Evidence Based Practice MMR Vaccine Who Has Concerns About the Safety of This Vaccine?

  • Published on
    28-Mar-2015

  • View
    213

  • Download
    1

Transcript

  • Slide 1

Slide 2 Evidence Based Practice Slide 3 MMR Vaccine Who Has Concerns About the Safety of This Vaccine? Slide 4 MMR Vaccine Who Would Be Able to Discuss All of the Issues of This Vaccine With Concerned Parents? Slide 5 The steps 1. Convert the information needs into answerable questions 2. Find the best evidence 3. Critically appraise that evidence for its validity and usefulness 4. Apply the results 5. Evaluate the performance Slide 6 Where Clinical Questions Arise From: Clinical findings Aetiology: Differential diagnosis: Diagnostic tests: Prognosis: Therapy: Prevention: Self-improvement: Slide 7 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building example Slide 8 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? example Slide 9 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? example Slide 10 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? example Slide 11 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? Ask What can I accomplish? or What could this exposure really affect? example Slide 12 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? Ask What can I accomplish? or What could this exposure really affect? example In healthy 1 year old infants Slide 13 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? Ask What can I accomplish? or What could this exposure really affect? example In healthy 1 year old infants Does giving combined MMR vaccine Slide 14 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? Ask What can I accomplish? or What could this exposure really affect? example In healthy 1 year old infants Does giving combined MMR vaccine When compared to not giving Slide 15 The four elements of well built clinical questions: Patient or problem InterventionComparison intervention outcome Tips for building Starting with your patient ask how would I describe a group of patients similar to mine? Ask: Which main intervention am I considering? Ask What is the main alternative to compare with the intervention? Ask What can I accomplish? or What could this exposure really affect? example In healthy 1 year old infants Does giving combined MMR vaccine When compared to not giving Lead to increased incidence of autism? Slide 16 A mother you see is reluctant to give her child the MMR vaccine because of current concerns that it may harm her child write three questions (at least) in pairs that this scenario presents for you. Slide 17 My questions 1. What are the benefits of giving mmr vaccine to a child at 1 year of age? 2. What risks of giving the vaccine have been identified? 3. Has an absolute risk for each scenario been published i.e. risk of harm if MMR not given versus risk of harm if MMR given? 4. Is there evidence of a link between MMR vaccine and autism? How do you show that an event is causally related with another event, (What is the difference between association and causation?) Slide 18 Slide 19 Judgement of a Cause Effect Relationship Strength of the association Biological credibility Consistency with other investigations Time sequence Dose response relationship