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Imperial-college-LLL event-London region-Hickson.pdf
 

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    Imperial-college-LLL event-London region-Hickson.pdf Imperial-college-LLL event-London region-Hickson.pdf Document Transcript

    • 5 steps to provide E-B Care First stepStage of EBP How this helps you1. Asking an answerable Focus your efforts on what • Form a clearly structured question about question. matters your problem which you will then be able2. Searching for the best Make the best use of your evidence. scarce time to search for3. Critically-appraising the Avoid bias in research and • Four parts to a structured or focused evidence. draw the right conclusions from it question4. Integrating the evidence Integrate the evidence into with expertise and patient’s your patients unique condition unique biology and values5. Evaluating performance Help you to improve M Hickson M Hickson1: The Patient or the Problem 2: The intervention that you are considering• The clinical condition and defining • Screening tool characteristics of the patients, population • Diagnostic test or problem area you are interested in. • Prognostic factor • Treatment • Causative agent M Hickson M Hickson 1
    • 3: The Comparison 4: The Outcome• What you would like to compare the • What would you like to see as the intervention with: outcome of the intervention?• Another treatment • What would you and the patient like to• Nothing achieve?• Standard practice M Hickson M Hickson= PICO An example• Patient/problem • P: Obesity • I: Surgery/gastric bypass• Intervention • C: Lifestyle advice• Comparison • O: Weight loss• Outcome • Does surgical treatment improve weight loss in obese patients compared to lifestyle advice? M Hickson M Hickson 2
    • 5 steps to provide E-B CareStage of EBP How this helps you1. Asking an answerable Focus your efforts on what question. matters2. Searching for the best Make the best use of your evidence. scarce time3. Critically-appraising the Avoid bias in research and evidence. draw the right conclusions from it4. Integrating the evidence Integrate the evidence into with expertise and patient’s your patients unique condition unique biology and values5. Evaluating performance Help you to improve M HicksonAssessing the evidence M Hickson M Hickson 3
    • Critical Appraisal To weigh up the evidence critically to assess its validity and usefulness M HicksonJournal Clubs The purpose • To practice critical appraisal • To help keep up-to-date with new research in a variety of areas, not just their own specialist area. • To evaluate whether our dietetic practice needs to change in the light of new research findings M Hickson M Hickson 4
    • New Journal Club CASP tools• ALL read the paper. • Critical Appraisal Skill Programme (Milton Keynes Primary Care Trust 2002)• Use the CASP tools as a guide. • http://www.phru.nhs.uk/casp/appraisa.htm• Think of 1-2 critical appraisal questions to ask – systematic reviews about the paper. – randomised controlled trials• Someone starts the ball rolling by asking a – qualitative research studies specific person a question. They try and answer – cohort studies and then they ask someone else a question. – case control studies• And so it goes round …..the paper is analysed – diagnostic test studies by everyone and it is a lot more interactive. – economic evaluation studies M Hickson M Hickson I am getting more out of Much more attending and see it as a constructive way ofChoosing the paper valuable process, even if spending my time. I the paper is not in my enjoy it now!! topic area.• Review top medical journals for nutrition I feel like we are related papers: learning together• BMJ, NEJM, Lancet, JAMA What dietitians think as a group• Choose a paper from these journals or any other related. I like it. I really do feel that I I am motivated to am learning from it. Hearing read the paper• Paper should be fairly generally and not other dietitians opinions often because I know it will very specialised to keep it relevant to the confirming your own, gives result in valid debate majority. you confidence. and discussion M Hickson 5
    • I feel much more A lot more You can’t get awaycompetent in about stats, with just reading theanalysing papers but stillon a daily basis for loads to go. abstract if you want to How to speed things up know whether themy own work. paper is any good!! • Read the methods first - be critical. That reading a paper is • Is it worth continuing? How to skim not all that scary or What they have learnt read a paper - difficult. That people • If the methods are flawed the results will it’s not always may have very different be too. necessary to views based on the sameplough through paper. • Ignore the abstractall the intro and Not assuming all discussion if • Only skim the intro for a brief background - studies are goodyou’ve read the just because they you don’t have to read it all. method and have been results published! M Hickson Practise, practise, practise Key to effectiveness • The more you do the easier it gets. • There are no short cuts to learning a new • Everyone MUST read the paper. skill. • Guidance or training is provided to all. • Keep practising - use it or lose it! • Club is supported and encouraged by • Don’t be put off by difficult papers - keep senior staff. going, they’re not all really complicated. • Someone chairs or facilitates the club to • Some papers are only difficult because ensure everyone can participate. they are badly written. M Hickson M Hickson 6
    • Key points• Re-evaluate your journal club• Use the CASP tools to help your appraisal skills• PRACTISE: The more you do the easier it gets. M Hickson 7