To determine value for adoption To reduce uncertainty To increase assurance To save costs To enhance “buy-in”

Quality Strength Significance Relevance

Appraising the Evidence Flashcards by Becky Appleton

Best Practice…take into consideration:

research evidence(clinically relevant)
expert opinion
organizational needs
patient preferences
situation

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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”

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decision making

adopt or reject alternatives

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pilot studies

To determine value for adoption
To reduce uncertainty
To increase assurance
To save costs
To enhance “buy-in”

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rejection strategies

active

after pilot

active decision to not adopt change

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rejection strategies

passive

non-decision

continue in status quo

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appraisal strategies

Quality
Strength
Significance
Relevance

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Five step approach

ask

is the research question well constructed to elicit a response or solution

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five step approach

acquire

search the literature for pre-appraised evidence or research of highest quality available

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five step approach

appriase

critical appraisal to determine validity and applicability

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five step approach

apply

institute reasonable recommendations to practice

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five step approach

assess

evaluate outcomes from a nursing practice framework

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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?

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individual studies continued:

review of the literature

Relevant
Adequate
Organized
Synthesized
Critical appraisal of major references
Summary
Implications
Adequately documented

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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

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Individual studies continued

results

Clear data presentation
Demographics described
Analysis methods appropriate
Summarization in charts, tables, graphs

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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