Week 12. Application/Practice and Clinical Decision Support Tools Flashcards Preview

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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

"lab study"

- 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

"clinical setting"

- 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

- 3-6months/phase
- Can take up to/over a year


Frozen shoulder: causes and capsular pattern

- ER, AB, IR


Making clinical decision: requirements

Define the:
- Question
- 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

1. Systems
(e.g. computerized decision support system)

2. Summaries
(e.g. EBG/Textbooks)

3. Synopses
(e.g. Critically Appraised Journal articles/abstracts)

4. Syntheses
(e.g. systematic reviews)

5. Studies
(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


Two potential futures due to technology

1. A more efficient version of what we do today - streamlined and optimized
2. Transformation of how we work, think, and make decisions