EBP-Evidence-Based Practice

How to Conduct Article Appraisal

Critical Appraisal Skills Programme (CASP, 2006) provides suggestions for general guidelines for critical appraisal. 3 key questions: 1. Is the study valid? 2. What are the results? 3. Will the results help my patients? CASP suggests considering the following during article appraisal: Rigor—methodological rigor and addresses the appropriateness of the research methods in the study Credibility—credibility of the research findings and addresses the presentation and meaningfulness of the results Relevance—relevance of the study and addresses the usefulness and applicability of the results to the clinician and the patient.

Chapter Summary and Key Points

EBP is about recognizing clinical problems; asking good clinical questions; finding, critically evaluating, analyzing, and synthesizing the evidence; and applying the best, most relevant evidence to clinical decisions and patient care recommendations. The distinguishing characteristic of EBP is that it assigns a hierarchy to specific categories of evidence. The systematic review process is guided and directed based on the clinical question.

Finding, Evaluating, and Applying Evidence

EBP is essentially about: Recognizing clinical problems Asking good clinical questions Finding, critically evaluating, analyzing, and synthesizing evidence Applying the most relevant evidence to clinical decisions and patient care recommendations

Hayward's Evidence-Based Information Cycle

Theoretical model that illustrates the process of practicing evidence-based medicine: 1.Assess 2.Ask 3.Acquire 4.Appraise 5.Apply evidence to answer clinical problems Hayward's Evidence-Based Information Cycle shows the cyclic nature of accessing the best information on the effectiveness of each intervention.

Theory in Clinical Practice and Research

Theory in Clinical Practice: Theory is a conceptual framework for a set of ideas, principles, or guidelines that can provide a contextual outline for students and practitioners in the process of coming to a conclusion or determination about a clinical situation. Theory in Research: Theory represents a frame of reference, or school of thought. A scientific theory refers to an entire group of related phenomena versus scientific law provides explanation for a specific single occurrence (law of gravity)

The Role of Theory: What is theory??

Theory is based on general principles rather than specific instances. Theory can be explained as a set of facts, propositions, or principles analyzed in their relation to one another and used to explain phenomena. Theory connects and offers explanation. Theory emphasizes how concepts or ideas interrelate with one another

What is Evidence-Based Practice (EBP)?

Evidence-based practice (EBP) is the process by which decisions about clinical practice are supported with research evidence/results. Clinicians use the best, up-to-date research evidence to help diagnosis and treat individual patients. Clinicians need be able to access, evaluate, interpret, and apply the medical literature. EBP - a step by step process for students and clinicians 1.Assess 2.Ask 3.Acquire 4.Appraise 5.Apply evidence to answer clinical problems Evidence-based practice: a three-part approach to patient care: 1.Valid research findings grounded in theory and science = RESEARCH 2. Clinical expertise and practical experience = EXPERIENCE 3. The medical needs, psycho-social interests, and ethical and religious values of the individual patient = SPECIFIC PATIENT

"How To" Steps for the EBP Process

How to define a question or problem: assessment and ask The EBP process begins with a clinical question or a clinical problem. Clinical questions must be distinctive and clearly based on the nature of the clinical problem. Assessment involves identifying key issues and then asking good, answerable questions. Assessment yields information; informed questions yield informed answers. Good information generates more good information. How to conduct article appraisal: "Article appraisal" refers to the appraisal of evidence discussed relative to its quality (e.g., bias, power, generalizability of results). How to understand basic research designs How to use the evidence to help yourself and your patients/population: apply Determine how to apply the knowledge obtained from the research evidence. Summarize the findings, and determine how or if the evidence connects to the clinical problem and provides a clear answer to the clinical issue in question. Establish conclusions directly supported by the evidence, and apply those findings to the question (minimize bias and reduce random error).

Evidence-Based Practice...

Is not an attempt to replace clinician judgment with scientific research. Is not a standardized treatment approach determined and dictated by science. Is not an agenda driven by administrators or policy makers to reduce medical expenses for more costly conditions by eliminating patient treatment options. Does not take away from more traditional means of acquiring clinical knowledge.

The Role of Research in EBP

Research results can offer evidence and validation for clinical decisions made in an attempt to provide optimal patient care. One role of research in EBP is to complement clinical experience with patient preference. Another role of research in EBP is to provide basic guidelines for conducting, interpreting, and applying empirical research ( observations) to clinical practice