EBP ch. 12 & 15 terms

criteria for evaluating EBP

1. Does the introduction focus on a specific area of practice? 2. is the purpose of the case study appropriate? 3. does the background literature clearly indicate a literature gap that this case study fills? 4. are multiple sources of evidence from the literature included? 5. if appropriate, is a theoretical framework presented for the case study? 6. is the case history presented clearly? 7. is the process of clinical care clearly described? 8. are outcomes identified? 9. are all appropriate history, process, and outcome elements included? 10. does the discussion address the case in the context of what is known, offering rationale for successful and unsuccessful outcomes? 11. are appropriate implications for practice provided? 12. are specific suggestions for future research delineated? 13. is the case study presented clearly? 14. is the case study presented logically?

discussion (Questions to consider when appraising nursing studies)

1. are the results based on the data presented? 2. is the evidence sufficient to draw conclusions 3. are the results interpreted in the context of the problem/purpose, hypothesis, and theoretical framework/literature reviewed? 4. are the concussions and generalizations clearly stated? 5. are the limitations of the findings clearly delineated? 6. are the generalizations within the scope of the findings or beyond the findings? 7. does the study contribute to nursing knowledge?

introduction (Questions to consider when appraising nursing studies)

1. does the introduction demonstrate the need for the study? 2. is the problem clearly and concisely identified? 3. is the problem presented with enough background material to acquaint the reader with the importance of the problem? 4. is the purpose of the study clearly stated? 5. are the terms and variables relevant to the study clearly defined? 6. are the assumptions clearly and simply stated? 7. if appropriate to the design, are hypotheses stated? 8. does the study use a theoretical framework to guide its study?

results (Questions to consider when appraising nursing studies)

1. is the presentation of data clear? 2. are the characteristics of the sample described? 3. was the best method(s) of analysis selected? 4. are the tables, charts, and graphs pertinent?

methods (Questions to consider when appraising nursing studies)

1. is the research approach appropriate? 2. was the protection of human subjects considered? 3. are the details of data collection clearly and logically presented? 4. are the instrument(s) appropriate for the study both in terms of the problem and the approach? 5. are the instrument(s) described sufficiently in terms of content, structure, validity, and reliability? 6. is the population and the method for selecting the sample adequately described? 7. is the method for selection of the sample appropriate? 8. is the sample size sufficient? 9. is attrition of sample reported and explained? 10. does the design have controls at an acceptable level for the threats to internal validity? 11. what are the limited to generalizability in terms of external validity?

review of the literature (Questions to consider when appraising nursing studies)

1. is the review of the literature (ROL) relevant to the problem? 2. is the ROL adequate in terms of the range and scope of ideas, opinions, and points of view relevant to the problems? 3. is the ROL well organized and synthesized? 4. does the ROL provide for critical appraisal of the contribution of each of the major references? 5. does the ROL conclude the summary of the literature with implications for the study? 6. is the ROL adequately and correctly documented?

Joanna Briggs Institute

An International Research and Development Unit of Royal Adelaide Hospital and an Affiliated Institute of the University of Adelaide that supports the development and dissemination of international systematic reviews and summaries of best practices to consumers, healthcare professionals, and all levels of healthcare systems, governments, and service provider units.

FYI 5

Clinicians must decide to adopt or reject innovations through reducing the uncertainty of an innovation. one strategy that individuals use to reduce uncertainty during the decision-making process is to try a portion of the innovation or adopt the innovation on a trial basis, which is called a pilot

Trip Database

Supports evidence-based practice by presenting evidence summaries fro healthcare providers

FYI 6

There are five steps for evaluating and implementing EBP: ask, acquire, appraise, apply and assess. nurses need to examine all the evidence to make recommendations about practice changes.

Primary Care Clinical Practice Guidelines

This site, compiled by Peter Sam at the UCSF School of Medicine, includes all guidelines, evidence-based,consensus, practice parameters, protocols, and other resources such as integrative studies, meta-analysis, critically appraised topics, and review articles.

FYI 7

Various professional associations and other clinical entities have developed CPGs to be used in practice settings. CPGs will continue evolving because of the momentum generated by EBP, and they will become more available because of the increased capacity to search the literature through computerization

case studies

a description of a single or novel event; a unique methodology used in qualitative research that may also be considered a design or strategy for data collection

Health Services/Technology Assessment Text

a free, web-based resource of full-text documents including guidelines that provide health information and support healthcare decision making for healthcare providers, health services researchers, policymakers, prayers, consumers, and the information professionals who serve these groups.

synopses

a level in the pyramid of evidence containing brief descriptions of evidence

summaries

a level in the pyramid of evidence containing detailed descriptions of evidence

syntheses

a level in the pyramid of evidence containing evidence to present a whole depiction of a phenomenon

systems

a level in the pyramid of evidence involving electronic medical records integrated with practice guidelines

studies

a level in the pyramid of evidence that contains quantitive and qualitative studies, case studies, and concept analysis

