Module 1-Slides

Question 1

Evidence Base Practice
(EBP)

Answer 1

Integration of Clinical expertise, Patient values, and the best Research Evidence into the decision-making process for patient care

Question 2

Framework for Clinical Decision-Making:
EBP Components

Answer 2

Best available research evidence
Clinical expertise
Patient values and preferences

Question 3

Why is EBP important?

Answer 3

Medical knowledge and accepted practice change rapidly
Volume of research articles is expanding exponentially
Integrating the evidence into practice regularly makes it easier to find and apply evidence during busy clinical schedules
Allows you to blend pt’s preferences w/research, resulting in pt-centered care

Question 4

EBP New Paradigm

Answer 4

De-emphasize intuition, unsystematic clinical experience, clinical training and common sense as sufficient grounds for practice
Stress the examination of evidence from pt-centered clinical research

Question 5

Scientific Evidence (Method)

Answer 5

Systematic, Empirical, and Controlled Critical Examination of hypothetical prepositions about the assumptions among natural phenomena

Question 6

Systematic

Answer 6

Logical sequence from the identification of a problem to interpretation of findings via the Organized collection and Objective analysis of data

Question 7

Empirical

Answer 7

Necessity for documenting objective data through direct observation, thus minimizing bias

Question 8

Controlled Critical Examination

Answer 8

Subject findings to empirical testing and to the scrutiny of others

Question 9

Deductive Reasoning

Answer 9

Theory testing; from facts to facts

Question 10

Inductive Reasoning

Answer 10

Theory development; looking for pattern/trend to generalization

Question 11

Phases of Research

Answer 11

1. Identify the Research Question
2. Design the Study
3. Implement the Study
4. Analyze the Data
5. Disseminate Findings

Question 12

Basic Research

Answer 12

Directed toward the acquisition of new knowleddge

Question 13

Applied (clinical) Research

Answer 13

Advances the development of new diagnostic tests, drugs, therapies and prevention strategies, answering questions with direct clinical application
-EED

Question 14

Types of Research

Answer 14

Explanatory - Experimental
Exploratory - Observational
Descriptive - Qualitative

Question 15

The Process of EBP

Answer 15

Five A’s
1. Ask
2. Acquire
3. Appraise
4. Apply
5. Asses

Question 16

Step 1: ASK
Clinical/ PICO Question

Answer 16

Background questions: etiology or GENERAL KNOWLEDGE about a pt’s condition

Foreground questions: ask for SPECIFIC KNOWLEDGE to inform clinical decisions about patient management in a PICO format

Question 17

PICO Format

Answer 17

P - Patient, Population or Problem
I - Intervention (exposure or test)
C - Comparison (if relevant; optional, not always available)
O - Outcome

Yes/No or WH Question Format

Question 18

P - Patient, Population or Problem

Answer 18

Description of primary condition of interest, demographics, pt characteristics

Who is involved? What is the problem?

Question 19

I - Intervention (exposure or test)

Answer 19

Description of specific intervention, diagnostic test, or prognostic factor that will lead to an outcome

Which main intervention are you going to apply?

Question 20

C - Comparison (if relevant; optional, not always available)

Answer 20

Description of a comparison intervention or diagnostic test (if relevant)

What is the alternative Tx?

Question 21

O - Outcome

Answer 21

Description of outcomes of interest, including potential side effects or harm and time frame

What are you trying to do for the pt?

Question 22

Sources of Clinical Questions and Example

Answer 22

Diagnosis and Measurement
-Are measures of periph. sens valid for assessing periph. npathies in pts w/Type 2 diabetes?
Prognosis
-In pts with Type 2 diabetes, how does an A1C of 7.5 influence disease prognosis?
Intervention
-In pts w/type 2 D who experience a frozen shld, will a corti injection be effective to improve shld fct?
Patient experiences
-In pts w/type 2 D, what factors contrib to lack of adherence to a med regimen and exercise?

Question 23

Step 2: ACQUIRE
Relevant Literature

Answer 23

Types of studies depend on the clinical question
Synthesized evidence:
-Systematic reviews
-Meta-analyses
-Clinical practice guidelines
-Scoping review

Question 24

Rank of the Hierarchy of Evidence

Answer 24

Top -> Bottom = Potential for Bias decreases as does the studies published

1. Animal Studies/Laboratory Studies
2. Case series/Case reports
3. Cohort/Case Control Studies
4. Controlled Clinical Trials
5. Randomized Controlled Trials
6. Systematic Reviews
7. Meta-Analysis

Question 25

Step 3: APPRAISE
The Literature

Answer 25

3 Primary questions:

Is the study valid?
Are the results meaningful?
Are the results relevant to my patient?

Question 26

Step 4: APPLY
The Evidence

Answer 26

Putting it all together to make a clinical decision
Evidence + Clinical expertise + Patient values

How well does the evidence fit your patient?

Question 27

Step 5: ASSESS
Effectiveness of Evidence

Answer 27

Did the patient improve?
Is additional evidence needed?
Do additional questions need to be answered?

Question 28

Barriers to Implementation of EBP

Answer 28

Lack of CRITICAL APPRAISAL skills
Lack of time
Access to the literature
Lack of resources
Strategies to address barriers