Flashcards in Week 12. Application/Practice and Clinical Decision Support Tools Deck (20):
Decision making approach: Paternalistic or parental approach
- usually clinician appraising the evidence (minimal or no attempt to ensure decision consistent with patient values/preference)
- Act upon patient
Decision making approach: clinician-as-perfect agent approach
- Discussing the evidence with the patient/family and engaging them to use the evidence (approaches that attempt to ensure decision consistent with patient values and experiences)
- Informed decision making process
- Shared decision making
Optimal decision-making approach
Shared decision making is likely optimal
3 questions when considering if results are relevant to patient?
1. Participants in the study similar to patients to whom I wish to apply findings
2. Were interventions applied appropriately
3. Are outcomes useful (good>harm)
Major issue when determining relevance to patients
- one better than the other
- finding is relevant to everyone
Evaluating Evidence: Efficacy
- does treatment/study work under ideal settings
- one step beyond an animal study; if it doesn't work in this stage there's no point on going further
Evaluating Evidence: Effectiveness
- does treatment/study work in the real world (clinical setting).
Why can "effectiveness" not be measured in RCT?
- Cannot be measured in controlled trails because act of inclusion into study is a distortion of usual practice.
Evaluating Evidence: Efficiency
Is the treatment worth it's cost.
- relationship between inputs (costs) and outputs (quality adjusted life-years, QALYs).
- More QALYs for the same or ferwer resources are more efficient
How is efficiency assessed?
1. cost minimalization, 2. cost-effectiveness,
3. cost-utility analysis
Frozen Shoulder Timeline between phases
- Can take up to/over a year
Frozen shoulder: causes and capsular pattern
- ER, AB, IR
Making clinical decision: requirements
- Clinical situation
- Clinical Knowledge
- Knowing the evidence
Making clinical decisions: what is the researcher contributing?
only contribute one component: information on the study
1. who was treated and
2. what intervention by what clinicians to reach what outcome
Making clinical decisions: relevance of results
- The average effect of the intervention
"Clinical trial can tell us about the effects of an intervention on patients with particular characteristics is the average effect of the intervention on a heterogenous population from which sample patients were drawn"
5S Hierarchy of Evidence
(e.g. computerized decision support system)
(e.g. Critically Appraised Journal articles/abstracts)
(e.g. systematic reviews)
(e.g. RCTs, Cohort, Case control/series)
6. Expert opinion: Classical Textbooks
Knowledge Translation: Passive Diffusion
research papers and conference talks to other scientists
Knowledge translation: Dissemination
targeted messaging to defined groups
Knowledge translation: Implementation
actively identifying and overcoming barriers to the use of knowledge; uses not only the message itself, but organizational and behavioural tools for use of evidence