EBP the process, CRAAP WK 3

Question 1

Provide small summary of EBP process (5 stages with defs for each)

Answer 1

Following sit down with client/gain understanding of symptoms;
1. Clinical question: convert info needs into focused questions out of care of client
2. Searching: efficiently searching for best evidence with which to answer the question
3. Evaluation: critically appraising evidence for validity/applicability (clinical usefulness)
4. Integration: applying results in clinical practice (client preferences, clinical expertise)
5. Self-evaluation: evaluating performance of evidence in clinical application (your performance with client)

Question 2

Describe clinical question. What is it’s use? What are it’s requirements?

Answer 2

convert info needs into focused questions out of care of client
-helps to focus what looking for to help clinical decision
-not too broad/too specific as impacts ability to find relevant items
-client driven but not specifically about client

Question 3

What is required for correct clinical questions

Answer 3

-relevant to case (not specific about cases personal info) i.e. who, which, outcome
-answerable by clinician gathering info (by assessment process usually)
-can be about assessment, prognosis, therapy, cause
-PICO framework (patient, intervention, comparison, outcome)

Question 4

Provide some examples of good clinical questions (PICO)

Answer 4

-Does Constraint-induced Aphasia Therapy (intervention) improve aphasia (outcome) in stroke patients (patient)?

-In kindergarteners (patient), is individual pull-out treatment (intervention) more effective than group pull-out treatment (comparison) for improving articulation disorders (outcome)?

Question 5

Describe distinction between knowledge gaps (EBP vs client specific)

Answer 5

both informs clinical practice/decision making

EBP-focuse on clinician core knowledge
-clinical Q posed to fill knowledge gaps/answerable by searching literature (research)

Client specific-info about client specifically
-clinician fills client-info gaps via assessment methods (collect case history/use test)
-all info comes under client factors

Question 6

Describe the searching step of EBP process

Answer 6

finding best evidence to answer clinical question
-relating to diagnosis/screening, prognosis
-therapy, journal articles, large databases, institutions devoted to EBF

Question 7

Define what is meant by evaluation in EBP process. Provide examples of where and what you may evaluate

Answer 7

information (journal articles, books) you found when searching must be critically appraised-evidence is not equal
-diagnosis and screening (validity and reliability)
prognosis (what outcomes, how likely, how long)
-therapy (validity, clinical importance, design of study)

Question 8

When a piece is more subjective and biased what is the effect. How can evidence be stronger?

Answer 8

more questionable=less quality

less bias=stronger evidence

Question 9

How is authorship/authority evaluated

Answer 9

-credentials (gives credibility in field) i.e. qualifications, experiences
-has been cited in other sources
-is there bias?

Question 10

How is purpose (of paper) evaluated

Answer 10

-what audience intended
-how readable is text
-inform, presents opinions, promote viewpoint, report research or sell product
-any biases?

Question 11

What should be evaluated (summary)

Answer 11

authorship, purpose, publisher, date of publication/currency, content and reliability

Question 12

How should publisher be evaluated for journals vs websites

Answer 12

journals
-academic institution, large org, non profit org
-publisher gives clues to reliability or bias
-peer reviewed?

websites
-who is target audience
-what does URL say (gov or org more reliable
-personal web pages hard to evaluate

Question 13

How to evaluate publication/currency

Answer 13

-when published
-what advances have occurred since first published
-should resources be current/are stats and facts recent enough

Question 14

How to evaluate content and reliability

Answer 14

-contains personal opinion? or documented fact
-can info be verified anywhere else
-is doc from published sources
-is it supported by evidence and appear valid

Question 15

Define external validity

Answer 15

extent to which sample reflect population in an accurate manner

Question 16

Gives light summary of evidence hierarchy

Answer 16

1. Experimental designs
   -systematic reviews
   -randomised control trials
2. Quasi-experimental designs
3. Observational/qualitative study
4. Observational/cross sectional
   -case studies
5. Expert opinion/lab research

Question 17

Describe curated evaluations of evidence

Answer 17

EBP guidelines, summary of highest available levels of evidence and giving direction for practice
-resources for speech pathologists, consumers, and funding bodies

Question 18

Describe rating systems for appraising evidence

Answer 18

critically appraise for reliability and validity
e.g. grading recommendations, assessments, development and evaluations

Question 19

Describe integrations as part of EBP process

Answer 19

applying results in clinical practice (client preferences, clinical expertise)
-identify relevant factors
-integrate all from previous steps to make clinical decision

Question 20

Describe self-evaluation as part of EBP process

Answer 20

evaluating performance of the evidence in clinical application (your performance with this client)
-To find the information I needed to answer my question
-To critically appraise the literature
-To clinically problem-solve
-To integrate with client and other factors
-What did I learn in the process?
-What can I do better next time?

Question 21

Describes types of ways clinicians use evidence

Answer 21

doing (create)
-complete first 4 steps of process
using
-step 2-searches restricted to resources already undergone critical appraisal
-skips step 33 but uses data from other
replicating (risky)
-skips step 2 and 3
-straight to decision by respected opinion leaders