`

PHARMACOLOGY
1.1B CLINICAL PHARMACOLOGY
CLINICAL PHARMACOLOGY
Bridging the gap of laboratory diagnosis and medical practice

MAIN OBJECTIVE
Promote the safety of prescription
Maximize the drug effect
Minimize side effects

CLINICAL PHARMACOLOGY

Discovery of new target molecules

Effect of drug usage in whole population
Ex. Insulin

CLINICAL PHARMACOLOGY
Medical and scientific training
Enables to evaluate evidences
Produce a well-designed studies

EVIDENCE BASED MEDICINE

Process by which clinical decisions are made using:
Best research evidence
Clinical expertise
Patients Values and Preferences

Evidence Based Practice (EBP)

Evidence Based Clinical Practice (EBCP)
Evidence based Health Care (EBHC)
Evidence Based Nursing (EBN)

Include methodologies that reduce the potential for bias

(randomization & blinding) and allow for comparison between
intervention and control groups.
Is an experiment and can provide sound evidence of cause and
effect.
Randomly assigns exposures and then follows patients forward
to an outcome.
Sound evidence of cause and effect
Exposure at random -> Outcome
SYSTEMATIC REVIEWS
Usually focus on a clinical topic and answer a specific question.
An extensive literature search is conducted to identify studies
with sound methodology.
The studies are reviewed, assessed, and the results
summarized according to the predetermined criteria of the
review question.
Thoroughly examine a number of valid studies on a topic and
combines the results using accepted statistical methodology to
report the results as if it were one large study. The Cochrane
Collaboration has done a lot of work in the areas of systematic
reviews and meta-analysis
1972 First RCT Prevention of prenatal death by
antenatal corticosteroid therapy for fetal maturation

Aka:
1991
Meta analysis: Steroids lower death risk
with 30-60%

Translating research into practice

PROCESS
Identify a practice issue
Formulate an answerable question

Ex. Why are we doing this?, Can we produce better outcome with greater
consistency

Search for best evidence

Critically evaluate the evidence and clinical relevance

Make recommendations
Apply to clinical practice

Evaluate impact/effectiveness/outcomes
5 AS OF EBP PROCESS

Analyze
Ask
Acquire
Appraise
Apply

CRITICALLY EVALUATING RESEARCH

TYPES OF STUDIES
Case series and case reports
Case control studies
Cohort studies
Randomized, controlled clinical trials
Systematic Review
Meta-analysis

STRENGTH OF THE EVIDENCE

Level I systematic review, meta-analysis, well designed
RCTs (gold standard) Level VII opinion

PICO(T)
P = Patient of problem
I = Intervention, prognostic factor, or exposure
C = Comparison
O = Outcomes
(T) = Type of study

CLINICAL PRACTICE GUIDELINES

Acute Stroke Treatment
BPH
Cancers: Breast, Cervical, Colon
Hypertension
Pneumonias (CAP, Hospital Acquired)
Rabies
Urinary Tract Infections

SUMMARY
Reduce variations in practice
Improve the quality of care provided
Maintain or improve patient outcomes
END OF TRANX

CASE SERIES / CASE REPORTS

Collections of reports on the treatment of individual patients or
a report on a single patient
No control groups with which to compare outcomes, so limited
statistical validity

CASE CONTROL STUDIES

With specific problem vs. Without
Outcome -> Possible exposure

COHORT STUDIES
Exposure / Treatment -> Outcome

No exposure/Treatment -> Outcome

RANDOMIZED, CONTROLLED CLINICAL TRIALS

Carefully planned projects that introduce a treatment or
exposure to study its effect on patients.
Page 1 of 1