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Research and EMS Research Guide
- 1. TRANSITION SERIESTRANSITION SERIES Topics for the Advanced EMTTopics for the Advanced EMT CHAPTER Research and EMSResearch and EMS 1
- 2. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD ObjectivesObjectives • Explain the integration of research into EMS education and practice. • Demonstrate that evidence-based research guides clinical decision making. • Discuss analyzing and interpreting research, the types, and scientific theory.
- 3. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Objectives (cont’d)Objectives (cont’d) • Express the involvement of the Advanced EMT in clinical and EMS systems research.
- 4. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD IntroductionIntroduction • In EMS we spend nearly 3 billion dollars each year delivering care, but little of what we do has truly been evaluated. • How do we know we are being helpful? • How do we know that the tools we use are effective?
- 5. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Figure 1-1 Research guides the care we provide.
- 6. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Evidence-Based ApproachEvidence-Based Approach • Outcomes of therapies and interventions are carefully measured to ensure the intended results. • When changes are made, decisions are based on clear indications and outcomes.
- 7. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Evidence-BasedEvidence-Based Approach (cont’d)Approach (cont’d) • Quality research and the evidence based approach allows the EMS profession to: – Answer questions – Expand resources wisely – Avoid spending time and money on ineffective therapies – Focus budgets on elements that mean the most to patient care
- 8. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD EMS ResearchEMS Research • Someone once said, “Not everything that is researched is true and not everything that is true has been researched.”
- 9. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Scientific MethodScientific Method • General observations are turned into an unproven theory or hypothesis. • Predictions are made based on the hypothesis. • Predictions are tested to either prove or disprove the theory.
- 10. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD BiasBias • Occurs when research is influenced by prior inclinations, beliefs, or prejudices. • Outcomes are manipulated to fit an expected outcome instead of being measured objectively against the hypothesis.
- 11. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Prospective vs. RetrospectiveProspective vs. Retrospective • Prospective research method – Designed to look forward and test therapies/outcomes in the future. – Easier to control errors and prevent bias.
- 12. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Prospective vs. RetrospectiveProspective vs. Retrospective (cont’d)(cont’d) • Retrospective research method – Looks at events that have occurred in the past, evaluating the outcome of therapies previously performed. – Difficult to control and less valid.
- 13. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD RandomizationRandomization • The research study compares one therapy against another by randomly assigning a specific therapy to patients as opposed to having predetermined groups – Bias is controlled – Improves objectivity – Utilizes blinding to improve objectivity
- 14. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD BlindingBlinding • Keeps the patient from knowing which therapy they are receiving. • Makes it very difficult to influence outcomes thus improving objectivity. – Single blind: the researcher knows who is getting what therapy – Double blind: neither the patient nor the researcher knows who is getting what therapy
- 15. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Control GroupsControl Groups • In medicine, a control group is commonly a known, or currently used therapy. • Helps to better evaluate outcomes fairly. • Comparison adds weight and value to the analysis.
- 16. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Study Group SimilarityStudy Group Similarity • When testing a new treatment, it is important that the subjects in the group have a degree of similarity.
- 17. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Systematic ReviewSystematic Review • A series of studies pertaining to a single question are evaluated • Results are reviewed, summarized, and used to draw evidence-based conclusions. • Made up of many different research experiments.
- 18. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Randomized Controlled TrialsRandomized Controlled Trials • The researcher randomly assigns eligible subjects into groups to receive or not receive the intervention being tested • A placebo may be used: – Sugar pill which has no effect
- 19. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Cohort/Concurrent Control/Cohort/Concurrent Control/ Case-Control StudiesCase-Control Studies • Two groups of therapies or patients are compared but they are not randomized. • Frequently retrospective in nature. • Difficult to control all aspects of similarity and methods among the groups. • Prone to bias.
- 20. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Case Series/Case ReportsCase Series/Case Reports • Review the treatment of a single patient or a series of patients. • Frequently report on unusual circumstances or outcomes. • No control group. • Always retrospective. • Not as valid as randomized studies.
- 21. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Meta-AnalysisMeta-Analysis • Compilation of different studies looking at a single topic. • Summarizes the work of others. • Often comments on outcomes.
- 22. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Level of EvidenceLevel of Evidence • The American Heart Association qualifies the validity of research in a linear fashion. • Assigns varying levels of importance based on the way studies are conducted. • Useful in evaluating the importance of data.
- 23. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Level of Evidence (cont’d)Level of Evidence (cont’d) • Can be used as a framework for considering the utility of a particular study.
