informatics chapter 27: transitional research: generating evidence for practice

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deb1316
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informatics chapter 27: transitional research: generating evidence for practice
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2013-09-10 12:54:12
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informatics chapter 27
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  1. describe the role of evidenced-based practice in informatics
    • EBP developed originally for its application in medicine
    • Sacket et al. (1996) " The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
    • Goode and Piedalue (1999) evidenced-based practice should be combined with other knowledge sources and "involves that synthesis of knowledge from research, retrospective or concurrent chart review, quality improvement and risk data, international, national, and local standards, infection control data, pathphysiology, cost effectiveness analysis, benchmarking data, patient preferences, and clinical expertise" 
    • EBP starts with a clinical question to resolve a clinical problem
    • use of EBP promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than on what is customary or opinion
  2. Clarify differences between EBP and translational research
    • EBP promotes the use of clinical judgment and knowledge with procedures and protocols to what is scientifically proven rather than on what is customary or opinion
    • Translational research: describes the methods used in translation of medical, biomedical, informatics, and nursing research into bedside clinical interventions
    • two ways: T1: the transfer of clinical research to its first testing on humans T2: transfer of clinical research to an everyday clinical practice setting
  3. Discuss the history of EBP
    • research results are critical to furthering EBP
    • concept of using randomized controlled trials and systematic reviews as the gold standard against which one should evaluate validity and effectiveness of clinical intervention was introduced in 1972 by Archie Cochrane, a scientist and physician 
    • Cochrane's belief that not all medical interventions were needed and some caused more harm than good was realized from his experiences of being a prisoner of war and medical officer while interning during WW2
    • Cochrane viewed that randomized clinical trial as a means of validating clinical interventions to limit the interventions to those that were scientifically based, effective and necessary
    • Cochrane's colleague, Iain Chalmers, began compiling a comprehensive clinical trials registry of 3500 clinical trial results in perinatal medicine
    • 1988, after being published in print 3 years prior, registry became available electronically
    • Chalmer's methods for compiling trials databases became a model for future registry assembly
    • National Health Service in England, recognizing the value of and need for systemic reviews for all of healthcare, developed the Cochrane Center
    • Cochrane Collaboration was initiated in 1993 and expanded internationally to maintain systematic reviews in all areas of healthcare
  4. ID Archie Cochrane and what were his ideas about RCT(randomized clinical trials) and research
    • Archie Cochrane: a scientist and physician
    • belief that not all medical interventions were needed and some caused more harm than good
    • viewed that randomized clinical trials as means of validating clinical interventions to limit the interventions to those that were scientifically based, effective and necessary
  5. define what is evidence
    • Evidence: includes standards of practice, codes of ethics, philosophies of nursing, autobiographic stories, esthetic criticism, works of art, qualitative studies, and patient and clinical knowledge
    • nurses may additionally draw on evidence from the context of care, such as audit and performance data, the culture of the organization, social and professional networks, discussion with stakeholders, and local or national policy
  6. Define meta-analysis
    Meta-analysis: best quality evidence because it uses multiple individual research studies to come to a consensus
  7. List barriers to application of evidenced-based practice
    lack of time, lack of access to libraries within a facility, lack of technology confidence, lack of knowledge on how to search for information, lack of value assigned to using research in practice, inadequate EBP knowledge and skills, lack of mentors in EBP, inadequate support and resources from admin, and insufficient time

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