Patient Values/PreferencesOrExpectationsClinicalData/KnowledgeResearchEvidenceOptimalDecisionWhat does the patientwant?What are they willing todo?What does your experience tellyou?What has been the experience ofyour colleagues?What does the researchsay?
Evidence Based Practice Inquiry ProcessFocusthequestionAdequateevidence?Assign /FindmentorIRBProposal&ApprovalDatacollectionDataanalysisDisseminateImpactand/oroutcomeInitialquestionUnitordepartmentresourceAssesstranslationof evidenceintopracticesettingCreateactionplanandimplementchangeEvaluateoutcomeand/orimpactFinalize teammembershipand scheduleconferencesReportresultstodecision-makersAdoptchangeandidentifynext stepsContact ResearchAdvisory CouncilorGroup (If Applicable)AppraisalofliteratureAssembleinitialprojectteamIf answer is yes,proceed to EBPProject.If answer is no,proceed to researchprojectConsultLibrarian &Do Lit. SearchAdapted from VCUHS Nursing Inquiry Process Diagram
Levels of EvidenceEvidenceBasedPracticeGuidelinesMeta- Analysis /SystematicReviewCritically AppraisedTopics[Evidence Syntheses]Critically Appraised IndividualArticles[Article Synopses]Randomized Control Trials (RCT’s)Cohort Studies / Cross-Sectional StudyCase Controlled Studies/Case ReportsReviewsBackground Information / Expert OpinionFiltered InformationUnfilteredInformationEBP Objective:Clinical Knowledge Bedside
Practice GuidelineAdvantagesCreated by panels of expertsBased on professional publishedliteraturehttp://www.gwumc.edu/library/tutorials/studydesign101/practiceguidelines.htmlStatement produced by a panel of experts that outlines current bestpractice to inform health care professionals and patients in makingclinical decisions. Where Can They Be Found?o PubMedo CINAHLo National Guidelines ClearinghouseDisadvantages Slow to change or be updated Not always available, espeicallyon controversial topics Recommendations might beaffected by the type oforganization creating theguideline
Review ArticlesReview Articles• Provide Overview of a field or subject• Synthesize Previous Research• Useful when you need background information and additional referencesSystematic Review• Evidence based search and review of the literature on a topic by anestablished method.Meta-Analysis• A systematic method that takes data from a number of independent studiesand integrates them using statistical analysis (Dorland’s Medical Dictionary for HealthConsumers)
Primary Research Articles• Present new and original scientific findings• Explain research methodology and provide dataRandomized Controlled Trials (RCT’s)Cohort StudiesCase-Controlled StudiesStudies that randomly assign individuals toan intervention group or to a controlgroup, in order to measure the effects of theintervention.Study in which a particular outcome, such asdeath from a heart attack, is compared in groupsof people who are alike in most ways but differby a certain characteristicStudy that compares patients who have a diseaseor outcome of interest (cases) with patients whodo not have the disease or outcome(controls), and looks back retrospectively tocompare how frequently the exposure to a riskfactor is present in each group to determine therelationship between the risk factor and thedisease.Types of Research ArticlesCause & Effect
Type of Question/ Best Type of StudyType of Question Best Type of StudyTherapyHow to select treatments to offer patients that do moregood than harm and that are worth the efforts and costs ofusing themRandomized Control Trial (RCT)PreventionHow to prevent a disease or conditionRCT/ Cohort Study / Case ControlPrognosisHow to estimate the patients likely clinical course overtime and anticipate likelycomplications of diseaseCohort Study/ Case Control/ Case Series or Case ReportDiagnosisHow to select and interpret diagnostic testsBlind RCT Compared to the Gold Standard(best treatment/test for diagnosis)Etiology/HarmHow to identify causes for diseaseRCT/ Cohort Study /Case ControlCost analysisEconomic costs of all facets of a intervention or diseasetreatmentEconomic AnalysisSearch Process Checklist
Selecting the Right Resource• Research Guides• Nursing Research Guide• Important Databases• PubMed/Medline (Free)• CINAHL• APA PsycNet/PsychInfo• Cochrane Library• TRIP Database (Free)• National GuidelinesClearinghouse (Free)• PubMed Health (Free)• Medline Plus (Free)http://guides.library.vcu.edu/nursingEvidenceBasedPracticeGuidelinesMeta- Analysis /SystematicReviewCritically AppraisedTopics[Evidence Syntheses]Critically Appraised IndividualArticles[Article Synopses]Randomized Control Trials (RCT’s)Cohort Studies / Cross-Sectional StudyCase Controlled Studies/Case ReportsReviewsBackground Information / Expert OpinionFiltered InformationUnfilteredInformation
EvidenceBasedPracticeGuidelinesMeta- Analysis /SystematicReviewCritically AppraisedTopics[Evidence Syntheses]Critically Appraised IndividualArticles[Article Synopses]Randomized Control Trials (RCT’s)Cohort Studies / Cross-Sectional StudyCase Controlled Studies/Case ReportsReviewsBackground Information / Expert OpinionFiltered InformationUnfiltered Information
Objectives:By the end of this presentation you will :• Have an understanding of how evidence based practice isdefined.• Understand the quality of the different types of literature thatare assessed when making decisions based on evidence.• Be aware of the different types of EBP questions and what studiesbest answer each type.
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