The Guideline to Community Preventive Services

a multidisciplinary, interdependent, nonfederal group that develops evidence-based practice guidelines for community preventive services

NGC

a public resource for evidence-based practice guideline summaries that provide inclusion criteria, attributes of the guideline, a glossary, the classification scheme, and summary of the content development.

systematic review

a rigorous and systematic synthesis of research findings about a clinal problem

meta-analysis

a scholarly paper that combines results of studies, both published and unpublished, into a measurable format and statistically estimates the effects of proposed interventions

integrative review

a scholarly paper that synthesizes published studies to answer questions about phenomena of interest

InfoPOEMS Patient-Oriented Evidence that Matters

a searchable database from the Journal of Family Practice.. summaries similar to ACP journal Club articles in mythology and format that are targets at family practitioners

pilot

a small study to test a new intervention with a small number of subjects before testing with larger samples; adopting an innovation on a trial basis

meta-synthesis

a systematic review that contains only qualitative studies; a scholarly paper that combines results from qualitative studies

case control studies

a type of retrospective study in which researchers begin with a group of people who already had the disease; studies that compare two groups: those who have a specific condition and those who do not have the condition

FYI 1

an organized framework, or pyramid of evidence, explains the importance and contribution of various levels of information of evidence-based healthcare delivery. the pyramid of evidence has five levels, known as the 5 s's: studies, syntheses, synopses, summaries, and systems

Domain 5 (domains of quality in the AGREE II instrument)

applicability addresses the behavioral, cost, and organizational consequences of applying the guideline

adoption

applying an innovation to practice

AGREE II

appraisal of Guidelines Research and Evaluation; Internationally developed instrument to evaluate clinical practice guidelines

traditional literature review

article based on common or uncommon elements of works with little concern for research methods, designs, or settings; narrative literature review

FYI 3

because the purpose of EBP is to answer clinical questions, and the oil is to efficiently find information, nurses should begin the search for information at the top of the pyramid and work down the various levels. the best option is having a system already in place that brings the information to the medical record.

Domain 4 (domains of quality in the AGREE II instrument)

clarity and presentation evaluates the format and clearness of the guideline

appraise (five-step approach for EBNP)

conduct a critical appraisal of the literature and studies. evaluate for validity and determine the applicability in practice

rejection

decision not to adopt an innovation

uncertainty

degree to which alternatives are perceived relative to the occurrence of an event and the probability of these alternatives

Physiotherapy Evidence Database PEDro

developed to provide rapid access to bibliographic details and abstracts of randomized controlled trials, systematic reviews, and evidence-based clinical practice guidelines in physiotherapy.

Domain 6 (domains of quality in the AGREE II instrument)

editorial independence specification of possible conflicts of interest are enumerated and the independence of the recommendations

assess (five-step approach for EBNP)

evaluate the application for the findings, outcomes and relevance to nursing practice.

prognosis (common critical questions)

evaluates the course of treatment over time, any complications, and overall prognosis

therapy (common critical questions)

examines therapeutic treatment(s) for healthcare problems and their efficacy, cost and potential harm

randomized controlled trials

experimental suites that typically involve large samples and are conducted in multiple sites

consistency

for any given topic, the extent to which similar findings are reported using similar and different study designs

FYI 4

fortunately, few ethical dilemmas arise when considering use of evidence. when nurses find evidence that can be applied to practice, they must consider changes carefully because lives are at stake; however, it is unethical not to a adopt practice guidelines when the evidence is clear.

The cochrane collaboration

founded in 1993. international not-for-profit organization that is dedicated to disseminating information about the effects of health care worldwide. has several resources at the disposal of evidence-based practitioners, one of them being the Cochrane Database of Systematic Reviews, published on a continuous bases form Cochrane Library. Best known for its comprehensive evidence-based summaries written in an easy-to-read style

GRADE

grades of recommendations, assessment, development, and evaluation; international, universal system for evaluating evidence

ask (five-step approach for EBNP)

identify the research question. determine whether the question is well constructed to elicit a response or solution

apply (five-step approach for EBNP)

institute recommendations and findings and apply them to nursing practice

the Joanna Briggs institute

international not-for-profit research organization that is part of the school of translational scene at the University of Adelaide, South Australia. its mission is to evaluate health outcomes for the client and community from an economic and clinical perspective. also focuses on the evaluation of research. identifies topics from systematic review, plans the review, and uses expert panels and reviewers to publish systematic reviews. more then 70 collaborating entities, providing the best clinical evidence at the point of care.

passive rejection

lack of consideration given to adopting an innovation; hence, old practices are continued

causation/harm/etiology (common critical questions)

looks at the causes of disease, including iatrogenic causes, potential harm, and benefits

descriptive studies

non experimental studies used to provide information about a phenomenon

FYI 8

nurses who engage in activities that promote EBP, such as journals clubs and policy committees, may find even after diligently reviewing the evidence, practice changes are not implemented. nurses need to follow agency policy and act as change agents to effectively bring the evidence to the point of care.

levels of evidence

predetermined scaled that guide decisions for ranking evidence; evidence hierarchies

evidence hierarchies

predetermined scales that guide decisions for ranking evidence; levels of evidence

Evidence-based medicine

presents abstracts of international medical journals with commentary on its clinical application to primary medicine.

