Flashcards in Information: Quality Not Quantity Deck (13):
What is evidence based medicine (EBM)?
Using the best evidence in scientific literature to provide the best care for an individual patient
What are the 3 principles of evidence based medicine?
1. High quality health care rests on objective and clinically relevant information
2. There is a hierarchy of evidence where some types are stronger than others
3. Scientific data alone is not sufficient basis for making clinical decisions
What is the number needed to treat?
+ The number of patients who need to be treated in order for one person to benefit
+ Ideally NNT is 1 i.e everyone who is treated benefits
+ The larger the NNT the less the benefit
What is a systematic review (detailed)?
+ An attempt to identify, appraise and synthesize ALL THE EMPIRICAL EVIDENCE that meets PRE-SPECIFIED ELIGIBILITY CRITERIA to answer a given research question
+ Researchers condcuting systematic reviews use explicit methods aimed at MINIMIZING BIAS in order to produce more RELIABLE FINDINGS that can be used to inform decision making
List potential sources of bias in medical research:
+ Selection bias
+ Performance bias
+ Attrition bias
+ Detecting bias
+ Reporting bias
+ Publication bias
+ Time-lag bias
+ Language bias
+ funding bias
+ Citation bias
+ Developed country bias
+ Multiple publication bias
What is a systematic review (simple) ?
+ Comprehensive literature search that identifies all similar and relevant studies that satisfy pre-defined:
- inclusion criteria
- exclusion criteria
+ Objective analysis of all qualifying primary research studies
What is meta-analysis (detailed)?
+ When results of the INDIVIDUAL STUDIES ARE COMBINED TO PRODUCE AN OVERALL STATISTIC
+ Data collected from more than once clinical trial; combined to generate average result
+ This aims to provide a more PRECISE ESTIMATE OF THE EFFECTS OF AN INTERVENTION and to reduce uncertainty
What us the confidence interval?
+ Describes the UNCERTAINTY OF THIS ESTIMATE
+ It describes a RANGE OF VALUES within which we can be REASONABLE SURE THAT THE TRUE EFFECT ACTUALLY LIES
What does the width of the confident interval tell you about the measurement?
+ Narrow = HIGHER level of confidence in results
+ Wide = LOWER level of confidence in results
What is NICE?
National Institute for Health and Care Excellence
What is the purpose of NICE?
+ Appraisal of new and implemental pharmaceutical interventions
+ Development and implementation of evidence-based guidelines for appropriate clinical practice
Rules when trying to asnwer a clinical question:
1. Systematic reviews/meta-analysis
2. NICE and SIGN guidelines
3. Medline, PubMed, Ovid etc.