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What is evidence-based medicine

A clinical decision informed by the best available evidence
- this evidence is usually in the form of published based papers
- it is also about integration of this evidence with the expertise and the experience of clinicians as well as the belief, values and opinions of the patient


What are the five steps of the EBM

1. patient presents with a clinical problem
2. formulate a focused research question - looking for the best evidence
3. search for the best evidence
4. critically appraise the evidence found
5. consider the evidence in the light of your expertise and decide whether or not to apply it


What does PICO stand for - used for degisning a question

P - population or patient - who is your patient, do they have a particular condition, are they part of a particular group
I - Intervention - what treatment might you give the patient
C - Comparison - you might want to compare two treatment or a new treatment with standard treatment
O - outcome - what are you hoping to achieve, reduction of symptoms, complete recovery, knowing what you want the outcome to be will help when it comes to searching for the evidence


What are the levels of evidence?

highest rated
1. systematic review of randomised control trials
2. randomised controlled trials
3. cohort studies
4. case-control studies
5. case series
6. expert opinion


what are some pros and cons of expert opinion?

- experts have a wider knowledge of the topic and so will be a useful input
- they have researched for years and should have a more comprehensive understanding

- maybe biased towards a certain point or support organizations opinion
- may not take into consideration of wider opinions


Where do you search for high-quality evidence

Health care specific search engines
- Evidence.Nhs
- tripdatabase

- pubmed
- cochrane libary - already been critically appraise


How to identify search terms

- think of possible synonyms, related terms, abbreviations or acronyms
- look at any articles that you know are relevant to the topic - what language do they use to describe their research, do they give their search strategy - if so what terms did they use


what is synopses of the evidence

- not source of primary research
- evidence has been read and summarised
- information presented in a concise manner
- up to date and accurate sources of clinical knowledge


name some places to get synopsis of evidence

BMJ best practise

clinical knowledge summaries


what does a critical appraisal enable you to do

- quickly exclude papers that are of too poor a quality to inform practise
- systematically extract the main points of a paper
- increase the effectiveness of you reading


what key questions does the critical appraisal allow you to answer

- is the study valid
- what are the findings of my study
- can I apply the findings to my patients


what would you look for in a good RCT

- good randomisation procedures
- patients blind to treatment
- clinicians blind to Treatment
- all participants followed up
- intention to treat analysis


what do you have to be aware of when analysing a systematic review or meta analysis

- publication bias
- hetrogeniety


papers with interesting results are more likely to be..

- submitted and accepted for publication
- published in a major journal
- published in English
- published in open access journals
- quoted by authors
- quoted in newspapers


how are results presented

- number needed to treat - number of people needed to treat to get one positive outcome = significant if it is between 2 and 5
- odds ratio
- relative risk
- mean difference = used if results are on a particular scale and they work out the average of the control group and treatment group and find the difference


what is difference between odds ratio and relative risk

Odds ratio
- you versus the rest of the population
- can sometimes relay it in a more positive light

Relative risk
- you versus all the runners (the entire population)

rare occasion not difference between odds and relative risk


what is a forest plot

- used for meta analysis
- down the middle you have the line of no effect
- the blob is best estimate or where the true result lies but you also have the confidence interval between
- larger studies have smaller confidence intervals whereas smaller studies have larger confidence interval
- if it crosses the line of no effect then it could be either of the result so the study is not significant whereas if it is on one side of the line than it is more significant
- they create a pooled result of all the studies to see if it is significant


What is the P value

- decides whether the results have occurred by chance
- if the P value is less than 0.05 is considered statistically significant


what out of odds ratio and relative risk is more likely to show the results in a favourable light

- odds ratio