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Skills for Evidence-Based Health Care

Skills for Evidence-Based Health Care. Suzana Alves da Silva, MD, MSc, PhD Senior Researcher at the Health Technology Assessment Unit of Amil Assistência Médica Internacional S/A, Rio de Janeiro, Brazil. Conflict of interest. None to declare.

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Skills for Evidence-Based Health Care

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  1. Skills for Evidence-Based Health Care • Suzana Alves da Silva, MD, MSc, PhD • Senior Researcher at the Health Technology Assessment Unit of • Amil Assistência Médica Internacional S/A, Rio de Janeiro, Brazil

  2. Conflict of interest • None to declare

  3. Scientifically Informed Medical Practice and Learning - SIMPLE Model “Knowledge does not extend from those who consider they know to those who consider they do not know. Knowledge is built in the relationship between human beings and perfects it self in the critical problematization of these relations.” Paulo Freire Suzana Silva, JECP 2010

  4. Expertise Scientifically Informed Medical Practice and Learning - SIMPLE Model Circumstances Evidence Patients

  5. Scientifically Informed Medical Practice and Learning - SIMPLE Model “Knowledge does not extend from those who consider they know to those who consider they do not know. Knowledge is built in the relationship between human beings and perfects it self in the critical problematization of these relations.” Paulo Freire Problem Delineation Suzana Silva, JECP 2010

  6. PROBLEM

  7. Categories of problem

  8. Categories of problems

  9. Actions and Choices will varie according to the domains of Therapy, Diagnosis, Prognosis and Harm What is the risk of AMI in 1 year in a asymptomatic pt with dislipidemia and calcium score of 100? Probability For how many times this risk will be increased if this pt has diabetes and smokes? Prognosis Performance For how much the use of calcium score as a prognostic test decrease the risk of cardiovascular events in asymptomatic pt with dislipidemia? Utility

  10. Actions and Choices will varie according to the domains of Therapy, Diagnosis, Prognosis and Harm What is the pretest probability of coronary artery disease in a 40 y/o women with atypical chest pain? Probability What is the test with best performance to investigate this patient? Diagnosis Performance For how much the use of angiotomography to investigate CAD in patients like mine decrease the risk of cardiovascular events compared to other strategies? Utility

  11. Analytical Framework

  12. Analytical Framework

  13. Types of information, study designs and sources

  14. The TDS Evidence Pyramids • Types of informationSummariesSynthesesSingle Studies • DesignsGuidelinesSystematic ReviewsRandomized and non randomized studies • SourcesSynopsesFiltered DatabasesLarge Biomedical Databases Suzana Silva and Peter Wyer. The Roadmap: a blueprint for evidence literacy within a Scientifically Informed Medical Practice and Learning model. The International Journal of Person Centered Medicine. In press.

  15. Finh et al. ACCF/AHA/ACP Guideline on Stable Ischemic Heart Disease. JACC 2012. Pretest Likelihood of CAD in Symptomatic Patients According to Age and Sex* (Combined Diamond/Forrester and CASS Data) 22 CAD indicates coronary artery disease; and CASS, Coronary Artery Surgery Study. *Each value represents the percent with significant CAD on catheterization. Adapted from Forrester and Diamond

  16. AngioCT Mowat 2008 +LR 9.5 • Angio CTx • x • Angio CTx -LR 0.05

  17. Cintigraphy Boado 1998 +LR 7.5 • SPECT • x • Angio CTx -LR 0.16

  18. Treadmill Test Morise and Diamond 1995 +LR 3.0 • x -LR 0.75

  19. if Test Result is + • x if Test Result is -

  20. Can we trust these results?

  21. Does the use of angiotomography compared to myocardium perfusion decreases the risk of cardiovascular outcomes?

  22. Sheribati el al. Association of Coronary CT Angiography or Stress Testing with Subsequent Utilization and Spending Among Medicare Beneficiares. JAMA 2011

  23. What is the risk of cancer if this patient is submitted to radiation exposure?

  24. Estimated Number of Patients Undergoing Computed Tomography (CT) That Would Lead to the Development of 1 Radiation-Induced Cancer, by Type of CT Examination and Age at the Time of Exposure, Based on the Median and Interquartile Radiation Dose Observed

  25. Directness of evidence

  26. Thank You! Obrigada! suzana.silva@amil.com.br

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