Flashcards in HadSoc Session 2 Deck (46):
Before EBP what were practises influenced too much by?
Professional opinion, clinical position, historical practice and precedent, organisational and social culture
Give two examples of ineffective/inappropriate interventions that support the use of EBP.
Prophylactic lidocaine in MI - published research found it caused harm but no one took notice until systematic review was published
MgSO4 in eclampsia seizures - cleaner benefit but only used by 2% of clinicians
What was the first Cochrane Centre?
Register of all RCTs in obs&gynae with systematic reviews and meta-analyses
What is EBP?
Integration of individual clinical experience with the best available external clinical evidence from systematic research
Why is a bottom-up approach required in EBP?
Pts will have comorbidities etc not represented in the trial and pt choice must be considered
What are the benefits of systematic reviews?
Help address clinical uncertainty from poor quality/biased/subjective traditional literature reviews to highlight gaps in research, increase certainty by appraisal and integration offer authoritative and generalisable up-to-date conclusions to save clinicians time and effort
What are the advantages of systematic reviews?
May reduce delay between research discoveries and impementation, help prevent biased decisions and are relatively easily converted into guidelines and recommendations
What is the disadvantage of systematic reviews?
Drs must be able to access and appraise them to be satisfied with quality of evidence
What is CASP?
Downloadable critical appraisal tool that provides a checklist of questions for different trial types to suggest what to look for to asses quality of evidence
Give some examples of sources of reviews and other evidence.
Peer-review medical journals, EBP-specific medical journals, Cochrane collaboration, NHS centre for reviews and dissemination, NIHR health technology assessment programme
What does the Cochrane collaboration include?
Database of systematic reviews, database of abstracts of reviews and effectiveness, controlled trials register (including protocols for reviews yet to happen) and review methodology database
What are practical criticisms of EBP?
Systematic reviews may not be possible across all specialities and to disseminate, RCTs are the gold standard but not always possible, choice of outcomes is very biomedical (limits trials and those that receive funding), needs good faith of pharma companies
What are the philosophical criticisms of EBP?
Probabilistic vs deterministic causality, aggregate population outcomes don't translate to individuals, potential to lead to unreflective rule followers, seen to legitimise rationing
How is the EBP implemented in the NHS?
It is legally obliged to follow NICE within 3 months (but individuals don't have to)
What are the difficulties with implementing EBP?
Evidence exists but Drs don't know, Drs know evidence but don't use it, organisational systems cannot support innovation, comissioning decisions reflect other priorities or resources are not available to implement change
What is the argument for EBP?
Health service delivery should be based on best available evidence of effectiveness and cost-effectiveness
Why is social science research needed?
To gain a better understanding of engagement in health-related behaviours and pt engagement with HCPs
What are quantitative methods of social science research?
Beginning with an idea or hypothesis collection of numerical data allows conclusions to be drawn by deduction
What are the strengths of quantitative methods in social science research?
Reliability and repeatability as samples tend to be large and therefore representative
Give some examples of research designs that are used in quantitative methods of social science research.
RCTs, cohort studies, case-control, cross-sectional surveys, secondary analysis of data from other sources, questionnaires
What are questionnaires commonly used to measure?
Exposure to risk factor, knowledge and attitudes or satisfaction with health services
What must questionnaires be?
Valid-accurate measure what they're supposed to
What must questionnaires be reliable?
So variation in results is from participants not inconsistencies in understanding or interpretation
What are published questionnaires?
Have been written and made freely available therefore validity and reliability can be tested before use
When are unpublished questionnaires used?
Specific contexts where a published questionnaire is not available
Describe the structure of a questionnaire.
Mainly closed Qs, can offer other 'please specify' option, can have open-ended Qs, can be self completed on paper or administered via the Internet, phone or interviewer
How do qualitative methods aim to make sense of phenomena?
In terms of meanings people bring to them
What are the principles of qualitative research methods?
Listen to what people have to say and understand their perspective, emphasis on meaning, experience and views, analysis emphasises researcher's interpretation and provides insight into people's behaviour
What research methods can be used in qualitative research?
Observation and ethnography, interviews, focus groups and documentary and media analysis
What is observation and ethnography?
Observation of human behaviour in its natural context to about prioritisation and rationalisation from individual recount. Either participant or non-participant
How are interviews conducted in qualitative research?
Semi-structured where interviewer has prompts for a clear agenda of topics but facilitates participant perspectives. Doesn't use leading Qs or respond +vely or -vely to response
What are focus groups good for?
Quickly establishing parameters or accessing group-based ideas
What are the problems with focus groups?
May encourage or dissuade views and not suitable to sensitive topics
What is needed for a successful focus group?
Fairly homogenous group and good facilitator
Her can documentary and media analysis be used in qualitative research?
Use artful reconstructions of described events to provide historical context and 'inside story' e.g. media coverage of breast and bottle feeding
What does analysis of qualitative data involve?
Close inspection of data, identification of themes and subsequent coding into scheme and constant comparison of data analysis against themes
What approach is needed to analysis of qualitative data?
Inductive, requiring analyst to immerse themselves in the data to carry out and ongoing iterative process
What are the advantages of quantitative research?
Good for describing, finding relationships, measuring and allowing comparisons
What are the disadvantages of quantitative research?
May force people into inappropriate categories, doesn't allow participant expression, may not access all important information, may not be effective at establishing causality
What are the advantages of qualitative research?
Good for understanding perspective, explaining relationships and accessing info not available quantitatively
What are the disadvantages of qualitative research?
Not good at finding consistent relationships, generalisability as it identifies a range of views from a potentially non-representative group, can be harder to gain ethics approval
What does good qualitative research lead after analysis?
What are the problems with qualitative research analysis?
Need to be robust but criteria for this is debatable
What is key in appraisal of qualitative research?
Transparency around sampling, methods and analysis
What does choosing a study design depend on?
Topic under investigation and research Q, research team preference and expertise, time and money available and funders and/or audience