EVIDENCE-BASED PRACTICE.pptx DIAGNOSIS, PROGNOSIS, AND PREVENTION.

DIAGNOSIS, PROGNOSIS, AND PREVENTION.

1. EVIDENCE-BASED PRACTICE: ACQUIRING THE EVIDENCE

2. CONTENT The key steps: Formulate a clinical question Search the literature Efficiently Confidently Appraise the evidence Apply the evidence

3. GOOD CLINICAL PRACTICE Knowledge from best external evidence based on clinical research Judgement from experience. Understanding of patient's beliefs & preferences. Sackett 1996

4. EVIDENCE BASED PRACTICE Conscientious, explicit and judicious use of current best evidence in making decisions about the care of an individual patient 4 Sackett. BMJ 1996;312:311-2

5. EBP FOR THE CLINICIAN Knowledge & Skills Proficiency Application Practice Confidence 5

6. THE 5 STEPS TOWARDS EVIDENCE BASED PRACTICE 1. Ask the right clinical question: Formulate a searchable question 2. Collect the most relevant publications: Efficient Literature Searching Select the appropriate & relevant studies 3. Critically appraise and synthesize the evidence. 4. Integrate best evidence with personal clinical expertise, patient preferences and values: Applying the result to your clinical practice and patient. 5. Evaluate the practice decision or change: Evaluating the outcomes of the applied evidence in your practice or patient. 6

7. Asking the Right Questions 7

8. 8 Clinical Process and knowledge requirements Etiology knowledge about causation Patient presentation knowledge about diagnosis Testing History Examination Investigation s Diagnosis knowledge about prognosis knowledge about therapeutic effectiveness Clinical outcome Therapy Changes prognosis Research evidence sought from literature searches Etiognostic Research Diagnostic Research Prognostic Research Therapy Research

9. The Question - Why is it so Important? A good answerable question will help us focus on evidence that is relevant to a patient’s clinical needs, (or your own knowledge needs). They can suggest high yield search strategies They can suggest the forms that useful answers might take (i.e. what is best research design to answer our question) 9

10. FORMULATING CLINICAL QUESTIONS There is no right or wrong way to turn a scenario/knowledge need into a question. Just make sure it is concise, clinical and uses appropriate language (avoid colloquialism, in favor of technical language). Ask one question at a time. 10

11. PICO: A FRAMEWORK FOR QUESTION P opulation I ntervention C omparison O utcome 11

12. SELECT BEST EVIDENCE Question Relevant Focused Appropriate Study Type Up to Date 12

13. RESEARCH STUDY DESIGN 13

14. RESEARCH DESIGN Diagnostic tests Prognosis Therapy Patients’ Preferences Cross sectional study Cohort study RCT Qualitative research 14 BMJ 1997;315:1636

15. WHAT RESOURCES COULD BE SEARCHED? SPECIALIZED DATABASES PEDro (Physiotherapy Evidence Database). Cochrane Library. PubMed/MEDLINE. CINAHL (Cumulative Index to Nursing and Allied Health Literature). REHAB+. EDUCATIONAL AND LIBRARY GUIDES University LibGuides . Centre for Evidence-Based Medicine (CEBM). 15

16. BEST EVIDENCE FOR YOUR QUESTION 16

17. WHY SHOULD WE BE CRITICAL IN OUR READING OF THE LITERATURE? Enhances Clarity and Deep Understanding Identifies Biases, Flaws, and Authenticity Fosters Active Engagement and Intellectual Growth Improves Related Skills and Broader Applications 17

18. QUALITY OF THE MEDICAL LITERATURE Journal High Quality Articles N Eng J Med 17% Ann Intern Med 13% JAMA 12% BMJ 9% Lancet 8% 18

19. WHAT DO WE MEAN BY RESEARCH QUALITY? Methodological Rigor and Soundness Originality and Novelty Relevance and Impact Transparency and Reproducibility Credibility and Expertise 19

20. QUALITY OF A STUDY The confidence that the study design, conduct and analysis has minimized biases in addressing the research question The better the quality, the higher is the likelihood that the results produced in the study are credible 20

21. QUALITY OF A STUDY Validity The degree to which the results of an observation are correct for the patients being studied. Bias A process that tends to produce results that depart systematically from the true values existing in the study population. Fletcher et al, 1988; Murphy, 1976 21

22. THE HAWTHORNE EFFECT What is it? 22

23. THE HAWTHORNE EFFECT Outcomes changed By virtue of doing the study Irrespective of the intervention 23

24. HIERARCHY OF EVIDENCE Experimental studies Randomized controlled trials Controlled Observational studies Case-control studies Uncontrolled Observational studies Case series Case reports 24

25. EBP BASIC SKILLS Formulate structured clinical question PICO(D) Search for evidence Systematic Select best evidence Critically appraise GATE Frame RAMMbo CASP CAT maker 25

