Protocol Development Insights from New 新协议开发的见解.pptVIP

Anaesthesia protocol development: Insights from National societies regarding new antiplatelets, new anticoagulants and haemostatic agents G Ogweno Dept Of Medical Physiology Kenyatta University Factors contributing to protocol based healthcare Cost pressures Technological advances Increase in management-led decision making Consumer awareness Value for money movement Availability of information Non-clinicians with the authority to question effectiveness International consensus Professional accountability Changing demographic profile Why protocols in anaesthesia? To ‘standadize’ medical care, increase quality , effectiveness, specificity, sensitivity, resoluteness and patient outcomes=clinical pathways ‘Experts’ best faith efforts to offer reasonable pathways for patient management To enhance best evidence based practice What are protocols? Special set of rules defining relationship=communication Based on current evidence Identify most important questions related to clinical practice, possible options and outcomes=decision points and course of action Identify, summarise, evaluate highest quality evidence, risk vs benefit and cost effectiveness Forms of protocols Summarized consensus statements on best practice Guidelines: diagnosis, treatment by national associations Clinical pathways Trials: clinical, research Levels of Evidence Hierachies of evidence Clinical trials I-well designed randomised controlled trials II-1a: well –designed controlled trials with pseudo-randomisation II-1b: well-designed controlled trials with no randomisation Cohort studies II-2a: well designed cohort (prospective) with concurrent controls II-2b: well designed cohort(prospective) with historical controls II-2c: well designed cohort (retrospective) with concurrent controls II-3: well designed case –controlled (retrospective) III- large differences from comparisons between times and/or places with or without intervention Iv-opinions of respected authorities based on clinical experience, des