Evidence-Based Practice -research methods

Evidence-Based Practice

1. Evidence-Based Practice (EBP) Process by which health care providers know how to find, critically appraise, and use the best evidence

2. EBP

3. Why Evidence-Based Practice (EBP) ?? Health care delivery is filled with uncertainty and many questions arise in every day practice… What kind of guidance would be most helpful to my patients? What clinical assessments and interventions are of the most benefit?

4. Common questions that arise in everyday practice:

5. Evidence to Support Best Practices is Constantly Changing

6. Formulating the Clinical Question

7. PICO Format

8. Patient Population Consideration of the patient and population of interest Limit to age group or subgroup if possible

9. Intervention Exposure Treatment Patient perception Diagnostic test

10. Comparison Could be true control, such as placebo or doing nothing Could be another treatment Sometimes it is the usual standard of care

11. Outcome Outcome may be very specific, e.g. death Outcome may be something that has a variety of measures, e.g. dehydration could be a measure, also tachycardia, dry mouth, fever, restlessness and irritability

12. PICO format example Are 35 to 55 year-old women (p) who have high blood pressure (I) at increased risk for acute myocardial infarction (O) compared with women without hypertension (C)

13. Rating System for Evidence Level I: evidence from systematic review, randomized control trials (RCTs), or evidence-based reviews Level II: evidence from one well-designed RCT Level III: evidence from well-designed studies without randomization Level IV: evidence from other types of studies including case-control and cohort studies Level V: evidence from systematic reviews of descriptive and qualitative studies Level VI: evidence from one descriptive or qualitative study Level VII: evidence from the opinion of authorities and/ or reports of expert committees Meynyk , B. & Fine-Overholt, E.. (2005). Evidence-Based Practice in Nursing and Healthcare. Lippincott, Wiliams & Wilkins.

14. Siwek, J. et al. (2002). Am Fam Physician 65, 251-258. A Rating System for Looking at Evidence in Individual Studies Level A: Randomized control trial (RCT) Level B: (other evidence) Well-designed, nonrandomized trial Non-quantitative systematic review Lower quality RCT’s, clinical cohort studies, case-control studies High-quality historical, less controlled studies, well-designed epidemiological studies Level C: consensus/expert opinion

15. Searching for the Best Evidence: Searchable Databases CINAHL MEDLINE: (PubMed) PEDro-pedro.org.au Cochrane - cochrane.org

16. Sway Link https://sway.office.com/xS3vBI0HXq8Q8QQT?ref=Link