Chapter 5 Flashcards
research evidence with clinical expertise, patient values, and clinical circumstances, to inform clinical decisions.
Evidence-based practice
Five A’s of EBP
•Ask
•Acquire
•Appraise
•Apply
•Assess
Step 1: Ask a Clinical Question
Background questions: Who, what, where, when, how, or why
Foreground questions: PICO format
‒Population or Problem
‒Intervention (Exposure or test)
‒Comparison (if relevant)
‒Outcome
Sources of Clinical Questions
●Diagnosis and measurement
●Prognosis
●Intervention
●Patient experiences
Are measures of peripheral sensation valid for assessing peripheral neuropathies in patients with type 2 diabetes?
Is an example of
Diagnosis
In patients with type 2 diabetes who have peripheral neuropathy, which measure of balance will provide the best assessment to predict falls?
Is an example of
Measurement
In patients with type 2 diabetes, how does an HbA1C of 7.5 influence disease progression?
Is an example of
Prognosis
In patients with type 2 diabetes who experience a frozen shoulder, will a corticosteroid injection be effective to improve shoulder function?
Is an example of
Intervention
In patients with type 2 diabetes, what factors contribute to a lack of adherence to a medication regimen and exercise?
Is an example of
Patient experiences
Step 2: Acquire Relevant Literature
●Types of studies depend on the clinical question
●Synthesized evidence: Systematic reviews, Meta-analyses, Clinical practice guidelines, Scoping review
How many levels of evidence are there
5
Levels of evidence are based on
Clinical question
Relative hierarchy of levels of evidence can be
graded up or down based on study quality
Level 1 example of evidence
Systematic reviews
Level 2 example of evidence
RCTs, observational studies with strong designs
Level 3 example of evidence
Study designs with poor control of bias, such as retrospective cohorts
Level 4 example of evidence
Descriptive studies such as case series
Level 5 example of evidence
Mechanistic reasoning
Step 3 in process of EBP
Appraise the Literature
Appraise the Literature has 3 primary questions
Three primary questions:
●Is the study valid?
●Are the results meaningful?
●Are the results relevant to my patient?
Step 4 in EBP
Apply the evidence
Applying the evidence involves
●Putting it all together to inform a clinical decision
•Evidence
•Clinical expertise
•Patient values
•Clinical circumstances
●How well does the evidence fit your patient?
Step 5 in EBP
Assess Effectiveness of Evidence
Assess Effectiveness of Evidence involves questions such as
●Did the patient improve?
●Is additional evidence needed?
●Do additional questions need to be answered?
Barriers to Implementation
●Lack of critical appraisal skills
●Access to the literature
●Lack of time
●Lack of resources
●Strategies to address barriers
involves the adaptation of quality research into relevant priorities
Knowledge Translation
Relates to the long-standing problem of underutilization of evidence.
Knowledge translation
Knowledge-to-Action Framework involves what 3 things
●Inquiry
●Synthesis
●Development of Tools
