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Roseman University Library - Evidence Based Practice

This powerpoint presentation will walk you through the basic concepts and techniques used in EBP research and application.

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Roseman University Library - Evidence Based Practice

  1. 1. Evidence Based Practice University Library
  2. 2. Evidence-Based Practice Definition The most commonly cited is that EBP is “the conscientious, explicit, and judicious use of current best evidence in making decisions”(Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal, 312(7023), 71-72. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8555924
  3. 3. History of EBP • Evidence-Based Practice has its roots in Evidence Based Medicine (also referred to as Evidence –Based Health Care). • EBM was created in the 1980s and popularized in the early 1990s as a response to medical textbooks being unable to keep up with rapid changes in medicine and being frequently based on the interpretations of a small number of people in a respective field. • At the same time, the medical literature in journals was being produced in record numbers, but at the same time was poorly organized.
  4. 4. EBP vs. Evidence-Based Medicine (EBM) • EBM is primarily limited to the health care field and focuses on a specific patient or population. • Evidence Based Practice can be applied to many fields. EBP is constantly being modified to best suit the subject to which it is being applied. • In all cases, you want to use the best evidence to inform your practice.
  5. 5. Common questions in everyday practice: • Which combination and sequence of treatments is most effective? • Which patient symptoms predict better or worse outcomes? • What is the experience of illness for a patient with this diagnosis? • Which treatment is most effective and will produce the best patient outcome? • If a diagnosis is left untreated, what might be the outcome?
  6. 6. The Evidence Based Practice Process The EBP process is comprised of 5 steps: 1. Defining a question that needs to be answered. 2. Acquiring the literature that will be analyzed. (building and executing the search) 3. Conducting a formal evaluation of the results, also referred to as critical appraisal. 4. Integrating the evaluated evidence into practice. 5. Re-evaluating the process to assess its efficacy and improve it in the future.
  7. 7. Defining the Question (PICO) P – Patient/Population/Problem I – Intervention (drug, diagnostic test, etc.) C – Comparative Intervention (what, if anything are we comparing it to) O – Outcome (what is our desired result) • The PICO format is used to construct the clinical question in a specific manner • Using PICO format helps you identify the most important parts of your question
  8. 8. Patient Population • Consideration of the patient and population of interest • Limit to age group, gender, or other group if possible
  9. 9. Intervention • Exposure • Treatment • Patient perception • Diagnostic test
  10. 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. 11. Outcome • Outcome may be very specific • Outcome may be something that has a variety of measures • Outcome may be inconclusive
  12. 12. PICO Example In a 52 year old African American male with Type II diabetes, is metformin better than insulin at regulating blood sugar? • Patient - 52 year old African American male • Problem - Type II diabetes • Intervention – metformin • Comparative Intervention – insulin • Outcome – Blood sugar levels
  13. 13. Pyramid of Evidence
  14. 14. Critical Appraisal involves carefully and systematically examining research to judge its validity, reliability, and the relevance to a particular context. Things to Consider: 1. Pyramid of Evidence 2. Placement on the Pyramid does not equate to importance of the work 3. Placement on the Pyramid does rank research by: • Subject area • Type of research done within subject area • Committees / organizations who create guidelines • Complexity and Content of the work Critical Appraisal
  15. 15. Types of Study Designs Experimental – controlled study design Observational – experiential and anecdotal Quantitative – results defined by numbers Qualitative – results defined by words Synthetic – reviews of multiple studies Study designs are driven by the research question being asked, the population being studied, and the desired results of the study.
  16. 16. Identifying Bias Part of critical appraisal is to identify potential biases in order to evaluate the validity of a study. Common Types of Bias  Conflict of Interest Bias – researcher benefits from results or funding entity benefits from results  Wrong Sample Size – usually due to small sample size  Positive Results Bias – results are more likely to be published because they are positive  Correlation Bias – results appear to correlate but actually do not, statistically  Missing Clinical Data Bias – data can be erroneously or intentionally omitted
  17. 17. Searching for the Best Evidence • CINAHL – Nursing literature • Cochrane – Systematic Reviews • PubMed – Clinical Queries • National Guidelines Clearinghouse: http://www.guideline.gov • Agency for Healthcare Research and Quality: http://www.ahrq.gov/clinic/cpgsix.htm • National Institute of Nursing: http://ninr.nih.gov/ninr
  18. 18. Questions? Library staff are here to help you. o Call us  702-968-2040 (Henderson)  801-878-1020 (South Jordan) o Text questions to 801-872-9715 o Ask a question online at http://libanswers.roseman.edu