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Evidence-based practiceorPractice-based evidence?Roger
Watson
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Evidence-based practice is your business
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Evidence-based praticeWhy do we need evidence?What is
evidence?What counts as evidence?Where do we find evidence?
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Why do we need
evidence?OpinionExperienceAuthorityExpertiseCommercial
companiesBudgets
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We used to be certain aboutBlood letting
Grommets for glue ear
Episiotomy
Lignocaine to prevent cardiac arrest post heart attack
Egg white and Oxygen to heal pressure sores
Vigorous rubbing of the buttocks with alcohol to prevent
pressure sores
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Pressure sore treatment (consecutive)1 patient
heals2345678910
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Pressure sore treatment (simultaneous)9 out of ten
improve87654321
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Probability10 out of ten improve
What about the 11th time?
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What is evidence?a thing or things helpful in forming a
conclusion or judgmentthat which tends to prove or disprove
something; ground for belief; proof. something that makes plain or
clear; an indication or sign
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What counts as evidence?The outcome of systematic enquiry
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Randomised Controlled Trials
The cardinal features of an RCT
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RANDOMISATIONCONROLBLINDING
The cardinal features of an RCTRandomisation
Control
Blinding
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InterventionControl group
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Meta analysisMeta-analysis is a statistical procedure that
integrates the results of several independent studies considered to
be combinable.Well conducted meta-analyses allow a more objective
appraisal of the evidence than traditional narrative reviews,
provide a more precise estimate of a treatment effect, and may
explain heterogeneity between the results of individual studies.Ill
conducted meta-analyses, on the other hand, may be biased owing to
exclusion of relevant studies or inclusion of inadequate
studies.
Meta-analysisSystematic reviewsRelationship between systematic
reviews and meta-analyses
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Regression towards the meanIn statistics,regression toward(or
to) themeanis the phenomenon that if a variable is extreme on its
first measurement, it will tend to be closer to theaverageon its
second measurementand if it is extreme on its second measurement,
it will tend to have been closer to the averageon its first.
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Evidence-based practicethe practice of health care in which the
practitioner systematically finds, appraises, and uses the most
current and valid research findings as the basis for clinical
decisions. The term is sometimes used to denote evidence-based
medicine specifically but can also include other specialties, such
as evidence-based nursing, pharmacy, and dentistry.
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Evidence-based medicineThe judicious use of the best current
evidence in making decisions about the care of the individual
patient.
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Acceptable definition of EBP?an approach to decision making in
which the clinician uses the best evidence available, in
consultation with the patient, to decide upon the option which
suits the patient best. (Muir Gray)
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Where do we find evidence?Evidence synthesis databases
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[email protected]
0000-0001-8040-7625
@rwatson1955
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