Home' Australian Pharmacist : Australian Pharmacist October 2012 Contents 806 Australian Pharmacist October 2012 I © Pharmaceutical Society of Australia Ltd.
SUPPORTING PHARMACY PRACTICE
A good understanding of the basis of
EBM is essential for any pharmacist
working in the modern health care
system. Treatments change rapidly and
everyday new medications and the
best evidence for care changes. It is
impossible to keep up but it is possible
to know where to look for information
and to have a set of steps you can use
to evaluate that evidence to ensure
that it is appropriate for your patients.
1. Which of the following factors
does an EBM approach take into
a) Individual clinical expertise.
b) External clinical evidence.
c) Patient preferences and values.
2. Which of the following does
NOT discriminate between huge
treatment effects and trivial ones?
3. Which of the following study types
would be considered to provide the
HIGHEST level of ‘evidence’?
a) Cohort study.
b) Systematic review of randomised
c) Case control study.
d) Single randomised controlled trial.
e) Personal experience.
4. Which of the following is a question
about the validity of a study?
a) Are there confounding factors that the
author(s) failed to consider?
b) Is the effect demonstrated significant?
c) Will the results be applicable to 40–50
year old patients in my local area?
d) How confident are we that the results
didn’t happen by chance alone?
Needed to Treat
Table 4: Example of risk rates for various experimental and control groups
experiences of the clinician to best utilise
the information for the medical literature
to treat the patient, it also means that
as health professionals we need to
understand that it is our role to explain
to our patients ‘evidence’ (or not) for the
treatments they will receive. In pharmacy
much of the ‘evidence’ we speak of is in
terms of adverse events associated with
treatments e.g. uncommon, rare etc.
However, we also need to think about
how we communicate the evidence
for treatments e.g. NNT or for that
matter the Numbers Needed to Harm
(NNH) for a therapy versus RR, RRR or
even ARR. For example, if we consider
Table 4, you would probably consider
a medication that you give you a 37%
relative risk reduction in your chance of
getting cancer. But would you take it if
I told you that 1,667 patients would need
to take it for one year to have one patient
not get cancer – are you that one patient?
National Collaborating Centre for Methods and Tools. Critical
appraisal tools to make sense of evidence. Hamilton, ON: McMaster
University. 2011. At:www.nccmt.ca/registry/view/eng/87.html
Giacomini M, Cook D for the Evidence-Based Medicine Working
Group. Users’ Guides to the medical literature, XXIII: qualitative
research in health care. Are the results of the study valid? JAMA
Bandolier Evidence based thinking about health care. At: .www.
Evidence-Based Medicine (Online Journal). At: http://ebm.
Clinical Evidence. At: www.clinicalevidence.com
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Many stroke survivors are at increased
risk of developing depression and up to
two-thirds of people who have a stroke
During national Stroke week last month
the link between stroke and depression
was highlighted with the release by
beyondblue of a free DVD and fact sheet.
Kate Carnell AO, CEO of beyondblue,
said that depression can often go
unrecognised and undiagnosed in people
who have had a stroke because the
two disorders have many symptoms in
common such as problems with memory,
difficulty controlling emotions, mood
The Tackling depression after stroke DVD,
developed with the National Stroke
Foundation, features interviews with
stroke survivors, their families and
their carers, and a psychiatrist who all
speak candidly about how depression
commonly affects stroke survivors and
their carers. It also provides helpful
insights for people who have experienced
stroke and is useful to GPs, counsellors
and other health professionals. It also
features an interview with a psychiatrist
who talks about the signs of depression
after stroke and effective treatments.
To order the free DVD, fact sheet on stroke
and depression, or information to support
carers, go to: www.beyondblue.org.au
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