Appraising the Evidence Flashcards
Best Practice…take into consideration:
research evidence(clinically relevant) expert opinion organizational needs patient preferences situation
Decision making: uncertainty…
the degree to which a number of alternatives are perceived with respect to the occurrence of an event and the relative probability of these alternatives”
decision making
adopt or reject alternatives
pilot studies
- To determine value for adoption
- To reduce uncertainty
- To increase assurance
- To save costs
- To enhance “buy-in”
rejection strategies
active
after pilot
active decision to not adopt change
rejection strategies
passive
non-decision
continue in status quo
appraisal strategies
- Quality
- Strength
- Significance
- Relevance
Five step approach
ask
is the research question well constructed to elicit a response or solution
five step approach
acquire
search the literature for pre-appraised evidence or research of highest quality available
five step approach
appriase
critical appraisal to determine validity and applicability
five step approach
apply
institute reasonable recommendations to practice
five step approach
assess
evaluate outcomes from a nursing practice framework
general appraisal of individual studies
review of the literature
- Problem clear and concise
- Sufficient background material
- Significance evident
- Purpose clear
- Clear definitions
- Assumptions clear
- Question or hypotheses clear
- Theory based?
individual studies continued:
review of the literature
- Relevant
- Adequate
- Organized
- Synthesized
- Critical appraisal of major references
- Summary
- Implications
- Adequately documented
individual studies continued
methods appropriate to question and purpose
- Correct design
- Human subjects
- Clear and logical data collection process
- Appropriate instruments
* Reliable and valid - Sampling method appropriate
* Population appropriate
* Adequate sample
* Attrition clarified - Controls for internal validity of design
- Limitations of external validity of design
Individual studies continued
results
- Clear data presentation
- Demographics described
- Analysis methods appropriate
- Summarization in charts, tables, graphs
individual studies continued
discussion
- Results based on the data
- Sufficient evidence for conclusions
- Consistent with problem, purpose, questions, design methods, and data analysis methods
- Clear conclusions
- Generalizations appropriate
- Limitations admitted
- Contribution to nursing knowledge
appraisal of meta analyses
- Do all studies fit the question
- Inclusion of both published and unpublished evidence
* lab notes, pilot studies - Systematic nature of selection
- Adequate number
- Merged statistical findings
appraisal of randomized control trials
- Examines treatment effects
* The greater the treatment effect, the better the treatment - Large samples from multiple sites
- Multiple control strategies
- Examine for bias
- Applicable results
cohort studies
retrospective or prospective correlational designs
- Comparison groups with similar risk factors
- Determine past behavior related to the risk factors (retrospective) or how risk factor leads to outcome of interest (prospective)
cohort studies
retrospective or prospective quasi experiemental design
- Comparison groups with similar risk factors
- Able to add an intervention or an intervention has been added in the past
- Determine how previous intervention has affected occurrence of outcome of interest (retrospective) or occurrence of outcome of interest after intervention occurs (prospective)
case control study
retrospective or prospective correlational design
- Compare cases who have an outcome of interest
* Why they arrived at that outcome (retrospective study) or how the outcome progresses in the future (prospective study)
case studies
descriptive
- No IV and DV
- No manipulation or randomization
- Use descriptive statistics
- Cross sectional or longitudinal
- Correlations (looks for similarities)
- Non-experimental designs (looks for differences)
qualitative
appropriate methods
- Design
- Sample
- Analysis
- Results
rapid critical appraisal
brief review
are the results of the study valid
- Consider appropriateness of design selected
- Consider randomization, control, bias, instrumentation, sampling issues
- Consider threats to internal validity of design
rapid critical appraisal
brief review
what were the results?
- Consider appropriateness of statistics or qualitative methods
- Consider magnitude of impact and/or strength of relationships
rapid critical appraisal
brief review
will the results assist in caring for my patients?
- Consider external validity of design issues
- Consider relevance to organizational issues
- Consider relevance to patient issues
- Consider importance to outcomes
Ranking Evidence
Many hierarchies of ranked evidence
Most have a medical model focusing on clinical significance:
- Diagnosis
- Therapeutic impact
- Prognosis
- Causation
Synthesizing the evidence:
first, sythesize the amount and type of support for the recommendation
determine the strength of your support:
another example for a new treatment intervention
grading the evidence
evaluate teh quality of the evidence
recommendation chart
determine your recomendation
make the recommendation
•Based on amount, quality, and findings from the available evidence, make a recommendation.
Clinical guidelines
- “A unit of knowledge derived from the basis of a review of the current state of scientific evidence”
- Based on current literature
- Does not take into account specific situations or specific patient needs
* General and not specific - AGREE-II form standardizes how guidelines are developed
Agree-II format for guidelines
six domains
scope and purpose of the guidelines stakeholder involvement rigor of development clarity and presentation applicabiltiy editorial independence
Agree-II format for guidelines
six domains
scope and practice of the guideline
purpose, aims, questions, population
Agree-II format for guidelines
six domains
stakeholder involvement
meets the needs of the intended users
Agree-II format for guidelines
six domains
rigor of development
gathering, sythesizing, and examination process
Agree-II format for guidelines
six domains
clairity and presentation
clear format
Agree-II format for guidelines
six domains
applicability
behavior, cost, and organizational consequences
Agree-II format for guidelines
six domains
editorial independence
conflicts of interest
