Lecture 1- Evidence Based Practice Flashcards
How would you define Evidence Based Practice (EBP)?
1) The Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients
- Combination of clinical expertise/expert opinion, client/patient/caregiver perspectives, & external scientific evidence
How can you use evidence to evaluate and manage a patient?
1) What is your clinical question?
2) Use PICO
What is PICO?
Population: kids, senior citizens, people with moderate hearing loss, people with single sided deafness
Intervention: amplification, ALDs, a certain test
Comparison: old test and new test, comparison of hearing aids, CI vs. BAHA
Outcome: does the evidence support what you want to do? Or does it not support what you want to do?
How can you find your evidence?
- Systematic review or meta-analyses
- Individual studies: MEDLINE, PubMed, ComDisDome, CINAHL (very good & unbiased), Google scholar
Why should you be wary of individual research?
- Need to understand the background of the author to consider bias
- No guarantee of scientific quality with individual studies
What is the Cochrane Library/Cochrane Collaboration?
Cochrane Library: Collection of 6 databases
Cochrane Collaboration: 7th database that provides information about
What are different kinds of evidence?
Case Report/Case Series: helpful for patients with difficult cases
Retrospective studies: not enough control
Prospective studies: more control
Controlled clinical study
Randomized controlled trial
Systematic Review Meta-analysis
Clinical Practice Guidelines/Health Technology Assessment: best form of evidence
What is the Patient-Oriented Evidence that Matters (POEM)?
- Evaluates the effectiveness of interventions that patients care about
- Contains information that directly tells clinicians that what they do for patients has been shown to let them live longer or better
What is Disease-Oriented Evidence (DOE)?
- Crucial to better medical practice
- Not sufficient for clinical evidence; does not take patient into account
What are the grades of recommendation for evidence?
A: consistent level 1 or 2 studies
- the best
- retrospective study vs. prospective study
B: consistent level 3 or 4 studies or extrapolations from level 1 or 2 studies
- Journal articles
C: level 5 studies or extrapolations from level 3 or 4 studies
- Journal articles
D: level 6 evidence or troublingly inconsistent or inconclusive studies of any level
Summarize the Cox, Johnson, and Xu study from 2016.
- Comparison of premium and basic hearing aid technology
What is one reason for poor adoption rate?
- Lack of perceived benefit
What are some differences between basic/premium hearing aids?
- Ear to ear technology
- More frequency bands and more signal processing channels
- Adaptive noise reduction
- Adaptive directional microphones
Hearing aid cost factors
- Not related to evidence based benefit
- Service
- Research behind developing the premium hearing aids
Independent research has not establish that premium features are beneficial
Goals of the study:
- Determine overall effectiveness of basic/premium hearing aids from patient perspective
- Difference in effectiveness of basic/premium hearing aids from patient perspective
- Were there differences between manufacturers
Results
- No statistically significant data for premium technology
- Statistically significant preference for the 2nd hearing aid the subjects wore
Discussion
- There was benefit from HAs, but there were no differences in the 2 technology levels
- Subjects were in program 1 the majority of the time
What steps should I follow to use evidence based practice?
1) Formulate an answerable question around an area of clinical uncertainty
2) Locate the evidence
3) Appraise the evidence to establish its validity and relevance
4) Implement the findings
5) Evaluate performance
