice gap Errors in the interpretation of research evidence Pressure from “payers” for justification for services Pressure from families for more involvement in decision-making
SLIDE 7
SLIDE 8
The demand for EBP
The existence of a research-practice gap Errors in the interpretation of research evidence Pressure from “payers” for justification for services Pressure from families for more involvement in decision-making
SLIDE 9 Arch Dis Ch 2001;84:24-30
SLIDE 10
SLIDE 12
The need for EBP
The data explosion Changes in clinical practice
More teamwork More management in primary care Less continuity of care
SLIDE 13 5,000? per day 1,500 per day 95 per day
Medical Articles Per Year
Rule 31 – Review the World Literature Fortnightly
"Kill as Few Patients as Possible" - Oscar London
SLIDE 14
Is keeping up to date Mission Impossible?
SLIDE 15
EBP does not consist of:
Sole reliance on evidence from RCTs Making decision by the simple application of guidelines
SLIDE 16
Structured questions provide a framework which helps: Identify your information needs Guide your search strategy Decide the extent to which evidence applies to your particular problem
SLIDE 17 Sources of evidence
http://www.tripdatabase.com/ https://www.evidence.nhs.uk/
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SLIDE 18 Sources of evidence
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http://www.testingtreatments .org/new-edition/
SLIDE 19
Structuring questions is not about designing the perfect study – it is about helping you use existing evidence to inform practice
SLIDE 20
Getting the question right
Who What Why
SLIDE 21
Clinical Problem
Population Intervention Comparison Outcome
SLIDE 22
Clinical Problem
Populationop ulation Interventionnt ervention Comparisono mparison Outcometcome
SLIDE 23
Clinical Problem
P I C O Exposure
SLIDE 24 In India, should birth attendants clean newborn babies in the community with chlorhexidine swabs?
Ppulation Intervention Comparison O
SLIDE 25 Should Sarah take inhaled steroids for her asthma?
Plation Iention Crison Oe
SLIDE 26
Clinical Problem
Population Intervention Comparison Outcome
Study Question
Population Itervention Cmparison Outcome
SLIDE 27 Clinical Decision Making
What are the treatment options and the possible outcomes For each treatment option, how likely is each possible outcome? What is the relative value of each
