What Is Evidence Based Practice

What Is Evidence Based Practice

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  WHAT IS EVIDENCE BASEDPRACTICE?
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  Patient Values/ Preferences Or Expectations Clinical Data/ Knowledge Research Evidence Optimal Decision What doesthe patient want? What are they willing to do? What does your experience tell you? What has been the experience of your colleagues? What does the research say?
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  Evidence Based PracticeInquiry Process Focus the question Adequate evidence? Assign / Find mentor IRB Proposal & Approval Data collection Data analysis Disseminate Impact and/or outcome Initial question Unit or department resource Assess translation of evidence into practice setting Create action plan and implement change Evaluate outcome and/or impact Finalize team membership and schedule conferences Report results to decision- makers Adopt change and identify next steps Contact Research Advisory Council or Group (If Applicable) Appraisal of literature Assemble initial project team If answer is yes, proceed to EBP Project. If answer is no, proceed to research project Consult Librarian & Do Lit. Search Adapted from VCUHS Nursing Inquiry Process Diagram
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  Levels of Evidence Evidence Based Practice Guidelines Meta-Analysis / Systematic Review Critically Appraised Topics [Evidence Syntheses] Critically Appraised Individual Articles [Article Synopses] Randomized Control Trials (RCT’s) Cohort Studies / Cross-Sectional Study Case Controlled Studies/ Case Reports Reviews Background Information / Expert Opinion Filtered Information Unfiltered Information EBP Objective: Clinical Knowledge Bedside
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  Practice Guideline Advantages Created bypanels of experts Based on professional published literature http://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.html Statement produced by a panel of experts that outlines current best practice to inform health care professionals and patients in making clinical decisions.  Where Can They Be Found? o PubMed o CINAHL o National Guidelines Clearinghouse Disadvantages  Slow to change or be updated  Not always available, espeically on controversial topics  Recommendations might be affected by the type of organization creating the guideline
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  Review Articles Review Articles •Provide Overview of a field or subject • Synthesize Previous Research • Useful when you need background information and additional references Systematic Review • Evidence based search and review of the literature on a topic by an established method. Meta-Analysis • A systematic method that takes data from a number of independent studies and integrates them using statistical analysis (Dorland’s Medical Dictionary for Health Consumers)
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  Primary Research Articles •Present new and original scientific findings • Explain research methodology and provide data Randomized Controlled Trials (RCT’s) Cohort Studies Case-Controlled Studies Studies that randomly assign individuals to an intervention group or to a control group, in order to measure the effects of the intervention. Study in which a particular outcome, such as death from a heart attack, is compared in groups of people who are alike in most ways but differ by a certain characteristic Study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor and the disease. Types of Research Articles Cause & Effect
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  Type of Question/Best Type of Study Type of Question Best Type of Study Therapy How to select treatments to offer patients that do more good than harm and that are worth the efforts and costs of using them Randomized Control Trial (RCT) Prevention How to prevent a disease or condition RCT/ Cohort Study / Case Control Prognosis How to estimate the patient's likely clinical course over time and anticipate likely complications of disease Cohort Study/ Case Control/ Case Series or Case Report Diagnosis How to select and interpret diagnostic tests Blind RCT Compared to the Gold Standard (best treatment/test for diagnosis) Etiology/Harm How to identify causes for disease RCT/ Cohort Study /Case Control Cost analysis Economic costs of all facets of a intervention or disease treatment Economic Analysis Search Process Checklist
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  Selecting the RightResource • Research Guides • Nursing Research Guide • Important Databases • PubMed/Medline (Free) • CINAHL • APA PsycNet/PsychInfo • Cochrane Library • TRIP Database (Free) • National Guidelines Clearinghouse (Free) • PubMed Health (Free) • Medline Plus (Free) http://guides.library.vcu.edu/nursing Evidence Based Practice Guidelines Meta- Analysis / Systematic Review Critically Appraised Topics [Evidence Syntheses] Critically Appraised Individual Articles [Article Synopses] Randomized Control Trials (RCT’s) Cohort Studies / Cross-Sectional Study Case Controlled Studies/ Case Reports Reviews Background Information / Expert Opinion Filtered Information Unfiltered Information
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  Evidence Based Practice Guidelines Meta- Analysis / Systematic Review CriticallyAppraised Topics [Evidence Syntheses] Critically Appraised Individual Articles [Article Synopses] Randomized Control Trials (RCT’s) Cohort Studies / Cross-Sectional Study Case Controlled Studies/ Case Reports Reviews Background Information / Expert Opinion Filtered Information Unfiltered Information
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  Objectives: By the endof this presentation you will : • Have an understanding of how evidence based practice is defined. • Understand the quality of the different types of literature that are assessed when making decisions based on evidence. • Be aware of the different types of EBP questions and what studies best answer each type.