26. AT-A-GLANCE Acronym Title Aim Groups Limbs – Intervention v Comparator Absolute Risk Reduction Number Needed to Treat (NNT) Clinical Conclusion Education for patients/carers 26

27. AT-A-GLANCE Acronym: is there a study name? as a mnemonic Title: Full title, authors, institute, journal, full reference Aim: specific aim of the study and why, what outcomes were used? Groups: who were the research subjects, inclusion criteria, exclusion criteria, who excluded by chance or bias Limbs – Intervention v Comparator, ? Versus placebo, ? Blinded, how randomised, Absolute Risk Reduction: What the main results?, what the main results on the outcomes studied, other main results, ? Side-effects, other harm events Number Needed to Treat (NNT): How many people do you need to treat to have one beneficial effect? Eg how many people to save a life? How many treated to have side-effects? Clinical Conclusion: What are the main clinical conclusions for you and the team? Can the results be implemented locally? ? Change in guideline needed? ? Clinical audit needed? Education for patients/carers: How can you explain the results to a patient/guardian prior to consent and explanation? State what you will actually say eg “Research has shown that………what do you think?” 27

28. LEVELS OF EVIDENCE Level Type of evidence I Evidence obtained from at least one randomized controlled trial or from meta-analysis of randomized controlled trials II Evidence obtained from at least one well-designed controlled study without randomization III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case control studies IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities 28

29. GRADING OF RECOMMENDATIONS Grade Recommendation A (Evidence level I) Requires at least one randomized controlled trial as part of the body of literature of overall good quality and consistency addressing the specific recommendation B (Evidence levels II, III) Requires availability of well-conducted clinical studies but not randomized clinical trials on the topic of recommendation C (Evidence level IV) Requires evidence from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates absence of directly applicable studies of good quality 29

30. SUMMARY 30

31. overcoming nervousness CONFIDENCE-BUILDING STRATEGIES

32. engaging the audience Make eye contact with your audience to create a sense of intimacy and involvement Weave relatable stories into your presentation using narratives that make your message memorable and impactful Encourage questions and provide thoughtful responses to enhance audience participation Use live polls or surveys to gather audience opinions, promoting engagement and making sure the audience feel involved 32

33. selecting visual aids ENHANCING YOUR PRESENTATION

34. effective delivery techniques Effective body language enhances your message, making it more impactful and memorable: Meaningful eye contact Purposeful gestures Maintain good posture Control your expressions This is a powerful tool in public speaking. It involves varying pitch, tone, and volume to convey emotion, emphasize points, and maintain interest: Pitch variation Tone inflection Volume control 34

35. navigating q&a sessions Know your material in advance Anticipate common questions Rehearse your responses Maintaining composure during the Q&A session is essential for projecting confidence and authority. Consider the following tips for staying composed: Stay calm Actively listen Pause and reflect Maintain eye contact 35

36. speaking impact Your ability to communicate effectively will leave a lasting impact on your audience Effectively communicating involves not only delivering a message but also resonating with the experiences, values, and emotions of those listening 

37. speaking impact Learn to infuse energy into your delivery to leave a lasting impression One of the goals of effective communication is to motivate your audience METRIC MEASUREMENT TARGET ACTUAL Audience attendance # of attendees 150 120 Engagement duration Minutes 60 75 Q&A interaction # of questions 10 15 Positive feedback Percentage (%) 90 95 Rate of information retention Percentage (%) 80 85 37

38. final tips & takeaways CONSISTENT REHEARSAL Strengthen your familiarity REFINE DELIVERY STYLE Pacing, tone, and emphasis TIMING AND TRANSITIONS Aim for seamless, professional delivery PRACTICE AUDIENCE Enlist colleagues to listen & provide feedback Seek feedback Reflect on performance Explore new techniques Set personal goals Iterate and adapt 38

39. speaking engagement metrics IMPACT FACTOR MEASUREMENT TARGET ACHIEVED Audience interaction Percentage (%) 85 88 Knowledge retention Percentage (%) 75 80 Post-presentation surveys Average rating 4.2 4.5 Referral rate Percentage (%) 10 12 Collaboration opportunities # of opportunities 8 10 39

40. 40 Greenhalgh, T. (2010).  How to read a paper: The basics of evidence-based medicine  (4th ed.). Wiley-Blackwell. Vatkar , A. (2025). Understanding the Levels of Evidence in Medical Research.  PMC .  https://pmc.ncbi.nlm.nih.gov/articles/PMC12064251/ Fineout-Overholt, E., & Johnston, L. (2005). Teaching EBP: asking searchable, answerable clinical questions.  Worldviews Evid Based Nurs , 2(3), 157-160.  https://doi.org/10.1111/j.1741-6787.2005.00032.x

41. thank you BRITA TAMM 502-555-0152 [email protected] www.firstupconsultants.com