Paramedic Care: Principles & Practice Chapter 5 PDF

Paramedic Care: Principles & Practice Sixth Edition Chapter 5 EMS Research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (Rese...

Paramedic Care: Principles & Practice Sixth Edition Chapter 5 EMS Research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (Research) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical– legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (1 of 3) Solid and objective research program will drive EMS practices in the coming years Outcomes-based research – Determine whether procedure, drug, treatment, strategy improves patient outcomes (mortality, morbidity, quality of life) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (2 of 3) National EMS Research Agenda (2001) recommendations – Develop EMS researchers; support them early in their careers – Collaboration between EMS researchers and other disciplines – Establish funding stream for EMS research within government – Establish alternate funding source for EMS research – Recognize need for EMS research – View research as necessary for improvement of patient care – Enhance ethical approaches to research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Introduction (3 of 3) Research – Key to maintaining focus on improving health of community in competitive and cost-conscious health care market – Ensures best possible patient care provided in prehospital and out-of-hospital settings Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Research and the Scientific Method (1 of 2) Science: state or fact of knowledge derived through scientific method Research: use of scientific method to study given issue Scientific method: – Process by which scientists construct accurate representation of world; reliable, consistent, nonarbitrary Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Research and the Scientific Method (2 of 2) Steps of Scientific Method – Observe and ask questions – Collect, analyze, synthesize data – Construct hypothesis – Test hypothesis by experimentation – Analyze results and draw conclusions – Revise hypothesis – Report results Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-1 Steps of the scientific method. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (1 of 6) Quantitative research: – Describes phenomena in numbers Qualitative research: – Describes phenomena in words Mixed research: – Combination of quantitative and qualitative research; uses both numbers and words to describe phenomena being studied Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 5-1 Summary of Research Types Quantitative Mixed Research Qualitative Blank Research Research Scientific method The researcher tests The researcher Deductive and the hypothesis with generates a hypothesis inductive data (deductive after collecting data approach) (inductive approach) Focus Narrow topic Variable topic Wide topic Behavior Studied under Studied in more than Studied in natural controlled conditions one context environment Nature of reality Objective Common sense Subjective (pragmatic) Nature of data Numbers Numbers and words Words Data analysis Statistical Statistical and words Words Results Generalizable Could be generalizable Nongeneralizable Report Statistical Mixed Narrative Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (2 of 6) Retrospective research: – Examines information that already exists Prospective research: – Study starts now; examines what happens from this point forward Type of research most used in medicine: – Quantitative Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (3 of 6) Quantitative versus Qualitative Research – Quantitative research is objective and specific ▪ Determines relationship between one thing (independent variable) and another (dependent or outcome variable) and describes it with numbers (statistics) ▪ Independent variable: affects dependent variable under study ▪ Dependent variable (outcome): variable being affected Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (4 of 6) Quantitative versus Qualitative Research (cont ) inued – Nonexperimental quantitative research: ▪ Independent variables that cannot be manipulated for one reason or another – Survey-quantitative research: ▪ Reflects public opinion for marketing and social science research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (5 of 6) Quantitative versus Qualitative Research (cont ) inued – Qualitative research relies on collection of qualitative (nonnumeric) data ▪ Seeks “why” and not “how” of phenomena being studied ▪ Occurs in natural setting ▪ Role in quality assurance Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Types of Research (6 of 6) Prospective versus Retrospective Studies – Retrospective studies: ▪ Looks at existing data—events have already occurred. Increased bias in existing data – Prospective studies: ▪ Use research form or instrument specifically designed for study; objective, accurate, complete Track things that are going to happen. More expensive to conduct Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (1 of 12) Experimental study: both control group (group of subjects who do not have manipulation of independent variable) and treatment (also known as experimental) group that the independent variable is applied to – Subjects randomly assigned to one group – Ensure demographics between groups similar Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (2 of 12) Quasi-experimental study: scientist does not randomly assign subjects to the study groups – Greater chance of having groups demographically different, and of introduction of bias – Considered less valid than experimental studies Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (3 of 12) Observational study: does not have control group – Single or multiple groups studied without comparison to control – Scientist does not control variables – Less valid than experimental or quasi-experimental studies – Important role in medicine Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (4 of 12) Specific Study Types – Randomized controlled trials (RCTs): ▪ Subjects randomized into treatment group and control group – Single or double blind study – Meta-analysis of randomized controlled trials: ▪ Combines results of several prior studies Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-4 In a randomized controlled trial, a treatment group and a control group that is not receiving the treatment are being studied. The results of the two groups can be compared. