Chapter 25
Translational
Research:
Generating
Evidence for
Practice
Objectives
• Clarify the differences between evidence
based practice and translational research.
• Describe models for int...
Introduction
• Evidence-based practice, translational
research and research utilization are all words
which have been used...
Research Utilization and
Translational Research
• Research utilization is a subset of evidence-
based practice.
• Translat...
What is Evidence?
• Discussion abounds in the area of what
constitutes evidence.
• Considered the most reliable, the rando...
Hierarchy of Evidence
• In order to use evidence in practice, the weight
or validity of the research must be determined.
•...
Weight of Evidence
• The hierarchy identifies meta-analysis as the
best quality evidence since it utilizes multiple
indivi...
Bridging the Gap Between
Research and Practice
• requires an understanding of the key
concepts and barriers,
• accessibili...
Barriers to Applying Evidence to
Practice
• lack of time
• lack of access to libraries within the facility
• lack of techn...
Bridging the Gap Between
Research and Practice
• In an observational study of the information
seeking behaviors of on-duty...
Technology and Research
• The collaborative component of research is
supportive of informatics science.
• Technology has b...
The role of informatics
• An informatics infrastructure is critical to
supporting a clinician’s access to information in a...
Gathering Evidence for Practice
• The Cochrane Collaboration showed an increasing
need to improve on the speed of knowledg...
Agency for Healthcare Research
and Quality
• The AHRQ (AHRQ.gov) is a government
sponsored organization with the mission o...
National Guidelines Clearinghouse
• Part of an AHRQ initiative
• NGC is a comprehensive database of
evidentially based cli...
More on NGC
• The NGC website allows users to browse the
website for the clinical guidelines, view abstracts
and full text...
PubMed4Hh
• Pub Med for handhelds
• powerful and free app for smart phones
that provides access to the National Library
of...
Developing Evidence-Based
Practice Guidelines
• Careful analysis and discussion of the
research and/or other forms of evid...
Meta-analysis and Generation of
Knowledge
• The strength of the systematic review is its
ability to corroborate findings a...
Meta-analysis and Generation of
Knowledge
• Meta-analysis, a form of systematic review,
uses statistical methods to combin...
Meta-analysis Steps
1. defining the problem followed by protocol
generation
2. establishing study eligibility criteria fol...
Meta-analysis Disadvantages
• The often sited criticism of meta-analysis is
that emphasis is on quantitative studies, not
...
Open Access
• There are two vehicles for Open Access:
– archives
– journals
• Open Access journals are generally peer-revi...
Thought Provoking Questions
1. Twelve hour shifts are problematic for patient and nurse
safety and yet hospitals continue ...
Thought Provoking Questions
2. The use of heparin versus saline to maintain the patency
of peripheral intravenous catheter...
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Chapter 25

  1. 1. Chapter 25 Translational Research: Generating Evidence for Practice
  2. 2. Objectives • Clarify the differences between evidence based practice and translational research. • Describe models for introducing research findings into practice. • Identify barriers to research utilization in practice.
  3. 3. Introduction • Evidence-based practice, translational research and research utilization are all words which have been used to describe the application of evidential knowledge to clinical practice. • In evidence-based practice, the goal is to decrease practice variability, increase patient safety and eliminate unnecessary cost.
  4. 4. Research Utilization and Translational Research • Research utilization is a subset of evidence- based practice. • Translational research is used to describe the translation of medical, biomedical, informatics and nursing research into bedside clinical interventions. • Research results are crucial to furthering evidence-based practice.
  5. 5. What is Evidence? • Discussion abounds in the area of what constitutes evidence. • Considered the most reliable, the randomized control trial (RCT) is often termed the gold standard for evidence. • Evidence includes standards of practice, codes of ethics, philosophies of nursing, autobiographical stories, esthetic criticism, works of art, qualitative studies and the patient and clinical knowledge.
  6. 6. Hierarchy of Evidence • In order to use evidence in practice, the weight or validity of the research must be determined. • An example of an evidential hierarchy by Stetler et al. (1998) prioritizes evidence into 6 categories: – Meta-analysis – Individual experimental studies – Quasi-experimental studies – Non-experimental studies – Program evaluations such as quality improvement projects – Opinions of experts
  7. 7. Weight of Evidence • The hierarchy identifies meta-analysis as the best quality evidence since it utilizes multiple individual research studies to come to consensus. • Qualitative research allows us to understand the way in which the intervention is experienced to the researcher and to the participant as well as the value of the interventions to both parties.
  8. 8. Bridging the Gap Between Research and Practice • requires an understanding of the key concepts and barriers, • accessibility to research findings, • access to clinical mentors for research understanding, • a reinforcing culture and • a desire on the part of the clinician to implement best practices.
  9. 9. Barriers to Applying Evidence to Practice • lack of time • lack of access to libraries within the facility • lack of technology confidence • lack of knowledge on how to search for information • lack of value assigned to using research in practice.
