Decision Making

• What is evidence-based medicine?

  Use of best evidence for patient care
• What does the evidence-based learning Venn diagram represent?

  Combination of factors for best medical decisions
• What do NICE guidelines provide?

  Summaries on evidence for informed decisions
• What is background knowledge in medicine?

  Stable information about standard treatments
• What is foreground knowledge in medicine?

  Information that changes with new evidence
• What drives foreground knowledge?

  Evidence and its organization
• What does CKS stand for in NICE guidelines?

  Clinical Knowledge Summaries
• What are the primary steps to develop foreground knowledge?

  1. Write up a case report or series
  2. Conduct a case control study
  3. Access a cohort for a cohort study
• What is a case report or case series?

  Single incident vs multiple similar cases
• What is a case control study?

  Observational study to draw conclusions
• How are case control studies conducted?

  Start with outcomes and trace histories
• What is a cohort study?

  Observational study following a group over time
• What is the problem with observational data?

  Shows correlation, not causation
• How can causality be assessed?

  Conduct a randomized controlled trial (RCT)
• How is an RCT conducted?

  Groups must match closely in characteristics
• What happens if many studies are conducted on the same subject?

  A meta-analysis is undertaken
• How is a meta-analysis conducted?

  Systematic review followed by statistical analysis
• What does a meta-analysis provide?

  Larger sample size and greater precision
• What do systematic reviews include?

  Greater range of patients than single studies
• What is the traditional hierarchy of evidence?

  • Systemic review and meta-analysis
  • RCTs
  • Cohort studies
  • Case control studies
  • Case reports/series
  • Expert opinion at the bottom
• What are some issues with RCTs?

  Ethics, feasibility, and cost concerns
• What is considered the 'gold standard' in research?

  A well-designed, applicable RCT
• What does NICE stand for?

  National Institute for Health and Care Excellence
• What is the aim of NICE?

  Reduce variation in treatment availability and quality
• What is shared decision making?

  Collaborative process between patient and professional
• What does the BRAN acronym stand for in shared decision making?

  • Benefits
  • Risks
  • Alternatives
  • Nothing