Evidence Based Practice

MMR Vaccine

Who Has Concerns About the Safety of This Vaccine?

MMR Vaccine

Who Would Be Able to Discuss All of the Issues of This Vaccine With

Concerned Parents?

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

Where Clinical Questions Arise From:

• Clinical findings • Aetiology: • Differential diagnosis: • Diagnostic tests: • Prognosis: • Therapy: • Prevention: • Self-improvement:

The four elements of well built clinical questions: Patient or problem

Intervention Comparison intervention

outcome

Tips for building

example

The four elements of well built clinical questions: Patient or problem

Intervention Comparison intervention

outcome

Tips for building

Starting with your patient ask “how would I describe a group of patients similar to mine?”

example

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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

The four elements of well built clinical questions: Patient or problem

Intervention Comparison 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?

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.

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?)

Judgement of a Cause – Effect Relationship

• Strength of the association

• Biological credibility

• Consistency with other investigations

• Time sequence

• Dose – response relationship