Information: Quality Not Quantity

Question 1

What is evidence based medicine (EBM)?

Answer 1

Using the best evidence in scientific literature to provide the best care for an individual patient

Question 2

What are the 3 principles of evidence based medicine?

Answer 2

1. High quality health care rests on objective and clinically relevant information
2. There is a hierarchy of evidence where some types are stronger than others
3. Scientific data alone is not sufficient basis for making clinical decisions

Question 3

What is the number needed to treat?

Answer 3

+ The number of patients who need to be treated in order for one person to benefit

+ Ideally NNT is 1 i.e everyone who is treated benefits

+ The larger the NNT the less the benefit

Question 4

What is a systematic review (detailed)?

Answer 4

+ An attempt to identify, appraise and synthesize ALL THE EMPIRICAL EVIDENCE that meets PRE-SPECIFIED ELIGIBILITY CRITERIA to answer a given research question

+ Researchers condcuting systematic reviews use explicit methods aimed at MINIMIZING BIAS in order to produce more RELIABLE FINDINGS that can be used to inform decision making

Question 5

List potential sources of bias in medical research:

Answer 5

\+ Selection bias
\+ Performance bias
\+ Attrition bias
\+ Detecting bias
\+ Reporting bias
\+ Publication bias
\+ Time-lag bias
\+ Language bias
\+ funding bias
\+ Citation bias
\+ Developed country bias
\+ Multiple publication bias

Question 6

What is a systematic review (simple) ?

Answer 6

+ Comprehensive literature search that identifies all similar and relevant studies that satisfy pre-defined:

• inclusion criteria
• exclusion criteria

+ Objective analysis of all qualifying primary research studies

Question 7

What is meta-analysis (detailed)?

Answer 7

+ When results of the INDIVIDUAL STUDIES ARE COMBINED TO PRODUCE AN OVERALL STATISTIC

+ Data collected from more than once clinical trial; combined to generate average result

+ This aims to provide a more PRECISE ESTIMATE OF THE EFFECTS OF AN INTERVENTION and to reduce uncertainty

Question 8

What us the confidence interval?

Answer 8

+ Describes the UNCERTAINTY OF THIS ESTIMATE

+ It describes a RANGE OF VALUES within which we can be REASONABLE SURE THAT THE TRUE EFFECT ACTUALLY LIES

Question 9

What does the width of the confident interval tell you about the measurement?

Answer 9

+ Narrow = HIGHER level of confidence in results

+ Wide = LOWER level of confidence in results

Question 10

What is NICE?

Answer 10

National Institute for Health and Care Excellence

Question 11

What is the purpose of NICE?

Answer 11

+ Appraisal of new and implemental pharmaceutical interventions

+ Development and implementation of evidence-based guidelines for appropriate clinical practice

Question 12

Rules when trying to asnwer a clinical question:

Answer 12

1. Systematic reviews/meta-analysis
2. NICE and SIGN guidelines
3. Medline, PubMed, Ovid etc.

Question 13

What is a meta-analysis (simple)?

Answer 13

Integrated analysis of the numerical data from all qualifying studies