What is evidenced based practice?
Evidenced-based practice is the integration of best research evidence with clinical expertise and patient values and circumstances
What does it mean by Best research evidence?
We mean clinically relevant research, often from the basic sciences, but especially from clinical research into the accuracy and precision of diagnostic tests, etc etc.
New evidence from clinical research invalidates previously accepted diagnostic tests and treatments and replaces them with new one that are more accurate, efficacious and safer.
What does mean, median and mode mean?
Mean: summing individual values and dividing by the number of values (average)
Median: The middle point of a set of values (measure of central tendency)
mode: most frequently occurring value in a set of values
Whats the P-value and how is considered statistically significant?
Is a measure of the strength of evidence against the null hypothesis. Its not an estimate of any effect quantity.
eg a test as a p-value of 0.001. This is way less than 0.05 = very stat signif
What is the confidence interval?
Intervals have a upper and lower estimates and give a measure of precision or uncertainty of study.
95% of such intervals will contain the true population value.
CI’s indicate the strength of evidence
Whats the hierarchy of evidence for therapy users?
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- Systematic Review of Randomised controlled trials
- Individual RCT (with narrow confidence intervals)
- Systematic Review of cohort studies
- Individual cohort studies
- Outcomes research (no control group), and studies of a disease population.
- Systematic review of case-control studies
- Individual Case-control study
- Case series
- Expert opinion without
Evidence- based practice (EBP) requires the following steps
- Converting information needs from clinical encounters into questions with an answerable format.
- Locating the best available evidence in order to answer these questions.
- Critically appraising evidence- internal validity, assessing size and effect and relevance to your practice
- Applying inför from critical appraisal to care of individual patients
Why do we formulate the questions clearly for research?
- They help is focus our time on evidence directly related the patient problems
- They can give us high yield search strategies
- They crystallise our thinking if we need to refer to patient
- when our questions get answered our knowledge base grows
A good clinical question has 4 components. What are they?
PICO
- Population, patient or problem
- Intervention, prognosis factor, or exposure
- comparison
- Outcomes
Give me an example of how you would right a well built PICO question?
In patients with {patient population/problem} does {intervention} affect {outcome} compared to comparison {comparison} , if any?
What are the kind of studies you should look for?
For Therapy?
Evidence of aetiology or harm is usually found in what studies?
- Randomised controlled clinical trials. Systematic reviews are the best of these
- Diagnosis is found in trials which compare tests with a reference or gold standard
- Evidence of aetiology or harm is usually found in cohort studies or case control studies
Whats the difference between a case control study and a case series or case report?
Case control studies are studies in which patients who already have a specific condition are compared with people who don’t. These can test for rare disease including harm.
Case series and case reports consist of collections of sports on the treatment of individual patients. Have no statistical validity but may generate a hypothesis that needs testing.
What is a systematic review?
Whats a meta-analysis?
What are practice guidelines?
- Systematic Reviews focus on a clinical topic and answer a specific question.
- Meta-Analysis takes the systematic review a step further by using statistical techniques which summarises the results of several studies into a single estimate of their combined result.
- Practice Guidelines are systematically developed statements to assist practitioner and patient make decisions about appropriate health care for specific clinical circumstances.
