Uploaded byChristian van Rij
Valuing research
Dr. Christian van Rij emphasizes the importance of research-based evidence in clinical practice for optimal patient treatment, advocating for ongoing education and self-directed learning to avoid reliance on outdated information. He outlines various research methodologies, including randomized clinical trials, and stresses the significance of critical appraisal in establishing true correlations in medical studies. The document encourages clinicians to continually update their knowledge to maintain effectiveness and relevance in their practice.
Valuing research
- 1. Valuing Research byCliniciansDr Christian van Rij @ 18th February 2010Continuing Educationfor Clinical Officers at Wasso Hospital
- 2. ResearchBiochemical InventionsTreatment InsightsRenewedideas for theBest Current Treatment PlansHighest Patient Benefit Lowest Side Effects Cost Efficient
- 3. Guided by GuidelinesAgreedsummery of Best Treatment PlansLow value if based on opinions/ideasHigh value if based on Research EvidenceShould be up to date: old ideas are not modern!
- 4. Guided by SeminarsToremind or update your knowledgeShould be applicableShould be reflecting the newest Evidence Based Medicine (and not merely opinions)
- 5. Being Told vsReading yourselfhttp://www.flickr.com/photos/90306674@N00/3196584510
- 6. Being Told vsReading yourselfNot always somebody present to guide you in the issueRoad signs may be outdatedOvercome by getting updated maps & reading them yourself!http://www.flickr.com/photos/waltzer/2428713783
- 7. Approach for ResearchIdeaHypothesisProvethat the hypothesis is true
- 8. Use proper statisticalmethodsA man with red colors is 129 times more likely to be gored by a bull!But what is the Base Rate?www.flickr.com/photos/jagf/4249757103/in/pool-toros
- 9. Type of ResearchStudyObservational Experience(Retrospective) Cohort StudyRandomized Clinical TrialPreferably Prospective and Double BlindA Meta-analysis Study can be appliedLikeliness of describing a true causative relationship
- 10. How does aRCT work?Patient groupIntervention groupControl groupPICOOutcomeOutcomeStatistical Difference?
- 11. Critical AppraisalSatisfied withthe patient group?Confounding factors which were not randomized?Sufficient external validation of the group?Proper hypothesis for a causative relationship?True correlation?
- 12. Stork Population andnumber of newborns; January 2004; Paediatric and Perinatal Epidemiology; volume 18:1:P88-09http://nl.wikipedia.org/wiki/Bestand:Stork_with_new-born_child.pngStork Population & Baby Birth Rates
- 13. Correlation Intervention &OutcomeEffect
- 14. Positive CorrelationIncreasing theintervention increases the outcomeExample: adrenaline as intervention and heart rate as outcomeRelative Risk > 1Effect
- 15. Negative CorrelationIncreasing theintervention decreases the outcomeExample: beta-blocker as intervention and heart rate as outcomeRelative Risk 0 < 1Effect
- 16. Correlation Intervention &OutcomeCorrelation was by ChanceCorrelation was Real
- 17. Correlation maybe byChance only?P-ValueDescribes the Probability that the correlation was caused by chance onlyIt is agreed that a P-value below 0.05 is small enough to assume that the correlation did not happen by chance
- 18. Key PointsDon’t gofor personal experience as evidence: this is the level of traditional healersInstead of reading only road signs (which might not always be present or up to date), learn to read maps yourself!If you want to be a sharp doctor: make it a habit to sharpen yourself regular!Not updating yourself will make you outdated!
- 19. Questions and DiscussionFeelfree to pop up any question or remark!
Editor's Notes
- #3 New Biochemical DevelopmentsACE-inhibitorsAntionesin-Receptor AntagonistsTreatment DevelopmentsLower Uterine Segment incisions for CSLaparoscopic procedures instead of LaparotomyRenewed Ideas about best current treatment plans
- #4 Although cultural values can be reflected in guidelines: A drug for infertility might be acceptable in a Maasai community but not in European communityA treatment in a NICU that causes blindness but prevents mental retardation: what is experienced worse can differ per cultureBut cultural values should not be simply assumed: they should studied, understood and quantified by Social Sciences.
- #10 Obervational Experience:It is my experience that … we treated 8 patients with …. and sawRetrospective Study:We identified a group of 1000 people who ate a lot of fruit, andWe identified a group of 1000 people who were not eating fruitWe saw that in the group of fruit eaters there was a lot of malaria, So we conclude that eating fruit is a risk factor for developing malariaWhen there are several randomized double blind clinical trial, a meta-analysis study can be applied to achieve the highest certainty of truth.
- #11 Splitting into the two groups should be truly randomized; control for confounders
- #12 Example of the questionable causative relationship:Prevalence of storks and baby birthsIncrease of antenna’s or cellphones and the increase of cancers
- #13 Hypothesis can not give an understandable causative relationship with the outcome.In order to prove a paradigm, you should actually also come up with a hypothesis with which you can deny the paradigm._______________________________Data from Berlin (Germany) show a significant correlation between the increase in the stork population around the city and the increase in deliveries outside city hospitals (out-of-hospital deliveries). However, there is no correlation between deliveries in hospital buildings (clinical deliveries) and the stork population. The decline in the number of pairs of storks in the German state of Lower Saxony between 1970 and 1985 correlated with the decrease of deliveries in that area. The nearly constant number of deliveries from 1985 to 1995 was associated with an unchanged stork population (no statistical significance). However, the relevance of the stork for the birth rate in that part of Germany remains unclear, because the number of out-of-hospital deliveries in this area is not well documented. A lack of statistical information on out-of-hospital deliveries in general is a severe handicap for further proof for the Theory of the Stork.Paediatric and Perinatal EpidemiologyVolume 18 Issue 1, Pages 88 - 92Published Online: 22 Jan 2004http://www3.interscience.wiley.com/journal/118774766/abstract?CRETRY=1&SRETRY=0
- #15 The intervention increases the risk for the measured outcome.For example adrenaline will increase heart rate.
- #16 The intervention reduces the risk for the measured outcome.For example betablocker andheartrate
- #17 Correlation can be caused by chance, but if there is good randomization, a higher number of tests will make the chance that the correlation seen is simply caused by chance.Also point out that no correlation would mean a Relative Risk of 1: which means that there is no difference to have the risk or not in respect to the measured outcome.
- #18 Correlation does not imply causation