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-3 Meta-analysis is an analysis of the combined results of several prior studies. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (5 of 12) Specific Study Types (cont ) inued – Nonrandomized controlled trials: ▪ Control group and treatment group; assignment to groups not randomized ▪ Also called quasi-experimental studies ▪ Less validity than RCT, but utility in some circumstances Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-6 In a randomized controlled trial, assignments to the treatment group and the control group are made at random. In a nonrandomized study, assignments to the two groups are, as the name indicates, not randomized. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (6 of 12) Specific Study Types (cont ) inued – Cohort study: ▪ Observational; subjects who have certain condition and/or who receive particular treatment followed over time; compared with another group not affected by condition Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-7 A cohort is a group of subjects who share a certain characteristic. For example, all could be cancer patients. A cohort study observes and compares the cohort group with a group whose members do not have the cohort characteristic. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (7 of 12) Specific Study Types (cont ) inued – Cross-sectional study (analysis): ▪ Observational; various groups compared without control; looks at single point in time – Case series: ▪ Looks at group of patients with similar condition Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (8 of 12) Specific Study Types (cont ) inued – Case report: ▪ Structured study of single patient who is unique or interesting to medical community in general – Expert opinions, editorials, rational conjecture: ▪ Suitable for use before scientific research is available or while scientific research is occurring Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (9 of 12) Specific Study Types (cont ) inued – Animal research (in vivo): understanding how certain drugs and procedures affect biological systems ▪ Findings in one species do not necessarily apply to other species ▪ Computer modeling starting to replace aspects of animal research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (10 of 12) Specific Study Types (cont ) inued – Bench research (in vitro): ▪ Scientific research at most basic level; important in learning how universe functions Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-2 Hierarchy of validity of study types. The most valid type of study is at the top of the pyramid, and the least valid is at the bottom. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (11 of 12) Quality of research supporting clinical practice: – Stratify scientific evidence based on type and validity of experimental designs used – Type of design helps to identify the quality of the evidence found Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-8 The American Heart Association levels of evidence. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 5-9 Oxford Center for Evidence-Based Medicine levels of evidence. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Experimental Design (12 of 12) Study Validity – Validity: whether or how well study supports the conclusions – External validity : assures results can be generalized, or possess generalizability – Internal validity: ensures results can be attributed to the cause Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Considerations in Human Research (1 of 2) While medical research essential, overriding concern is rights of those who serve as subjects in studies – Nuremburg Code of 1947: first code to guide ethical practice in human research – Helsinki Declaration: subject makes informed decision about participating in research; assurance by researcher that patient’s safety protected – Ethical Principles and Guidelines for the Protection of Human Subjects of Research Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Considerations in Human Research (2 of 2) Institutional Review Board (IRB) – Committee that approves, monitors, reviews human research – Goal is to protect human subjects – Approves/disapproves study before it begins – Requires researchers to modify or terminate study if subjects at risk Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (1 of 6) Statistics: – Mathematics of collecting and analyzing data to draw conclusions and make predictions ▪ Descriptive statistics: – describe basic features of data obtained in a study ▪ Inferential statistics: – information from sampled observations of population; make conclusions about population Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (2 of 6) Descriptive Statistics – Describe nature of sample – Mean (average): add values, then divide sum by number of values involved – Median: put the values into numerical order, then find middle value – Mode: most common value in set of data Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (3 of 6) Descriptive Statistics (cont ) inued – Variance: take each value, then subtract mean from it – Standard deviation: take square root of variance Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (4 of 6) Inferential Statistics – Estimating parameters of population – Sampling error: estimation of difference between value obtained from sample and value that would be obtained from entire population – Confidence interval: variability added or subtracted to original proportion Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (5 of 6) Quantitative and Qualitative Statistics – Qualitative statistics: data nonnumeric in nature; assigned number indicating ranking or ordering of importance or severity ▪ Nominal or ordinal data – Quantitative statistics: numerical in nature Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved An Overview of