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Why do we need EBP?
We are being given direct access. Helps with lawsuits. Patients are attempting to self-educate
What is the Sackett definition of EBP?
Evidence-based practice is the integration of best research evidence with clinical expertise and patient values
What are the five sources of evidence that lead to effective clinical decisions?
Patient preferences, beliefs and values, research evidence, clinical assessment, clinical expertise
An informed clinical decision draws upon...
Strength of scientific evidence, patient eval, patient preference
List four reasons that there is an increased interest in EBP
Rapidly expanding access to evidence. Reimbursers starting to use evidence in cases, lack of time for assimilating new evidence (must become an efficient absorber of new articles) and the experience/knowledge disparity between experienced clinicians who lack new knowledge and inexperienced clinicians fresh out of school
What is the difference between traditional EBP and information mastery?
- Traditional - search original/primary research and assess that research yourself
- Information Mastery - Search high quality secondary aggregate sources (lit reviews, systematic reviews) and cite their methods/results
what are the steps of EBP?
Formulate question, search the literature, evaluate the literature, combine evidence with clinical expertise and patient values, evaluate the effectiveness and efficiency of methods
What is the background question?
Question about general knowledge of the etiology, pathophysiology, and prognosis of the disorder and subsequent intervention
What is the foreground question?
Relates to specific information that will guide the management of the patient. aka the PICO question
PICO stands for/represents?
- population - which population are we treating?
- intervention - which is being considered? Think therapy, product, procedure, referral, and the like. This could also be a step in the process of treatment, such as a prognostic factor or diagnostic test.
- comparison or control - appropriate when comparing the effectiveness of two interventions or tests. Not relevant for one intervention
- outcomes - what measurements are relevant in understanding the effectiveness of an outcome? BE SPECIFIC! Quantitative and qualitative scales for pain, ROM, ambulation, gait quality, etc. are good for this
What is the difference between a PICO question and a research question
- A PICO tries to give the best possible evidence for a patient's intervention of choice
- A research question tries to get better outcomes for a population by advancing the field for better efficacy
What are examples of secondary sources?
books, review articles, website's author summaries, systematic reviews, pre-assessed clinical guidelines, clinical practice guidelines
What defines a quality source of EBP research?
- Author credentials
- Quality references: Pubmed
- Recent/regular updating
- Endorsement by respected groups
- Disclosure of funding source
Where can you find evidence?
- Books, clinical guidelines, journals
- Search engines (OVID, PubMed)
- Databases - medline, CINAHL, Healthstar
- Cochrane, Hooked on Evidence
What is MEDLINE? what is MeSH?
MEDLINE is a medical journal/database started in 1870's by John Billings Shaw that covers mostly American Peer Reviewed journals MeSH is an indexing thesaurus used by MEDLINE
Cumulative index to nursing and allied health literature. American bias, uses modified MeSH, uses allied health/therapy journals
Clinical/nonclinical aspects of health care delivery
- Evidence-based clinical practice guidelines
- Cochrane database
- Hooked on evidence
Obtaining the Citation - what's needed?
- Full text/figures
- PDF preferred
What is the purpose of evaluating the literature?
Strengths weaknesses of study, usefulness and applicability of the study