Lecture 1, Principles of EBP & Formulate Question PDF

Evidence Based Practice • Introduction on The Principles of Evidence-Based Practice • Step 1 of EBP: Formulating a Question 10/27/2019 Evidence-Based Practice (EBP) is: “Integration of best research evidence with our clinical expertise and our patient’s unique values and circumstances" (Straus, R...

Evidence Based Practice • Introduction on The Principles of Evidence-Based Practice • Step 1 of EBP: Formulating a Question 10/27/2019 Evidence-Based Practice (EBP) is: “Integration of best research evidence with our clinical expertise and our patient’s unique values and circumstances" (Straus, Richardson, Glasziou, & Haynes, 2005, p. 1). The rst component "When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life" (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000, p. 1). What Evidence-Based Practice is Not: • • • • Something we’ve been doing for ages A tool of managers and insurers Restricted to randomized trials and systematic reviews Antipathetic to patient-centered medicine ‫مضاد للطب الذي يركز على املريض‬ ‫• شيء كنا نفعله منذ زمن طويل • أداة للمديرين وشركات التأمني • مقتصرة على التجارب‬ ‫العشوائية واملراجعات املنهجية • غير متعاطف مع الطب الذي يركز على املريض‬ The Essence of Evidence-Based Practice It is about the information we use to make decisions. All evidence is sought and examined systematically  Evidence , wherever possible, is quantified  Evidence is considered in All decisions in healthcare  Evidence doesn’t make decisions: Human beings do  The evidence informs our practice as dietitians Sources of Evidence Patient’s Unique Values and Circumstances Best Research Evidence ‫من هنا‬ EvidenceBased Practice Clinical Expertise Sources of Evidence Or religion Patient’s Unique Values and Circumstances Best Research Evidence Clinical Expertise Values, preferences, expectations Clinical state and circumstances Results of scientific research Personal knowledge, expertise, and expectations Established experts ‫الخبراء املنشأة‬ ‫ السريرية لدينا‬،‫أفضل األدلة البحثية‬ ‫الخبرة والقيم الفريدة ملريضنا‬ .‫ويجب أن تبلغنا الظروف بذلك يمارس‬ • The best research evidence, our clinical expertise, and our patient’s unique values and circumstances should INFORM our practice. – As dietitian, we make the decisions about patient care. (It’s our license.) • These decisions should be well-informed / intelligent ones. 5 Steps for EBP 1. Ask a focused clinical question 2. Search for the best research evidence 3. Appraise the quality of the research evidence 4. Integrate the research evidence with information about the patient and clinical expertise 5. Reflect on the process to improve the future ‫التفكير في عملية تحسني املستقبل‬ 1) Ask a focused clinical question What makes a clinical question well-built?  The question should be directly relevant to the problem at hand.  The question should be phrased to facilitate searching for a precise answer.  To achieve these aims, the question must be focused and well-articulated for all 3 parts of its 'anatomy‘: 1. The patient or problem being addressed 2. The exposure/intervention being considered and/or the comparison intervention or exposure 3. The clinical outcomes of interest. Types of Clinical Questions • Foreground questions • Background questions Background Questions • Ask for information about a condition. • Have two essential components – a question root (who, what, where, when, how, why) with a verb – a condition or an aspect of a condition. • Can cover a range of biologic, psychological, or sociological questions ‫يمكن أن تغطي مجموعة من العوامل البيولوجية أو النفسية أو أسئلة اجتماعية‬ Background Questions • Examples – Who are the people most affected by hypertension? – What are the common characteristics of people with elevated LDL level? Here he wanna know risk factors – When do complications following sleeve wanna know time and gastrectomy usually occur? He relationship and complications – What are the side effects of Lipitor? He wanna leading causes + risk factors Meet Daisy Middle-aged African American woman With type 2 diabetes Group Discussion Give Examples of Background Question on Daisy’s Case Middle-aged African American woman With type 2 diabetes Background Question Example on Daisy’s case • What patient characteristics are associated with an increased risk of type 2 diabetes? When the complications starting happen to you? What the side e ects of What’s the risk factors associated with increased What’s the complications? Who are the people who most e ected with type 2 diabetes? How to mange her diabetes? What’s the strategies? Family history Medications Dietary and food Psychological symptoms Previous education? ‫املستوى املادي؟‬ Foreground Questions • Ask for specific information about managing patients with a condition. • Have three essential components – Patient and/or problem – Exposure (intervention) or comparison intervention – Clinical outcomes Foreground Questions • Examples – In the obese adolescent, is diet and exercise more effective in reducing weight compared to exercise alone? – How do school breakfast programs affect childhood obesity rates? – Does having access to fresh fruits and vegetables in every neighborhood stores affect nutritional health of Saudis living in urban areas? Group Discussion Give Examples of Foreground Question on Daisy’s Case Middle-aged African American woman With type 2 diabetes Foreground Question Example on Daisy’s case • Does clinic attendance improve glycemic control in a middle-aged, African American woman with type 2 diabetes? Formatting Your Clinical Question Using the PECO Approach: Patient/ Problem Sometimes referred to as Intervention Exposure/ Comparison Group Outcome P E C O The 3 Parts of a Clinical Question (PECO) 1. Participants (patient(s) you want to treat) 2. Exposure (an intervention if about diet) and/or Comparison (there is always an alternative! another diet, nothing …) 3. Outcome (usually a disease or condition you want to prevent or manage) Example • The PICO format for the above foreground question would be as follows: • Patient: middle-aged, African American woman with type 2 diabetes • Intervention: clinic attendance • Comparison: no clinic attendance • Outcome: hemoglobin A1c levels Questions Can Relate to: (Dawes, et al., 2005) • • • • • • • • • Intervention Prevention Harm/risk Cause/etiology Differential diagnosis Diagnostic testing Prognosis ‫التخمني‬ Cost effectiveness Quality of life Thank You