Session 2 - Evidence Based Healthcare Flashcards
What is the definition of evidence based practice?
Integration of clinical expertise with the best available external clinical evidence from systematic research. Cannot be ‘cookbook’ medicine.
What are the reasons for evidence based health care?
Ineffective treatments are a waste of resources
Variations in treatments create inequalities
Previous practice was based too much on expert opinion, tradition , clinical fashion and organisation and social culture.
Why are systematic reviews needed?
Traditional literature reviews are outdated and can be biased and subjective.
Quality of studies need to be reviewed as they can sometimes be poor.
Can help address clinical uncertainty.
They can help address missing or gaps in research.
Why are systematic reviews useful to clinicians?
Save clinicians time from having to locate and appraise studies themselves.
Give authoritative, up to date conclusions about which are generalisable.
Reduces time between research and implementation.
What are some of the practical criticisms of the evidence based practice movement?
Impossible to create and maintain all the systematic reviews necessary to be able to inform clinicians on any scenario.
May be challenging and expensive to implement all findings
RCTs are gold standard but they are not always possible or even necessary or desirable (ethical considerations)
Choice of outcomes is often biomedical.
Requires good faith on part of the pharmaceutical companies.
What are philosophical problems of the evidence based practice movement?
Does not align with most doctors method of reasoning
What is best for the majority is not necessarily best for the patient in front of you.
Potential of EBM to generate unreflective rule followers
Might be understood as a way to legitimise rationing.
Professional responsibility/autonomy
What are some of the problems with getting evidence based medicine into practice?
Doctors aren’t aware of evidence
Doctors know about evidence but don’t use it. - habit
Organisational structures can’t allow innovations
Commissioning groups have different priorities
Resources are not available to implement change.
How do NICE allow evidence to be put into practice?
NICE guidlines must be implemented with three months of being issues or the organisation is fined.
Give some examples of quantitive research designs?
RCTs Cohort studies Case-Control studies Secondary data sources - ONS census - national surveys - local and regional studies
Define validity
You are measuring what you are supposed to be measuring
Define reliability
Measuring things consistently
Differences in results are due to differences between participants, not from inconsistencies in how things are measured.
How can you ensure validity and reliability in a questionnaire?
Use a published questionnaire that has been peer reviewed.
What are the two types of questions that can be used on a questionnaire and what are the advantages and disadvantages of a each.
Closed questions - data received can be easily analysed, can be completed over the phone, self completed. however pigeon holes people into picking certain options.
Open questions - allows people to express themselves but it is much more difficult to analyse the data, take longer to complete.
What are the advantages of quantitative methods of collecting data?
Easy to analyse Fairly quick to complete Good at describing and measuring Good at finding relationships between things Allows comparisons
What are the disadvantages of quantitative methods of collecting data?
Can put people into inappropriate categories
Don’t allow people to express themselves in the way they like
May not access all important information
May not be effective in establishing causality.
