evidence based medicine (...healthcare). you are working in a community team and a few of the cnss...

Evidence Based Medicine(...healthcare)

You are working in a community team and a few of the CNSs consistently advise dexamethasone

8 mg od for non specific cancer related breathlessness.

How would explain EBM to the team?

How would you go about trying to incorporate EBM into the team?

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”

Sackett & Straus

Ask

Access

Appraise

Apply

Assess

Ask – convert the clinical puzzle into an answerable question

Access

Appraise

Apply

Assess

Ask

Access – search to find the answer to that question

Appraise

Apply

Assess

Ask

Access

Appraise – critically evaluating the evidence to decide if it is, and if so how, reliable and robust

Apply

Assess

Ask

Access

Appraise

Apply – extract the useful information, address generalisability and patient concerns and decide what clinical action is needed

Assess

Ask

Access

Appraise

Apply

Assess – keep a record, evaluate and improve the process

Presentations will cover: 1. search strategy; 2. search results; 3. the validity of this evidence; 4. the importance of this valid evidence; 5. can this valid, important evidence be applied to your patient; 6. your evaluation of this process.

3-part Clinical Question

Patient’s Name Learner:

Target Disorder:

Date and place to be filled:

Intervention (+/- comparison):

Outcome:

Critically AppraisedTopic

Best Evidence Topic

www.bestbets.org

Ask the right question

General question

Patient characteristics Intervention or defining questionRelevant outcome

Ask the right question

General question Are corticosteroids helpful for breathlessness?

Patient characteristics Intervention or defining questionRelevant outcome

Ask the right question

General question Are corticosteroids helpful for breathlessness?

Patient characteristics In patients with cancer / palliative care patientsIntervention or defining question

Relevant outcome

Ask the right question

General question Are corticosteroids helpful for breathlessness?

Patient characteristics In patients with cancer / palliative care patientsIntervention or defining questiondo corticosteroids Relevant outcome

Ask the right question

General question Are corticosteroids helpful for breathlessness?

Patient characteristics In patients with cancer / palliative care patientsIntervention or defining questiondo corticosteroids Relevant outcome reduce breathlessness

Ask the right question

General question

Patient characteristics Intervention or defining questionRelevant outcome

Levels of Evidence

Levels of Evidence

BET

AThere is good evidence to support the use of the procedureBThere is fair evidence to support the use of the procedureCThere is poor evidence to support the use of the procedureDThere is fair evidence to support the rejection of the procedureEThere is good evidence to support the rejection of the procedure

Tips on EBM success

Focus on actual learning needs Center around real clinical decisions

Focus on applying research…not doing it Focus on interpreting statistics… not doing them

Balance passive with active learning Research evidence adds to clinical expertise, patient

values and circumstancesBuild lifelong learning abilities

Humiliate SpRs for not knowing the answers already

Alternative Approaches to Medicine

Six factors influence the uptake of innovations

1. Relative benefit – what’s in it for me?2. (non)-Complexity – is it easy to learn?3. Trialability – can I try it out easily?4. Observability – can I see others do it?5. Compatability – fit with ideas and work6. Reinvention – can I adapt it to me?