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Adult health.pptx

  1. Critical Thinking and Evidence Based Medicine for Adult Health Nursing Msc Students Dr.Beka A.(GP)
  2. Critical Thinking Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.
  3. What is Evidence-based medicine • Evidence-based medicine(EBM) requires the integration of the best research evidence with our clinical expertise and our patient's unique values and circumstances.
  4. What is Evidence-based medicine • By best research evidence, we mean clinically relevant research, sometimes from the basic sciences of medicine, By clinical expertise, we mean the ability to use our clinical skills and past experience to rapidly identify each patient's unique health state and diagnosis By patient values, we mean the unique preferences, concerns, and expectations that each patient brings to a clinical encounter
  5. History of Evidence Based Medicine • In 1972, Professor Archie Cochrane, a medical doctor and researcher in the UK, highlighted the fact that most treatment related decisions were not based on a systematic review of clinical evidence. He proposed that researchers should collaborate internationally to systematically review all the best clinical trials specialty by specialty. This highlighted gaps that existed between research and clinical practice and started to convince practitioners of the benefits of an evidence-based approach.
  6. History of Evidence Based Medicine • The term ‘evidence-based medicine’ was introduced by Gordon Guyatt and his team in 1991 to shift the emphasis in clinical decision- making from ‘intuition, unsystematic clinical experience, and pathophysiologic rationale’ to scientific, clinically relevant research.
  7. History of Evidence Based Medicine • In 1996, D. L. Sackett, a Canadian-American doctor and founder of the first department of clinical epidemiology at McMaster University in Ontario, explained that evidence-based clinical decision-making is a combination of not only research evidence but also clinical expertise, as well as the unique values and circumstances of individual patients.
  8. How to Practice EBM
  9. How to Practice EBM • Step 1—converting the need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into an answerable question by asking two types of question Background questions Ask for general knowledge about a condition, test, or treatment Foreground questions Ask for specific knowledge to inform clinical decisions or actions
  10. How to Practice EBM Step 2—tracking down the best evidence with which to answer that question • Always look for the best evidence
  11. How to Practice EBM Step 3—critically appraising that evidence for its validity, impact and applicability • Validity: Internal and external validity ; Construct validity, criteria validity and Content validity • Impact: size of the effect • Applicability: Usefulness in our clinical practice
  12. How to Practice EBM • Step 4—integrating the critical appraisal(the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context) with our clinical expertise and with our patient's unique biology, values, and circumstances
  13. How to Practice EBM •Step 5—evaluating our effectiveness and efficiency in executing steps 1 to 4 and seeking ways to improve them both for next time
  14. What are the limitations of EBM? Discussion about the practice of EBM naturally engenders negative and positive reactions from clinicians. Some of the criticisms focus on misunderstandings and misperceptions of EBM, such as the concerns that it ignores patient values and preferences and promotes a “cookbook” approach Relegation of clinical judgment and mechanistic reasoning, and over- reliance on the reliability of clinical trials and systematic reviews
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