Phar 1821 (2022) week 1 lecture note
Week 1 – Information sources for pharmacists (Evidence based practice)
LO - describe ‘Evidence Based Medicine’
- formulate a research question
- distinguish between primary, secondary, and tertiary resources
- develop a suitable search strategy for an enquiry
- gain an understanding of how to grade evidence
- have an awareness of key types of evidence
Evidence - the conscientious, explicit and judicious (showing good judgment)
Based use of current best evidence in making decisions about the care of
Medicine individual patients.
(EBM) - an approach to decision making in which the clinician uses the best
scientific evidence available, in consultation w/ the patient, to
decide upon the option which suits the patient best.
- The practice of EBM req the integration of individual clinical
expertise + w/ the best available external clinical evidence from
systematic research & our patient’s unique values and
circumstances.
EBM vs. EBP
EBM EBP
- careful & meticulous use of - integrates individual clinical
up-to-date evidence in the expertise w/ the best
decision-making process available clinical evidence
regarding individual patient obtained from systematic
care research
- decision-making done by
professionals + in
consultation w/ a patient
(participation of patients
inv!)
- “shared” decision-making
- today, it’s keener towards
“patient-centred care”
EBP - current, systematic review of the science
Components - integrate science w/ clinician’s experience
- active & informed participation by the patient
Research 1. Identify the problem/patient --- P
Questions 2. Define the intervention --- I
(PICO) 3. Consider a comparison (or control) --- C
4. Define the outcome (what is the desired outcome?) --- O
, Example:
Given problem: Your next patient is a 72-year-old woman with
osteoarthritis of the knees and moderate hypertension (elevated BP),
accompanied by her daughter, a lab tech from the hospital. The daughter
wants you to give her mother one of the new COX-2 inhibitors. She has
heard that they cause less GI bleeding. Her mother is concerned that the
new drugs will mean more out of pocket costs each month.
Fyi:
- COX-2 inhibitor is a newer type of NSAIDS
- Celecoxib is a COX-2 enzyme inhibitor
- Celebrex is a generic brand/drug of Celecoxib
- COX-1 inhibitor – increases bleeding after constant use
PICO example for this problem:
P = 72-year-old woman w/ osteoarthritis of the knee & moderate
hypertension
I = COX-2 inhibitor
C = other NSAIDS
O = less GI bleeding while maintaining pain control
Research Question:
In a 72-year-old woman w/ osteoarthritis of the knee, can COX-2 inhibitor
use decrease the risk of GI bleeding compared with other NSAIDs?
Ibn Sina Aka Avicenna
(981 – 1037)
-the drug must have specific mode of action
-it must be tested on a well-defined single disease
-the time of action must be observed
-the effect of the drug must occur constantly and not transient
(temporary)
- testing a drug on a lion or a horse might be DIFFERENT from its
effect on MAN
James Lind – a Scottish physician, on board of HMS Salisbury, divided 12 sailors w/ scurvy
1797 into 6 groups of 2 sailors and given one of the following treatments:
- cider
- Elixir, vitrol
- vinegar
- sea water
- nutmeg + a mixture of garlic & mustard
- Fresh fruit (2 oranges and 1 lemon daily for 6 days)
Week 1 – Information sources for pharmacists (Evidence based practice)
LO - describe ‘Evidence Based Medicine’
- formulate a research question
- distinguish between primary, secondary, and tertiary resources
- develop a suitable search strategy for an enquiry
- gain an understanding of how to grade evidence
- have an awareness of key types of evidence
Evidence - the conscientious, explicit and judicious (showing good judgment)
Based use of current best evidence in making decisions about the care of
Medicine individual patients.
(EBM) - an approach to decision making in which the clinician uses the best
scientific evidence available, in consultation w/ the patient, to
decide upon the option which suits the patient best.
- The practice of EBM req the integration of individual clinical
expertise + w/ the best available external clinical evidence from
systematic research & our patient’s unique values and
circumstances.
EBM vs. EBP
EBM EBP
- careful & meticulous use of - integrates individual clinical
up-to-date evidence in the expertise w/ the best
decision-making process available clinical evidence
regarding individual patient obtained from systematic
care research
- decision-making done by
professionals + in
consultation w/ a patient
(participation of patients
inv!)
- “shared” decision-making
- today, it’s keener towards
“patient-centred care”
EBP - current, systematic review of the science
Components - integrate science w/ clinician’s experience
- active & informed participation by the patient
Research 1. Identify the problem/patient --- P
Questions 2. Define the intervention --- I
(PICO) 3. Consider a comparison (or control) --- C
4. Define the outcome (what is the desired outcome?) --- O
, Example:
Given problem: Your next patient is a 72-year-old woman with
osteoarthritis of the knees and moderate hypertension (elevated BP),
accompanied by her daughter, a lab tech from the hospital. The daughter
wants you to give her mother one of the new COX-2 inhibitors. She has
heard that they cause less GI bleeding. Her mother is concerned that the
new drugs will mean more out of pocket costs each month.
Fyi:
- COX-2 inhibitor is a newer type of NSAIDS
- Celecoxib is a COX-2 enzyme inhibitor
- Celebrex is a generic brand/drug of Celecoxib
- COX-1 inhibitor – increases bleeding after constant use
PICO example for this problem:
P = 72-year-old woman w/ osteoarthritis of the knee & moderate
hypertension
I = COX-2 inhibitor
C = other NSAIDS
O = less GI bleeding while maintaining pain control
Research Question:
In a 72-year-old woman w/ osteoarthritis of the knee, can COX-2 inhibitor
use decrease the risk of GI bleeding compared with other NSAIDs?
Ibn Sina Aka Avicenna
(981 – 1037)
-the drug must have specific mode of action
-it must be tested on a well-defined single disease
-the time of action must be observed
-the effect of the drug must occur constantly and not transient
(temporary)
- testing a drug on a lion or a horse might be DIFFERENT from its
effect on MAN
James Lind – a Scottish physician, on board of HMS Salisbury, divided 12 sailors w/ scurvy
1797 into 6 groups of 2 sailors and given one of the following treatments:
- cider
- Elixir, vitrol
- vinegar
- sea water
- nutmeg + a mixture of garlic & mustard
- Fresh fruit (2 oranges and 1 lemon daily for 6 days)