Statistics (6 of 6) Other Types of Data – T test – Analysis of variance (ANOVA) – Chi square test – Odds ratio: how strong association is between risk factor and condition it is associated with Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Format of a Research Paper (1 of 2) Abstract: – Need for study, research methods used, results encountered Introduction: – Description of pertinent, previously published papers on subject of investigation – Why undertaken; purpose of study; what hypothesis authors wanted to test Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Format of a Research Paper (2 of 2) Methods section: – How authors conducted study Results: – Researchers provide data (summary) Discussion section: – Authors interpret findings; describe significance Summary (conclusion): – Brief recap of main findings of study Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 5-2 Research Paper Format for Some Emergency Medicine Journals Prehospital Annals of Emergency Academic Emergency Emergency Care Medicine Medicine Abstract Abstract Abstract Introduction Introduction Introduction Methods Methods Methods Results Results Results Discussion Limitations Discussion Conclusions Discussion Limitations References References Conclusions References Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved How a Research Paper Is Published (1 of 2) All peer-reviewed journals follow same general procedure – Submit to scientific journal for publication – After receiving paper, editor sends to one or more members of review board – Reviewers blinded as to names of authors and affiliated institutions Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved How a Research Paper Is Published (2 of 2) Reviewers read paper; evaluate for adherence to standards of research methods, pertinence to field, value for practitioners Reviewers send comments to editor, who then decides whether to publish it, send it back for revisions, or reject it Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Accessing the Scientific Literature Journal publishers have archived their publications online – Can be downloaded as PDF files or directly – Most journals require subscription/library affiliation – Some are free (open-access journals) – National Libraries of Medicine: accessible database of medical and scientific literature (PubMed) – Loansome Doc: document retrieval service accessed through web Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved What to Look for When Reviewing a Study (1 of 3) Was research peer reviewed? Was there a clear hypothesis or study purpose? Was study approved by IRB, and was it conducted ethically? Was study type appropriate? What population were the researchers studying? Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved What to Look for When Reviewing a Study (2 of 3) What inclusion and exclusion criteria did researchers use? How did investigators draw their sample? How many groups were patients divided into; were patients assigned to control and study groups properly? Were control and study groups the proper size? Were effects of confounding variables (other things that may have affected study outcome) taken into account? Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved What to Look for When Reviewing a Study (3 of 3) What kind of data did investigators collect; did they analyze data with proper statistical tests? Were results reported properly? How likely is it that the study results would occur by chance alone? Are author’s conclusions logical and based on the data? How good was EMS system in which study was done? Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Applying Study Results to Your Practice (1 of 2) Evaluate the field and its knowledge base to make informed decision about how to interpret a piece of research Distinguish between the statistical and clinical significance of the study – Just because the outcome was statistically significant, does not make it clinically significant Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Applying Study Results to Your Practice (2 of 2) Be sure that the patient is similar enough to study group to benefit from intervention Speak to management of your organization, especially medical director Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Participating in Research (1 of 2) Before participating, things to find out: 1. Determine the question 2. Prepare hypotheses (null/research) 3. Decide what you wish to measure and how you will do it 4. Define population 5. Identify limitations of your study Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Participating in Research (2 of 2) Before participating, things to find out: (cont ) inued 6. Get approval of proper authorities (IRB/principal investigator [PI]) 7. Determine how you will get informed consent from study subjects 8. Gather and analyze data 9. Determine what you will do with results Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Evidence-Based Decision Making Use of best practices and clinical pathways based on clinical and scientific evidence ensures care is safe, efficacious, cost-effective – Formulate question about appropriate treatments – Medical literature searched and organized – Scientific evidence stratified based on validity and reliability – If evidence supports change in practice, change is made – Once practice changed, ongoing evaluation must be carried out Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Table 5-5 Applying Classification of Recommendations and Level of Evidence (Data from Circulation. http://circ.ahajournals.org/manual/manual_IIstep6.shtml ) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Summary Solid, well-conducted scientific research is key to improving prehospital care It is essential to prove paramedics make a difference in terms of reducing mortality, morbidity, pain, and suffering Benefit: increased revenue stream Future of EMS depends on aggressive research program If we don’t define EMS and EMS care, someone else will Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Copyright This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted. The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved