Ch 10 Flashcards
Need to develop skills that make using evidence a vital part of everyday clinical reasoning.
Familiarize yourself with the EBP resources that are available via the Internet.
◦Bookmark the sites that will help you quickly obtain the best information.
◦Learn how to use keywords.
Bennett and Bennett (2000). EBP is a process that involves clinical expertise, relevant research, colleague support, family and client choice. To integrate EBP into practice, clinicians must:
◦Ask a clinical question classified into diagnosis, treatment, prevention, or prognosis.
◦Formulate the question into P.I.C.O. (patient/disease, intervention, comparative intervention, outcome), and then search the literature.
Decide if the information you find is valid and clinically significant (critically appraise the literature).
Do the results apply to my client?
◦Does the treatment fit into my client’s values and preferences?
◦Do I have the resources to implement this treatment?
◦Do I have the training or skill necessary to implement these interventions
Evidence-Based Practice Barriers
◦Difficulty finding time to search for evidence, then appraise and implement it.
◦Lack of access to computers and journal articles that are needed to carry out EBP.
◦Lack of training about EBP and how to carry it out.
◦Limited quantity of evidence in specific practice areas.
◦Insufficient quality of evidence.
◦Research does not provide certainty since findings cannot be applied to individual patients.
◦Clinical research does not tell of client’s
Solution to Barriers
Solution 1: Support from Managers
Solution 2: Make EBP a Priority
Solution 3: All Stakeholders Needed
Solution 1: Support from Managers
◦Clinicians need the support of mangers and to be given access to necessary resources such as computers, journal access, and ongoing training
◦Haynes (1998) suggests that managers/organizations:
◦Produce guidelines for how to develop evidence-based clinical guidelines.
◦Use information systems that integrate evidence and guidelines with patient care.
◦Develop facilities and incentives to encourage effective care and better disease management systems.
◦Improve effectiveness of educational and quality.
◦Improve programs for practitioners.
Solution 2: Make EBP a Priority
Bennett and Bennett (2000):
◦Seek out continuing education opportunities.
◦Make use of EBP resources such as Web sites and journal clubs.
◦Participate in research evaluating interventions within your discipline.
◦Participate in or establish a journal club.
◦Seek out or contribute to evidence based clinical practice guidelines.
◦Negotiate work time to search and appraise research.
Solution 3: All Stakeholders Needed
◦Clinicians and Researchers must work together—create linkages.
◦Research professionals need to demand/emphasize the timely transfer of theoretical knowledge into practice.
◦Research studies should be carried out in the field to begin with to ensure relevancy of studies
Issues Related to Skill Level, Quality and Quantity of Evidence
Familiarize Yourself with the Numerous EBP Resources Available:
◦EBP directories/Web sites that give access to systematic reviews.
◦Methods that search, summarize, evaluate, and rank methodology and study implications.
◦Use search databases such as Pedro (that weed out inferior RCTs).
◦OTseeker, McMaster PLUS, and otevidence.info.
Critically Appraised Topics
◦Break the evidence search process into 5 parts:
- Translate these needs into answerable questions.
- Track down the best evidence to answer them.
- Appraise that evidence for its validity and applicability.
- Integrate that evidence with clinical expertise and apply
it in practice. - Evaluate the performance of the intervention.
5 Major Types of Critically Appraised Topics
(1)Diagnosis
(2)Prognosis
(3)Evaluating risk and harm in a case-control study
(4)Evaluating risk and harm in a cohort study
(5)Treatment, prevention, and screening
- Diagnosis/screening
Involves finding relevant studies that identify disease symptoms and assess the diagnostic accuracy of those symptoms.
◦If the symptom in question is present, how likely is it that the patient has the disease or condition?
◦Compare new diagnoses with the “gold standard
- Prognosis
Assesses the ability of a symptom to forecast probable outcomes (predict the future of a condition for one person).
- Risk and harm in case-controlled studies
◦Analyzes information on the presence of risk factors using a statistical technique called an odds ratio (OR)
