EBP Week 2 Summary PDF

2.1 review of ebp 1 principles evidence based practice Sackett’s Definition “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients” Why is it important? integration of evidence into our clinical decision-making should enhance outco...

2.1 review of ebp 1 principles evidence based practice Sackett’s Definition “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients” Why is it important? integration of evidence into our clinical decision-making should enhance outcomes and reduce unwarranted variation in practice standards of care are good! Best-practice guidelines for clinical care should be a clinician’s obligation to consider but not necessarily supersede the other tenets of evidence-based care IMO, it’s better to be consciously ineffective than to be unconsciously ineffective what evidence practice is NOT… A cookbook approach — Evidence is always tempered by the patient’s unique circumstance and needs A replacement for experience and expertise Solely a reflection of RCTs and meta-analyses A cost-cutting measure — Hopefully, it identifies both efficacy (does it work)... and efficiency (how well it works) what evidence practice is… Data/information which tends to prove or disprove a construct Data/information that makes something more plain or clear and, the best evidence is free of bias unfortunate evidence perspectives “Copy from one, it's plagiarism; copy from two, it's research; copy from three and it’s a fact of practice” “The plural of anecdotes is evidence” (if enough people think it or say it – it must be true) “When you let the data talk, it changes the conversation.” “Without data, you’re just another person with an opinion.” “It is not necessary to change. Survival is not mandatory.” the problem w expert opinion.. you are often bestowed guru status Without apology – “I am not a Guru” as evidenced by the John Child’s “guru litmus test” on his Evidence in Motion blog what is the public’s attitude about utilization of ebp? what are elements of EBP? 3 elements EBP is less like a stool and more like a funnel how to use evidence Use the evidence like a lamp post — for illumination – not for support (not necessarily for confirmation) Use the evidence to not only support your paradigm — but to challenge it -to give us better ideas david poulter get familiar w this steps to facilitate an EB approach 2.2 PICO Step 1: Framing the Question - Begins w/ asking a good question - Decide if we need background or foreground - Background - Indicated need for general information - What is this? - How do you diagnose it? - How to treat it? - Assessed by - Evidence based textbooks - Review Articles - Foreground - Specific or complex clinical queries - Patient centered questions that involve interpretation & consideration of risk vs. benefit - Assessed by - Pre-assessed, critically reviewed studies from literature - High on the evidence hierarchy as possible - PICO - P stands for patient/population - Who is the patient? - Disease of injury, chief complaint, age, gender, race, health status, previous history - I stands for Intervention - Therapy, Prognosis, Diagnosis, Harm, Prevention - Diagnose - Identify source of problem - Prognose - Predict outcome - Intervene - Recommend product, procedure, treatment - C stands for Compare - Methodology - What are alternatives? - Control, Placebo, Different Treatment, Different Pathology - O stands for outcome - What do we want to accomplish? - Accurate diagnosis, change in pain, change in patients perception of status, change in fxnal outcome measure - T stands for time (usually added) Examples *be as specific as possible* Template Why is the PICO helpful? - Focuses your question - Facilitates your search - Hones the results - Makes you time efficient - S Searching - PLUG & FILL PICO QUESTION SEARCH - Produces several high quality articles that address the pico question - Even Easier - AskMedline feature - *he emphasized this one 2.3 Study Design Know the orders know how to categorize them recommendation all depends on level of evidence from study!! mum & - - three ways to grade level of evidence!!! = 2.4 Searching the Literature for Evidence Resources Database vs Search Engine database is a collection of stored articles - medline/CINAHL (cumulative index of nursing and allied health literature) search engine is a program designed to search the database - PubMed/Ovid 7 mully’s fav Cochrane systematic reviews quick answer to particular question Diagnostic Test Accuracy DiTA Pedro Physiotherapy evidence database CPGs or systematic review meta analysis or RCT good for intervention study, PICO question pedro score talks about validity/stats (out of 10) Pedro scale eligibility criteria defined (no point value) random allocation concealed allocation baseline comparable blind subject - therapists - assessors adequate follow up intention to treat analysis b/w group comparisons point estimates of variability Paired t test Unpaired t test wilcoxon Mann Whitney-U McNemar nominal data Repeated Measures ANOVA ANOVA Friedman KruskalWalls ANOVA chi-square can use Kappa for reliability for Pearsons Product Moment spearman’ s rho or phi point coefficient biserial