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