Evidence-based nursing

presents abstracts of selected research with an expert commentary on its clinical application

BMJ Clinical Evidence

presents summaries that address common or important clinical conditions seen in primary and hospital care and benefits and harms of preventative and therapeutic interventions. a rigorous process of developing the summaries is described. drug safety alerts and links to national guidelines are included.

DynaMed

provides clinically organized summaries of nearly 1,800 evidence-based topics for use at the point of care via the internet and/or PDA

UpToDate

provides evidence-based clinical information to a variety of clinicians on the internet, on CD-ROM, and on Pocket CD

American College of Physicians Smart Medicine ACP Smart Medicine

provides evidence-based guidance to improve clinical care. topics include diseases, screening and prevention, complementary/alternative medicine, ethical/legal issues, procedures, quality measures, and drug resources.

SUM Search

provides references to answer clinical questions about diagnosis, etiology, prognosis, and therapy (plus physical findings, adverse treatment effects, and screening/prevention) by searching sources such as Merck Manual, MEDLINE, National Guideline Clearinghouse from AHRQ, Database of Abstracts of Reviews of Effects, and Pub Med

The Cochrane Library

provides systematic reviews related to clinical topics. the complete reviews are available by subscription, either on CD-ROM or via the internet. abstracts of the reviews are available on the website

active rejection

purposefully deciding not to adopt an innovation

cohort studies

quasi-experimental studies using two or more groups; epidemiological designs in which subjects are selected based on their exposure to a determinant

diagnosis (common critical questions)

queries the selection and interpretation of diagnostic tests

other (common critical questions)

questions may be written related to prevention, clinical examinations, coast, point of contract, or patient/client data

clinical practice guidelines

recommendations based on evidence that serve as useful tools to direct clinical practice

Domain 3 (domains of quality in the AGREE II instrument)

rigor of development evaluates the purpose of gathering and synthesizing the evidence and how it was examined

systematic reviews

rigorous and systematic syntheses of research findings about clinical problems

meta-analysis

scholarly papers that combine results of studies, both published and unpublished, into a measurable format and statistically estimate effects of purposed interventions

concept analyses

scholars papers that explore the attributes and characteristics of a concept

Domain 1 (domains of quality in the AGREE II instrument)

scope and purpose of the guidelines purpose, aims, clinical questions, and target population are evaluated

acquire (five-step approach for EBNP)

search the literature for reappraised evidence or research. secure the best evidence that is available

U.S. Preventive Services Task Force USPSTF

sponsored by AHRQ, systematically reviews the evidence of effectiveness of a wide range of clinical preventive services, including screening tests, counseling, immunizations, and chemoprophylaxis.

Domain 2 (domains of quality in the AGREE II instrument)

stakeholder involvement identifies the congruence of meeting the needs of the intended users

First Consult

supports clinical decision making by providing concise, readable summaries of evidence that relates to patient care.

practice guidelines

systematically developed statements to assist healthcare providers with making appropriate decisions about health care for specific clinical circumstances

quality

the aggregate of quality rating for individual studies, predicted on the extent to which bias was minimized

nonpropositional knowledge

the art of nursing or knowledge that is obtained through practice

absolute risk reduction (ARR) (definitions of clinically significant statistics)

the difference in risk between the control group (X) and the treatment group (Y). ARR= X-Y

quantity

the magnitude of effect, numbers of studies, and sample size or power

numbers needed to treat (NNT) (definitions of clinically significant statistics)

the number of patients that must be treated over a given period of time to prevent one adverse outcome. NNT= 1 / (X-Y)

odds ration (OR) (definitions of clinically significant statistics)

the odds of an experimental patient suffering an event compared to a patient in the control group or the odds of risk

relative risk reduction (RRR) (definitions of clinically significant statistics)

the percentage reduction in risk in the treated group (Y) compared to the control group (X). RRR=Y/X x 100%

relative risk (RR) (definitions of clinically significant statistics)

the risk of the outcome in the treated group (Y) compared to the risk in the control group (X). RR=Y/X

propositional knowledge

the science of nursing or knowledge that is obtained from research and scholarship

FYI 2

within the 5 s's are several types of evidence, including case studies, concept analyses, meta-syntheses, systematic reviews, traditional literature reviews, integrative reviews, meta-analyses, practice guidelines, and abstract

Agency for Healthcare Research and Quality AHRQ

works with 12 Evidence-Based Practice Centers that develop evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other healthcare organization and delivery topics. professional societies, health plans, insurers, employers, and patient groups can nominate topics. they sponsor a National Guideline Clearinghouse at http://guideline.gov.