  10. 10. Bridging the Gap Between Research and Practice • In an observational study of the information seeking behaviors of on-duty nurses, McKnight (2006) noted that nurses did not feel ethically comfortable with taking time from patient care to read publications, nor was much time available. • Nurses may see the job of interpreting research as too complex or may see the organizational culture as a barrier to implementation.
  11. 11. Technology and Research • The collaborative component of research is supportive of informatics science. • Technology has become so important to research that the National Institutes of Health has invested in re-engineering of the clinical research enterprise as part of its roadmap initiative for medical research (National Institutes of Health, 2007).
  12. 12. The role of informatics • An informatics infrastructure is critical to supporting a clinician’s access to information in a clinical setting. • As an example of the integration of informatics and the medical record, Matter (2006) describes the positive effects of a successful integration of referential links with EBP clinical content in the clinical pathway on patient outcomes.
  13. 13. Gathering Evidence for Practice • The Cochrane Collaboration showed an increasing need to improve on the speed of knowledge acquisition and access to evidence. • With the goal of promoting the use of research findings, and tool use based on these findings, the Agency for Health Care Research (AHRQ) became an active participant in pushing evidence forward into practice.
  14. 14. Agency for Healthcare Research and Quality • The AHRQ (AHRQ.gov) is a government sponsored organization with the mission of reducing patient risk from harm, decreasing healthcare cost and improving patient outcomes through the promotion of research and technology applications focused on evidence-based practice.
  15. 15. National Guidelines Clearinghouse • Part of an AHRQ initiative • NGC is a comprehensive database of evidentially based clinical practice guidelines and related documents which are regularly published through the NGC listserv and are available on the NGC website (http://www.guideline.gov/).
  16. 16. More on NGC • The NGC website allows users to browse the website for the clinical guidelines, view abstracts and full text links, download full text clinical guidelines to personal digital assistive (PDA) devices and smartphones, obtain technical reports and compare guidelines. • There are a growing number of written and electronic resources available to assist in creating guidelines and offering information about evidence-based practice.
  17. 17. PubMed4Hh • Pub Med for handhelds • powerful and free app for smart phones that provides access to the National Library of Medicine – supports PICO searches, clinical queries and multi-language searches – provides links to consensus abstracts.
  18. 18. Developing Evidence-Based Practice Guidelines • Careful analysis and discussion of the research and/or other forms of evidence in this scenario may reveal that given the context, implementation may not be practical. • Information technology is important in synthesizing the research regardless of the model.
  19. 19. Meta-analysis and Generation of Knowledge • The strength of the systematic review is its ability to corroborate findings and reach consensus. • Systematic reviews show the need for more research by revealing the areas where quantitative results may be lacking or minimal.
  20. 20. Meta-analysis and Generation of Knowledge • Meta-analysis, a form of systematic review, uses statistical methods to combine the results of several studies. • Meta-analysis is “the statistical analysis of a large collection of analysis results from individual studies for the purpose of integrating the findings.”
  21. 21. Meta-analysis Steps 1. defining the problem followed by protocol generation 2. establishing study eligibility criteria followed by literature search 3. identifying the heterogeneity of results of studies 4. standardizing the data and statistically combining the results 5. sensitivity testing to determine if the combined results are the same
  22. 22. Meta-analysis Disadvantages • The often sited criticism of meta-analysis is that emphasis is on quantitative studies, not qualitative. • The analysis is only as good as the studies used in the analysis. • Collection and dissemination of these meta- analysis and systematic reviews are available in paper and on-line through the internet, although many such databases require a subscription.
  23. 23. Open Access • There are two vehicles for Open Access: – archives – journals • Open Access journals are generally peer-reviewed and freely available. • The publishers of open access do not charge the reader but obtain funds for publishing elsewhere. • Open access journals may charge the author for publishing.
  24. 24. Thought Provoking Questions 1. Twelve hour shifts are problematic for patient and nurse safety and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report which referred to studies as early as 1988 which discussed the negative affects of rotating shifts on intervention accuracy. Workers with 12 hour shifts realized more fatigue than workers on 8 hour shifts. In another study done in Turkey by Ilhan et al(Ilhan, Durukan, Aras, Turkcuoglu, & Aygun, 2006), factors relating to increased risk for injury were: age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units and working for more than eight hours. As a clinician reading these studies, what would your next step be?
  25. 25. Thought Provoking Questions 2. The use of heparin versus saline to maintain the patency of peripheral intravenous catheters has been addressed in research for many years. The American Society of Health System recently Pharmacists (ASHSP) published a position paper in January 2006 (American Journal of Health System Pharmacists, 2006) advocating their support of the use of 0.9% saline in the maintenance of peripheral catheters in non-pregnant adults. It seems surprising that their position paper references articles that advocate the use of saline over heparin dating from 1991. What do you feel are some of the barriers which would have caused this delay in implementation?

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