The document discusses a collaboration between Prof Arif Khwaja of the Sheffield Kidney Institute and Prof Meguid El Nahas of the Global Kidney Academy called the "Double Act". It also discusses the Sheffield Kidney Institute from 2001 to 2018 and presents the "5 Whats" framework for critically appraising evidence including considering what an intervention is for, the validity of evidence, relevance/utility, risk-benefit ratio, and cost-benefit ratio. There are repeated references to thinking critically and the "5 Whats" framework.
8. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
9. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
10. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
14. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
15. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
17. Sheffield Kidney Institute
5Whats
• What is this intervention FOR?
• What is the Evidence: VALIDITY ?
• What is the Relevance: UTILITY ?
• What is the RISK:BENEFIT?
• What is the COST:BENEFIT?
So lets go through the 5 WHATs, so that we learn them, memorise them and apply them throughout our course.
The first WHAT consist of asking WHAT is the intervention/test/investigation for….was it justified?
What was the primary endpoint of a RCT?
What were the secondary endpoints?
What did the study aim to achieve?
The first WHAT consist of asking WHAT is the intervention/test/investigation for….was it justified?
What was the primary endpoint of a RCT?
What were the secondary endpoints?
What did the study aim to achieve?
The second WHAT asks the very important question of What is the Evidence derived from the study?
What is the validity of a the study or the trial or the paper I am dealing with?
Is it of good quality?
Is it VALID?
By VALID, here we mean is it of good quality and does it fulfil good validity criteria that allows me to believe the data presented and subsequently quote it or use it in my clinical practice.
For instance, is the RCT on a given intervention in CKD valid or invalid; if it is of such quality that I judge it to be invalid, meaning unreliable and not providing good enough evidence, then I would not take its findings into consideration.
So the concept of VALIDITY that you need to understand and regularly apply as one of your benchmarks is very important.
The third WHAT refers to a question about the UTILITY or USEFULNESS of the facts and data you are studying.
Such data may be of high quality and passed the test of VALIDITY but may not be that useful after all.
It may not be relevant to your own practice; UTILITY in that case would be minimal to YOU.
USEFULNESS, refers more to whether the findings and data you are dealing with are truly clinically useful; for instance an intervention may be VALID and RELEVANT to your patient (Good UTILITY) but not applicable or USEFUL to your own clinical practice. The intervention may for instance not be available to you, your clinic or your country. The intervention may be of good UTILITY but when you come to apply it the NNT (Number Needed to Treat) may be so high and the benefit so minimal that it is not worth considering. In that case it is not CLINICALLY USEFUL and its TRNSLATIONABILITY, as far as your clinical practice is concerned minimal.
So UTILITY & USEFULNESS are slightly different concepts that relate to the APPLICABILITY of your you are dealing with in YOUR own clinical circumstances.
The fourth WHAT refer to RISK versus BENEFIT
An intervention can be very effective, the study is fully justified theoretically and the intervention much needed clinically, the study is VALID and of high quality, it is directly applicable to you and your patients (UTILITY/USEFULNESS), BUT:
The RISKS associated with such test/intervention/treatment are high compared to the benefits; in that case a RISK:BENEFIT analysis where the risk is higher that the benefit would let you re-consider whether it is justifiable or not?
An intervention can be of some benefits but is associated with a high risk of serious adverse events (SAE), in that caseyou would not use it or use it with certain precautions.
The fifth and last WHAT relates to the Pharmacoeconomics of a given test/intervention/treatment.
It may have fulfilled the previous 4 WHATS, but its cost is prohibitive.
In that case, even though the intervention is of undoubted benefits, its cost is so high that you cannot apply it or afford it.
This is a brief summary of the 5 WHATs that I would like you to apply to most of the activities you undertake throughout this NOC.
So REMEMBER the % WHATs and lets apply them.
