pen Flashcards
KNOWLEDGE TRANSLATION
is “the effective and timely incorporation of
evidence-based information into the
practices of health professionals in
such a way as to effect optimal health
care outcomes and maximize the
potential of the health system.”
Knowledge Translation Program – University of Toronto
Adapted from Canadian Institutes for Health Research definition, 2001
Evidence-based Practice (EBP)
Distinguishes evidence from propaganda • Probability from certainty • Data from assertions • Rational belief from superstitions (example dont take babies out until a few month old- vit d) • Science from folklore
Dietitians of Canada’s EBP Approach
Educate members about evidencebased decision making – Tutorial • Provide a dynamic tool to help practitioners quickly find evidencebased answers to their practice questions = PEN (Practice-based Evidence in Nutrition)
Evidence-Based Practice/Policy Cycle
assess aks acquire appraiseapply-> (ask and assess starts over)
Assess
Assess an issue or a practice • Think about a practice-based topic or issue & the kinds of information dietitians/ nutritionists are looking for. • Consider the types of decisions to be made, where there is controversy or new information available.
Ask
Ask specific questions that can be answered
Frame the topic or issue you have identified in
“Assess” into searchable questions. PICO is an
often used format:
P Population - who are the relevant patients,(toddlers)
clients or groups?
I Intervention or exposure of interest
C Comparison or control (different from other children)
O Outcome (what are the patient, client or grouprelevant
consequences of the exposure)
Acquire
Acquire the scientific studies
First go to quality sources of pre-filtered information such
as: http://www.guidelines.gov, Cochrane Library, Best
Evidence, PIER, or UpToDate
Filtered
• Systems – include practice guidelines, clinical pathways,
care maps
• Systematic reviews - overview of evidence addressing a
focused question
Unfiltered
• Traditional literature review using relevant databases
such as Medline
Appraise
Appraise the quality of the studies
• Appraise the articles and materials to
grade the quality of the evidence used to
answer your questions.
• There are several methods for grading the
evidence
4 grades: a( huge amount of quality evidence)
b( good quality evidence but not enough, no one does randomized control trial- evidence is pretty good)
c(not alot of evidence but we have enough confidence to make this statement)
d: we are still profffesional but there is no way of knowing, ex. men getting osteoporosis, not enough evidence but guessing they get it too, now its moving up to an a as the more studies there are)
so much of nutrition is grade c (becuase we cant deprive ppl of nutrients- ethics)
Giving Evidence a Grade
Grade (A): The conclusion is supported by
good evidence. RCT, Metaanalysis
• Grade (B): The conclusion is supported by
fair evidence. Cohort, many studies support
• Grade (C): The conclusion is supported by
limited evidence or expert opinion. x-selectional (problem as there is no cause and effect exmaple ppl who drink diet coke have more cases of diabetes therefore diet coke causes diabetes
• Grade (D): No evidence from well designed
studies or authoritative sources was found
often shown as a pyramid - a at the top- have everything below it as well
the bottom is a D
Apply
Make recommendations
• Summarize the results of your review; make
recommendations using the concepts of validity,
importance and applicability.
Validity – Can I trust the information? (state the source &
level of evidence)
Importance – Will the information make an important
difference to my practice? (are the outcomes ones
practitioners or clients would care about)
Applicability – Can I use this information in my practice
setting? (consider access or cost issues etc) or with my
patients/clients
in catalgoue, want electronic resources- pen
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