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25 Cards in this Set
- Front
- Back
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what is evidence based medicine
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the integration of the best research evidence, with clinical expertise and patient values.
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five steps of evidence based medicine
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1. convert information into answerable question
2. find best evidence 3. appraise VALIDITY, IMPACT AND APPLICABILITY 4. integrate appraisal with clinical expertise 5. evaluate performance |
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types of studies
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clincal experience
case reports case studies case control study cohort study randomised placebo controlled clinical study. |
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systematic review
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different to conventional narrative reviews
systematic approach used to minimise bias and random errors useful for presenting accumulated results from primary research |
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meta analysis
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made cochrane collaborations LOGO
beneficial not benefical final status (diamond) |
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strength of evidence
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1. strong evidence (at least one systematic review)
2. strong evidence (at least one properly designed randomised control trial 3. (a) - evidence from psuedo-randomised control trials. (b) a comparitive study with concurrent controls (c) comparative study without concurrent controls. 4. evidence from well designed non-experimental study (>1group) [treatment that has been tried] no level - opinion based on clinical evidence. |
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assessing validity of systemic reviews
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is it randomised trials
do methods describe finding & all relevent trials, how validity of individual trials was assessed. were results consistent from study to study |
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assessing impact of systemic reviews
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absolute benefit
numbers needed to treat and for how long absolute risk of harm BENEFIT VS HARM |
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impact - relative risk reduction
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RRR - rate of events when taking med 1 - rate of events when taking med 2
_________________ rate of events when taking med 1 |
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impact absolute risk reduction
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rate of event when taking med 1 - rate of events when takign med 2
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numbers needed to treat
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1/ARR
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assessing applicability
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patient different from study patient?
intolerant to meds?? will it be subsidised? |
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quality cycle
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plan->do -> check -> act ->plan -> do -> check -> act
plan do check act plan do check act cyclee |
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DUE cycle
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collect data -> evaluate data -> feedback evaluated data -> action
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check =
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audit = check data and evaluate
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what is a DUE programme
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quality assurance programme specific to medicines
promotes qum (judicious, appropriate, safe and effective) |
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difference between QUM and DUE
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QUM is targeted at individual (improving patients quality of life)
DUE is oriented at the hospital wide level |
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why have DUE
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clinical beneits, evidence based medicine, educational benefits, economic benefits
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clinical benefits of DUE
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evaluate outcome
(nausea/vomitting diary, pain-control scales, incidince of DVT) alert adverse effects |
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standard benchmark in queensland for qulaity use of meds
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health quality and complaints commission
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educational benefits
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improve clinical skills
junior doctors (learn during data collection) consultants, prescribers, pharmacists |
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economic benefits
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potential to identify efficiencies
potential to justify expenditure |
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who is involved in DUE
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DUE pharmacist/post grad/project
QUM projects in 4th yr clinical pharmacists pharmacy department everyone |
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DUE steps
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1. make a start
2. identify drugs/ areas of practice for review 3. critical literature evaluation 4. define criteria 5. data collection form 6. collect data (via audit maker) 7. evaluate 8. feedback evaluation 9. action 10. assess results of repeat data collection 11. report, publish, present 12. monitor and re-evaluate regularly |
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examples of some studies
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NSAIDs, antibiotics in community acquired pneumonia, vancomycin, DVT prophylaxis
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