1st lecture / module Flashcards
Definition of EBP
EBP is the integration of clinical expertise,
patient values, and the best research
evidence into the decision-making process
for patient care.
Components of EBP: A Framework for Clinical
Decision-Making
▪Includes multiple perspectives:
* Best available research evidence
* Clinical expertise
* Patient values and preferences
All three elements are equally important!
Why is EBP important?
▪ According to DukeHealth, EBP is important for reasons as follows:
* Medical knowledge and accepted practice change rapidly.
* Volume of research articles is expanding exponentially.
* Integrating the evidence into practice regularly makes it easier to find
and apply the evidence during busy clinical schedules.
* EBP allows you to blend patients’ preferences with the research,
resulting in patient-centered care.
https://tutorials.mclibrary.duke.edu/ebpintro/
▪ Institute of Medicine (IOM) estimated that
* One-third (~33%) of healthcare spending is for therapies that do NOT
improve health;
* Fifty percent (50%) of the healthcare practices are of unknown
effectiveness, and
* Fifteen percent (15%) are potentially harmful or unlikely to be
beneficial.
▪ The Institute of Medicine (IOM) documented significant
gaps between
* “what we know” and “what we do”
* the cares people “should” and “actually” receive
* “published evidence” and “healthcare practice”
EBP is a Paradigm Shift.
The Former Paradigm:
Tradition-based practice
The following are sufficient grounds to
guide clinical practice
▪ Tradition
▪ Authority
▪ Evidence based upon
unsystematic observations from
clinical experience (anecdotal),
clinical training, and common
sense
The New Paradigm:
Evidence-based practice
▪ De-emphasize intuition, unsystematic
clinical experience, clinical training
and common sense as sufficient
grounds for practice
▪ Stress the examination of evidence
from patient-centered clinical
research
Scientific Method is defined as
“a systematic, empirical, and controlled critical
examination of hypothetical propositions about the
assumptions among natural phenomena.”
The nature of research is
- systematic, a logical sequence from the
identification of a problem to interpretation of
findings, via the organized collection and objective
analysis of data - empirical, the necessity for documenting objective
data through direct observation, thus minimizing
bias - controlled critical examination, subject findings to
empirical testing and to the scrutiny of others
the nature of research has 3 things associated with it
systematic, empirical, controlled critical examination
Types of Research
basic and applied (clinical) research
- Basic research is directed toward the
acquisition of new knowledge. - Applied (clinical) research advances
the development of new diagnostic
tests, drugs, therapies and prevention
strategies, answering questions with
direct clinical application.
✓Explanatory,
✓Exploratory, and
✓Descriptive research
Basic research
directed toward the
acquisition of new knowledge
Applied (clinical) research
advances
the development of new diagnostic
tests, drugs, therapies and prevention
strategies, answering questions with
direct clinical application.
✓Explanatory,
✓Exploratory, and
✓Descriptive research
Step 1: Ask a Clinical Question
Background questions
etiology or general knowledge about a
patient’s condition e.g.,
* What are the clinical signs of measles infection?
* How many people are affected by migraine headache?
* What is the pathology of Parkinson’s disease?
* Is frozen shoulder common in patients with type 2 diabetes?
Step 1: Ask a Clinical Question
Foreground questions
ask for specific knowledge to inform clinical
decisions about patient management in a PICO format
▪ Population or Problem
▪ Intervention (Exposure or test)
▪ Comparison (if relevant; meaning optional! not always available)
▪ Outcome
What is PICO?
Patient
* Who is involved? What is the problem?
▪ Intervention
* Which main intervention are you going to apply?
▪ Comparison (Optional)
* What is the alternative treatment? Don’t always have one!
▪ Outcomes
* What are you trying to do for the patient? e.g., improve function;
relieve pain; long-term abstinence from smoking; etc.
* e.g., decreased incidence of fall (specific ) vs. better quality of life (generic)
Your question can be framed in either format
(Yes/No or WH)
- Is Intervention X more effective than Intervention Y
in achieving Outcome Z in a specific
Patient/Population? OR - For a specific [Patient / Population], which
intervention, [between Interventions X and Y] is more
effective in providing [Outcome Z]?
Sources of Clinical Questions
▪ Diagnosis and measurement
▪ Prognosis
▪ Intervention
▪ Patient experiences