- 24. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Level of Evidence (cont’d)Level of Evidence (cont’d) • Level of Evidence 1 – The most valuable set of data results from randomized control trials or meta- analyses of RCTs. • Level of Evidence 2 – Studies using concurrent controls without true randomization. • Level of Evidence 3 – Studies using retrospective controls.
- 25. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Level of Evidence (cont’d)Level of Evidence (cont’d) • Level of Evidence 4 – Studies without a control group. • Level of Evidence 5 – Studies not directly related to the specific patient or population.
- 26. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Reviewing ResearchReviewing Research • Was the study randomized? • Was the randomization blinded? • If more than one group, were the groups similar at the start of the trial? • Were all eligible patients analyzed? • If they were excluded, why? • Were the outcomes a result of the therapy? • Is the outcome relevant?
- 27. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD Figure 1-2 Read and evaluate research
- 28. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD You and EMS ResearchYou and EMS Research • As an ALS provider of the future, you will be on the front line of conducting research. • Strong documentation will help improve future studies. • Your service, local hospital, or region may participate and enroll patients in a specifically-designed experiment. • You may take part in designing a study.
- 29. Transition Series: Topics for the Advanced EMT Joseph J. Mistovich • Daniel Limmer • Howard A. Werman, MD SummarySummary • EMS research is an important part of the future of our profession. • It is imperative to understand the basic concepts of research as well as know how to read and evaluate research literature. • Being involved in research development offers a rewarding pathway for enlightened providers.
Notes de l'éditeur
- Discuss the objectives.
- Discuss the objectives.
- Explain how scientific experimentation establishes facts and measures outcomes. Research offers EMS the opportunity to factually answer questions and helps guide our progress to better benefit patients. As the Advanced EMT, you should take steps to improve your understanding of research and help move EMS toward the evidence-based approach.
- In the evidence-based approach, outcomes of therapies and interventions are carefully measured to ensure that they have the intended results; then when changes are made, they are made based on clear indications and outcomes that point to meaningful improvements in patient care. This method is more apt to make changes for the better and less likely to ensue harm. Discuss the example in the book regarding the EMS budget and the decision to acquire new, expensive equipment. Discuss how research helps us decide if we should take the risk of purchasing the new equipment or hire another employee.
- In the evidence-based approach, outcomes of therapies and interventions are carefully measured to ensure that they have the intended results; then when changes are made, they are made based on clear indications and outcomes that point to meaningful improvements in patient care. This method is more apt to make changes for the better and less likely to ensue harm. Discuss the example in the book regarding the EMS budget and the decision to acquire new, expensive equipment. Discuss how research helps us decide if we should take the risk of purchasing the new equipment or hire another employee.
- Reaffirm the importance of analyzing research and interpreting the validity.
- Developed by Galileo almost 400 years ago as a process for answering questions and acquiring new knowledge.
- The key in research is to remain objective. Bias can occur when researchers have a financial gain in a particular outcome. Bias more frequently occurs as a result of poor methods utilized to conduct the research. Valid research uses methods designed to limit outside influences.
- Discuss prospective vs. retrospective research methods.
- Discuss prospective vs. retrospective research methods.
- Randomization is seen in high quality studies.
- Blinding a study makes it very difficult to influence the outcomes in any way thus the results are far more likely to be objective.
- Discuss control groups.
- Discuss study group similarity.
- Discuss the systematic review.
- In medicine, drugs are often tested in randomized studies using a placebo. To measure the outcome of the drug, patient’s are frequently randomized to receive either the actual drug or the placebo. Double-blinding process is typically utilized. The results of the new medication can be compared against the placebo control group to accurately assess the effect of the therapy.
- Discuss cohort/concurrent control/case-control studies.
- Discuss the characteristics of case series/case reports.
- Meta-analysis is not truly a study itself. Similar to systematic review but frequently of a much smaller scale.
- Every study should be reviewed independently and its importance determined.
- Every study should be reviewed independently and its importance determined.
- Level of Evidence 1 – Most valuable. Level of Evidence 2 – Often retrospective, more difficult to control without randomization, therefore less reliable. Level of Evidence 3 – Little control of these experiments, prone to bias.
- Level of Evidence 4 – Only one group is looked at, it is not compared to another group, and outcomes are difficult to understand without comparing with similar patients who received a different therapy. Level of Evidence 5 – Common in EMS, data is prone to a wide range of interpretation, makes assumptions about what whether works in different populations/circumstances will work in EMS as well.
- These questions can help the reader determine the validity and objectivity of the research literature.
- Discuss as needed.
- Review as appropriate.