Module 1-Slides Flashcards
Evidence Base Practice
(EBP)
Integration of Clinical expertise, Patient values, and the best Research Evidence into the decision-making process for patient care
Framework for Clinical Decision-Making:
EBP Components
Best available research evidence
Clinical expertise
Patient values and preferences
Why is EBP important?
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
EBP New Paradigm
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
Scientific Evidence (Method)
Systematic, Empirical, and Controlled Critical Examination of hypothetical prepositions about the assumptions among natural phenomena
Systematic
Logical sequence from the identification of a problem to interpretation of findings via the Organized collection and Objective analysis of data
Empirical
Necessity for documenting objective data through direct observation, thus minimizing bias
Controlled Critical Examination
Subject findings to empirical testing and to the scrutiny of others
Deductive Reasoning
Theory testing; from facts to facts
Inductive Reasoning
Theory development; looking for pattern/trend to generalization
Phases of Research
- Identify the Research Question
- Design the Study
- Implement the Study
- Analyze the Data
- Disseminate Findings
Basic Research
Directed toward the acquisition of new knowleddge
Applied (clinical) Research
Advances the development of new diagnostic tests, drugs, therapies and prevention strategies, answering questions with direct clinical application
-EED
Types of Research
Explanatory - Experimental
Exploratory - Observational
Descriptive - Qualitative
The Process of EBP
Five A’s
1. Ask
2. Acquire
3. Appraise
4. Apply
5. Asses
Step 1: ASK
Clinical/ PICO Question
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
PICO Format
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
P - Patient, Population or Problem
Description of primary condition of interest, demographics, pt characteristics
Who is involved? What is the problem?
I - Intervention (exposure or test)
Description of specific intervention, diagnostic test, or prognostic factor that will lead to an outcome
Which main intervention are you going to apply?
C - Comparison (if relevant; optional, not always available)
Description of a comparison intervention or diagnostic test (if relevant)
What is the alternative Tx?
O - Outcome
Description of outcomes of interest, including potential side effects or harm and time frame
What are you trying to do for the pt?
Sources of Clinical Questions and Example
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?
Step 2: ACQUIRE
Relevant Literature
Types of studies depend on the clinical question
Synthesized evidence:
-Systematic reviews
-Meta-analyses
-Clinical practice guidelines
-Scoping review
Rank of the Hierarchy of Evidence
Top -> Bottom = Potential for Bias decreases as does the studies published
- Animal Studies/Laboratory Studies
- Case series/Case reports
- Cohort/Case Control Studies
- Controlled Clinical Trials
- Randomized Controlled Trials
- Systematic Reviews
- Meta-Analysis
Step 3: APPRAISE
The Literature
3 Primary questions:
Is the study valid?
Are the results meaningful?
Are the results relevant to my patient?
Step 4: APPLY
The Evidence
Putting it all together to make a clinical decision
Evidence + Clinical expertise + Patient values
How well does the evidence fit your patient?
Step 5: ASSESS
Effectiveness of Evidence
Did the patient improve?
Is additional evidence needed?
Do additional questions need to be answered?
Barriers to Implementation of EBP
Lack of CRITICAL APPRAISAL skills
Lack of time
Access to the literature
Lack of resources
Strategies to address barriers
