HIEBP_Lecture 1 Introduction and Overview 18_Jan _2024 - Tagged.pdf

MBBS Stage 1 Genes, Behaviour and Environment Health Informatics and Evidence Based Practice Professor Patrick White School of Life Course and Population Sciences  At the end of this lecture you will have covered: What is evidence-based practice* The hierarchy of evidence in clinical pra...

MBBS Stage 1 Genes, Behaviour and Environment Health Informatics and Evidence Based Practice Professor Patrick White School of Life Course and Population Sciences  At the end of this lecture you will have covered: What is evidence-based practice* The hierarchy of evidence in clinical practice* The electronic patient record* Big data* What is implementation science* The National Institute for Health and Care Excellence* What is meant by Precision Medicine  Health Informatics and Evidence-Based Practice 18th Jan Health Informatics and Evidence–Based Patrick White 11.00am Practice Introduction and overview 18th Jan Implementation Science Patrick White HIEBP 14:00 19th Jan Evidence-Based Practice Patrick White 09:00 19th Jan When evidence-based practice is not Patrick White 10:00 implemented 19th -26th Tutorial: When evidence-based practice Patrick White Jan is not implemented  Health Informatics and Evidence-Based Practice 27th Jan Clinical Decision Support Systems Dr Iain Marshall HIEBM 15:00 27th Jan Big Data Technologies in Health Professor Vasa 16:00 Curcin Health Informatics and Evidence Based Practice Health Informatics and Evidence Based Practice  Evidence-based medicine Computers Electronic patient record Among the major changes in medicine: Authority and experience replaced by Evidence-Based Medicine The computer in and outside the clinical consultation The electronic patient record as an active partner in the consultation  What is evidence-based medicine? Sackett and colleagues, McMaster University, Ontario “Evidence-based medicine is the conscientious explicit and judicious use of evidence in making decisions about the care of individual patients” Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-2.  Why was this ground-breaking? Challenge to three fundamental precepts: Clinical Freedom “I know my patient and I know what is best for her” Doctor knows best “Trust me, ground up nutmeg is very effective in preventing flu, but you must take it every day” Established practice “Best to let the child sweat it out”; ”cigarettes really help my chest in the morning” Some evidence aphorisms Absence of evidence is not evidence of absence The fact that an opinion is widely held is no evidence at all that it is not absurd Facts are stubborn things. Whatever our inclinations, our wishes or the dictates of our passions, they cannot alter the facts and the evidence.  How do we synthesise information into evidence? Collecting, categorizing, sifting, testing, summarizing Hypothesis generating and experimenting Replicating experiments Randomised controlled Trials Hierarchy of Evidence  The randomized controlled trial- RCT RCT – experiment to reduce bias when testing the effectiveness of new treatments random allocation of subjects to two or more groups treat them differently, compare them with respect to a measured response the experimental group—receives the intervention being assessed the control group—receives an alternative treatment, such as a placebo the groups are monitored to determine the effectiveness of the experiment intervention, comparing the experimental to the control.  The stages of evidence development Perception of need Hierarchy of need – minor irritation to life threatening event Anecdotal reports Early experiments High quality evidence Multidisciplinary review Guideline endorsement Implementation Hierarchy of Evidence Electronic Patient Record Electronic Patient Record 1 Electronic Patient Record 2 Electronic Patient Record General Practice Record Internal links - prescriptions, diagnostic categories, screening, surveillance Clinical decision support systems – CDSS Learning Health System – AI / Machine Learning Etiquette of consulting with a computer screen  The electronic patient record Interrogation of millions of patient records to answer questions never thought possible – Big Data BIG DATA The definition of big data is data that contains greater variety, arriving in increasing volumes, more velocity and high veracity or quality. These are the four Vs of big data. Put simply, big data is larger, more complex data sets, especially from new data sources. These data sets are so voluminous that traditional data processing software just can’t manage them. But these massive volumes of data can be used to address business problems you wouldn’t have been able to tackle before.  The electronic patient record Interrogation of millions of patient records to answer questions never thought possible – Big Data Antibiotics are associated with increased risk of non-infectious disease - carcinoma of bowel, rheumatoid arthritis Probably through effect on the microbiome in the bowel Armstrong et al British Journal Cancer 2020  Can antibiotics increase risk of disease Increasing evidence of the role of the bowel microbiome in regulating the immune response. Do antibiotics disturb the good functioning of the microbiome by changing the bacterial composition and balance? Might antibiotics increase the risk of carcinoma of bowel, rheumatoid arthritis Probably through effect on the microbiome in the bowel Armstrong et al British Journal Cancer 2020  The context of evidence A holistic approach Drawing together evidence from patients, researchers, clinicians, statisticians, and others Awareness of increasing importance of computing Awareness of speed with which knowledge, understanding and evidence are changing COVID-19 BIG DATA NICE National Institute for Health and Care Excellence NICE NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. The National Institute for Clinical Excellence was established in 1999 as a NHS Special Authority. In 2005 it was expanded to include the public health functions of the Health Development Agency to become the National Institute for Health and Clinical Excellence In 2013 it become the National Institute for Health and Care Excellenceand cover social care. It left the NHS to become a non departmental public body. NICE What is next in applying evidence? Current paradigm is the application of evidence to groups of people Asthma guidelines, for example, direct us to the best treatment for people with asthma Can we hope for a treatment designed for the particular patient not the patient group? Targeting treatment to the individual has been called precision medicine or personalized medicine. The term precision medicine is becoming more established. Precision medicine - a shifting paradigm Pharmacogenomics – pharmacology and genetics How do genes affect a person’s response to particular drugs? Can we identify biomarkers that point to the greater efficacy of particular drugs for the particular patient? It is not clear if this approach will lead to a radical shift in the practice of medicine in the near future Big Data, computer algorithms, artificial intelligence, machine learning, hold out the hope that precision medicine will be possible. Implementation Science Implementation science can be defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence- based practices into routine practice, and, hence, to improve the quality and effectiveness of health services” What to do after convincing evidence shows that a new intervention will bring important rewards? Implementation In summary What is evidence-based practice* The hierarchy of evidence in clinical practice* The electronic patient record* Big data* What is implementation science* The National Institute for Health and Care Excellence*