Lecture 1 Flashcards
How is EBP essential
Helps w/ clinical decisions
EBP begins with … (3 things)
Clinical question
Appraisals of evidence
Evaluate clinical outcomes
3 things that comprise of EBP
External evidence
Internal evidence
Patient preference and values
Evidence generated through research to be generalized and used in other settings
External evidence
Evidence generated through practice initiatives, outcome management, and quality improvement
Internal evidence
_____ evidence that is not intended to generalized to other clinical settings
Internal evidence
Best available evidence is composed of what 3 types of research methods?
Qualitative, quantitative, and mixed methods
Subjective research
Qualitative
Research focused on data
Quantitative
Research that is the bets of both worlds
Mixed methods
Patient preferences, values, and concerns makes interventions more _______-________
Client-centered
Clinical judgment, internal evidence, clinical reasoning, evaluation, and use of healthcare resources help make up
Clinical experience
Hierarchy/levels of evidence
EBP produces better quality of
Care and pt outcome
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
Initiatives to Advance EBP
institute of Medicine’s Roundtable on Evidence-Based Medicine
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
USPSTF stands for
United States Preventive Services Task Force
AHRQ stands for
Agency for Healthcare Research and Quality
NCPAEP stands for
National Consortium for the Advancement of Pediatric and Adolescent Evidence-Based Practice
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.
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
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
Important concepts of evidence-based rehabilitation
Awareness
Consultation
Judgement
Creativity
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
- Systematic and controlled
- Empirical
- Amoral
- 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
- 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
- Asking a question
- Research existing evidence and determine hierarchy of relevant evidence
- 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
