Lecture 1 Flashcards by Aud R

How is EBP essential

Helps w/ clinical decisions

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EBP begins with … (3 things)

Clinical question
Appraisals of evidence
Evaluate clinical outcomes

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3 things that comprise of EBP

External evidence
Internal evidence
Patient preference and values

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Evidence generated through research to be generalized and used in other settings

External evidence

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Evidence generated through practice initiatives, outcome management, and quality improvement

Internal evidence

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_____ evidence that is not intended to generalized to other clinical settings

Internal evidence

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Best available evidence is composed of what 3 types of research methods?

Qualitative, quantitative, and mixed methods

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Subjective research

Qualitative

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Research focused on data

Quantitative

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Research that is the bets of both worlds

Mixed methods

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Patient preferences, values, and concerns makes interventions more _______-________

Client-centered

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Clinical judgment, internal evidence, clinical reasoning, evaluation, and use of healthcare resources help make up

Clinical experience

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Hierarchy/levels of evidence

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EBP produces better quality of

Care and pt outcome

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The focus of healthcare reform in the United States encompasses what is known as the Institute of Healthcare Improvement’s “Triple Aim,” which includes:

Enhancing the experience of care for those served

Improving the health of populations throughout the nation

Reducing per capita costs of national health care

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Initiatives to Advance EBP

institute of Medicine’s Roundtable on Evidence-Based Medicine

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Goal for institute of Medicine’s Roundtable on Evidence-Based Medicine

goal is for 90% of clinical decisions to be based on evidence by the year 2020

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USPSTF stands for

United States Preventive Services Task Force

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AHRQ stands for

Agency for Healthcare Research and Quality

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NCPAEP stands for

National Consortium for the Advancement of Pediatric and Adolescent Evidence-Based Practice

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Steps of the EBP Process

Ask the burning clinical question in PICO format.
Search for and collect the most relevant best evidence.
Critically appraise the evidence
Integrate the best evidence with one’s clinical expertise
Evaluate outcomes of the practice decision or change
based on evidence.
Disseminate the outcomes of the EBP decision or
change.

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Barriers to EBP?

Lack of administrative/management support and mentors

Lack of knowledge and skills relating to EBP

Misperceptions or negative attitudes about EBP

Information overload

Resistance to change

Lack of autonomy over practice and lack of incentives

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Strategies to Eliminate Barriers to Using Evidence-Based Practice

Establishing a clear philosophy and organizational vision in which EBP is valued and expected
•Developing a strategic plan to create a culture and environment that fosters EBP
•Dispelling misperceptions about EBP
•Teaching the basics of EBP
•Encouraging questions about currently used clinical practices
A determined effort is often required in order to address barriers and facilitate the implementation of EBP

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Important concepts of evidence-based rehabilitation

Awareness
Consultation
Judgement
Creativity

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Recognizing a problem, collecting data, and drawing a conclusion based on the data

Scientific method

What is considered the highest form of acquiring knowledge?

Scientific research

Can endorse currently held beliefs, but it can also call those beliefs into question

Method of Science

“systematic, controlled, empirical, amoral, public, and critical investigation of natural phenomena”

Scientific research

Scientific research can be what 4 things

1. Systematic and controlled 2. Empirical 3. Amoral 4. Public

Means that the scientific investigation is conducted in a manner that rules out other alternative explanations.

Systemic and controlled

Means that “the beliefs must be subjected to outside independent tests”

Empirical

Means that research findings do not have moral value, that is they are neither “good” nor “bad”.

Amoral

Means that the scientific research is evaluated by other independent individuals.

Public

Scientific Research has what 2 distinct lines of inquiry?

Empiricism Rationalism

Knowledge gained through experience and evidence

Empiricism

Empiricists use what type of reasoning?

Inductive reasoning

Type of reasoning that relies on evidence from specific cases to make inferences about general therapeutic principles.

Inductive reasoning

Knowledge gained through logical thought

Rationalism

Rationalist rely on what type of reasoning?

Deductive reasoning

Reasoning involving the use of general principles to make inferences about specific cases.

Deductive reasoning

Research used to acquire empirical data that can be used to develop, refine, or test a theory.

Basic research

Type of research that is directed towards solving problems and developing functional solutions or applications, and testing those theories that direct our practice

Applied research

Research that compares two or more conditions to determine a cause and relationship and allows the researcher to draw conclusions about observed differences

Experimental research

Considered the “gold standard” in experimental research

Randomized controlled trial

Involves the controlled comparison of an experimental intervention and a placebo

RTC

Research that explores data to determine relationships between variables. This type of research examines a phenomenon of interest and then explores its dimensions and how it relates to other factors. Research that describes a group of individuals or a set of variables to document and describe their characteristics.

Descriptive & Exploratory Research

Hierarchy of Evidence

Level I: Systematic reviews and well-designed meta-analyses of several Randomized Controlled Trials (RCTs) Level II: Well-designed RCTs Level III: Well-designed non randomized quasi-experimental studies Level IV: Controlled noninterventional descriptive studies, including correlational and case control studies Level V: Uncontrolled noninterventional studies, including case reports, and qualitative studies Level VI: Expert opinion of respected authorities

3 Scientific Principles

Testability Replication Objectivity

ask specific research questions instead of vague questions

Testability

reproducing the findings in one research study in a second research study

Replication

research questions and findings should be addressed and interpreted without bias.

Objectivity

The Research Process involves the research question; which is a process of

asking and answering questions

guides the research process in communication sciences

Scientific principles

Types of Research questions

1. Descriptive research question 2.Difference research question 3.Relationship research question

Research question that asks What is?” or “What exists?”

Descriptive research

Research question that asks “What is the difference?”

Difference research

Research question that asks “What is the relationship?”

Relationship research question

P in PICO

Patient and population

I stands for

Intervention

C stands for

Comparison

O stands for

Outcome

Prediction about how the research question will be answered

Hypothesis

What will happen if the hypothesis does not come true

Null hypothesis

“completing oral motor exercises improves swallowing” is an example of

Hypothesis

“swallowing does NOT improve with oral motor exercises” describes a

Null hypothesis

Researching the evidence involves

1. Asking a question 2. Research existing evidence and determine hierarchy of relevant evidence 3. Critically appraise the evidence

How do you critically appraise the evidence?

Through validity, reliability, and applicability

confidence to make an evidence-based change comes from a combination of what three things?

Level, quality, and strength of evidence

Strategies for sharing outcomes

Internal communication strategies External communication strategies

Strategy that can include email messages, reports, dashboards, and scorecards

Internal communication strategies

Strategy including podium or poster presentations at conferences and professional publications

External communication strategies

Peer review process involves

Having the author’s scholarly research reviewed and scrutinized by other experts in the same field

How many people are responsible for reviewing research

Editor-in-chief and 2-3 additional reviewers

stands for Uniform resource locator and it is the web address

URL

is a string of characters that permanently identifies an electronic document using unique characters (letters, numbers, etc)

DOI

True/False: Consulting a nursing journal article to determine the recommended turning frequency for immobile patients is an example of utilizing external evidence

True

A group of OTs have successfully implemented a new, evidenced-base protocol regarding post-CVA patient assessment. How should the OTs follow up this success?

Tell others about the results of their project