1 / 27

Evidence Based Practice for Beginners

Workshop Structure. Background

bernad
Download Presentation

Evidence Based Practice for Beginners

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Evidence Based Practice for Beginners An Introduction to EBP Joanne Oakes, Clinical Effectiveness Support Officer North Tees PCT

    3. Lets start with a quiz! (You may think this is a bit cruel at first but youll see the reasoning behind it later...)

    4. Early research James Lind and Scurvy In 1747 James Lind performed an experiment to determine what might be effective as a cure for scurvy. Lind divided his 12 men into 6 groups of two. All 12 shared a common diet for breakfast, lunch and dinner but each group received a different supplement ranging from half a pint of sea water daily to 2 oranges and 1 lemon daily.

    5. Randomised Controlled Trials (RCTs) Early randomised controlled trials were carried out by farmers in the former Yugoslavia Seeds were randomised to different conditions (e.g. receiving a particular fertiliser, more or less water, a control group etc) in a controlled environment.

    6. Different types of Research Methods

    7. What is Evidence Based Practice?

    8. What is Evidence Based Practice? Evidence-based practice (EBP) is the integration of best research evidence with clinical expertise and patient values.

    9. Implementing Research Findings in Practice (EBP Cycle)

    10. Example of an information need. Mrs Itchy has three children Bobby, 6, Billy, 9 and Belinda, 13. Bobby keeps coming home from school infected with head lice and passing them on to his siblings and parents. Mrs Itchy is finding that its costing her a small fortune for expensive treatments from the chemist. She wonders whether buying a nit comb would be a better alternative.

    11. PICO P = Patient/ Population/ Problem I = Intervention C = Comparison/ Control O = Outcome Exercise create a PICO structure for the head lice example.

    12. Finding the information Electronic databases Journal Articles (electronic and paper) Internet Courses are available for people whod like to further develop their searching skills and theyre FREE!

    13. So weve found 3 papers which is best? Exercise We have carried out a search and tracked down three papers on head lice that look interesting. Look at their PICO structures and see if any of them warrant further investigation.

    14. Appraising the paper Validity: Were patients randomised into the different treatment groups? Were all of the patients who started the trial accounted for at the end of the trial? (Was anyone not followed up? Were patients analysed using the intention to treat principle?) Were patients, health workers and study personnel blind to treatment? Were the groups similar at the start of the trial? Were the groups treated equally apart from the intervention?

    15. What do all of the numbers mean?

    16. Control Event Rate and Experimental Event Rate CER = No of events in the control group (e.g deaths) No of patients in the control group EER = No of events in the experiment group No of patients in the experiment group Exercise work out the CER and EER of being cured from head lice from the head lice paper CER = 31/40 = 0.775 = 78% EER = 12/32 = 0.375 = 38%

    17. Absolute Benefit Increase ABI = Absolute difference between the CER and the EER (i.e. CER - EER) (Alternatively called the Absolute Risk Reduction (ARR) when looking at a negative outcome) Exercise work out the ABI from the head lice paper = 78% - 38% = 40%. This means that if 100 people used malathion instead of bug busting, 40 would better off.

    18. Number Needed to Treat We know from the ABI that treating 100 people with malathion instead of bug-busting will see 40 of them better off. So how many do we need to treat to see 1 person better off? We use the calculation 100/ABI = NNT (If you remember algebra from school its just a case of dividing both sides by the ABI i.e if 100 = ABI then 100/ABI = ABI/ABI = 1) Exercise work out the NNT for the head lice paper 100/40 = 2.5. Always round the NNT up = 3. That means that we need to treat 3 people with malathion to see one extra person head lice free seven days after the end of the treatment.

    20. Relative Benefit (RB) and Relative Benefit Increase (RBI) The relative benefit (or relative risk if youre looking at a negative outcome) looks at your chance of having the outcome in the experimental group compared with your chance of having the outcome in the control group. RB = EER/CER RBI = 1-RB Exercise work out the RB and the RBI for the head lice paper RB = 38/78 = 0.487 = 49% RBI = 1-0.489 = 51% This means that you are increasing the relative benefit by 51%

    21. It sometimes helps to think of it in terms of a chart.

    22. Last bit of stats! Confidence Intervals and Statistical Significance. A 95% confidence interval means that you can expect the true result to lie within the given limits 95 times out of 100. If the 95% confidence intervals crosses 1 then the result is NOT statistically significant (this is because a value of 1 means that there is no difference between the interventions). e.g 3.2 (0.6 to 7.1).

    23. Transferability and Patient Values Can the results be applied to the local population? Were all clinically important outcomes considered? Does the regimen suit the individual patient?

    24. Implementation something to think about Even when you do have a good research base it often takes an age to implement the findings! Going back to the James Lind example, although his research was carried out in 1747, it wasnt until 1795 that lemon juice was issued to sailors which banished scurvy from the fleet. And even in the modern day we havent got all that much quicker! Consistent research on Thrombolisis has been around since at least 1970 but weve only really starting implementing it over the past few years.

    25. Quiz Time Again! Now lets work out your ABSOLUTE improvement and your RELATIVE improvement from the two different test results.

    26. How do I find out more? Visit www.teesebp.net or try reading one of the following:

    27.

More Related