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Evidence Based Practice
 

Evidence Based Practice

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A presentation educating the viewer on evidence based practice and how it can effect your clinical decisions.

A presentation educating the viewer on evidence based practice and how it can effect your clinical decisions.

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  • Welcome to this presentation on evidence-based practice. Evidence-based practice has its origin in Evidence Based Medicine, and has been a well-known approach in the pharmaceutical industry for many years. Evidence-based practice has been discussed in the audiological field for the last 5 years. Widex has carried out several dispenser focus group surveys in different countries – and the feedback was clear – all dispensers asked for more evidence to support their hearing aid choice. Evidence to support a hearing aid choice is the fundamental approach to evidence-based practice ....
  • After completing this presentation you will be able to : Explain the fundamental elements in evidence-based practice Identify the different steps of evidence-based practiceDescribe the difference between effectiveness and efficacy studies
  • This presentation is about decisions in the selection and fitting process. This is illustrated with the case of Ethel Tibbet, who is 75 years old. She lives alone. Ethel has bilateral moderate presbycusis. She has worn hearing aids for 10 years. She has a hard time following conversation, which is increasingly annoying for her family. Her family wants to know if the ”new” hearing aids will help Mrs. Tribett more….[click] The question is …..what should be the clinician’s recommendation and decision…..Evidence-based practice supports the clinician in the decision-making in the selection and fitting process……….
  • Widex’ focus is on providing the best possible starting point for making the clinical decisions involved in helping the client. We follow evidence-based practice. It’s important to understand three issues about evidence-based practice. First, “best available evidence”, which ideally refers to well-designed, patient-centred clinical research on the efficacy and effectiveness of rehabilitative treatments for hearing loss. This includes such matters as prescriptive fitting methods, technological innovations, audiological rehabilitation services, etc. Secondly, practitioners must use clinical acumen and rapport-building skills to describe and clarify each patient’s particular problems and circumstances, as well as their personal priorities and viewpoint. Thirdly, in EBP, these two types of knowledge (research results and patient specifics) are integrated in the optimal way for each individual. This means extracting the research evidence that is relevant to the patient’s situation and applying it prudently with consideration for what is likely to work in this unique set of circumstances.[click] According to Robin Cox ….Evidence-based practice (EBP) is the process by which audiologists make patient treatment decisions based on a careful study of the clinical evidence to make the right hearing aid choice
  • To determine what treatment to use for a particular patient, the clinician can call on their past experience or their knowledge of hearing disorders, check in a textbook, or ask an expert for advice. This traditional approach values expert opinion and standard approaches to care. EBP reflects a different mindset. It recognises that learning good clinical skills is essential for successful practice. However, the choice of treatment for an individual should be based, whenever possible, on specifically relevant current data. A fundamental tenet of the EBP approach is that clinicians can and should learn to evaluate the evidence from original research to answer their clinical questions and select optimal treatments for each patient.
  • Many questions arise when a clinician fits hearing aids and the perspective is ……do we have evidence to answer any of these questions. The questions could be [click] …………..are low knee-points better than high?……….. [click] Is frequency transposition better than frequency compression?……….. [click] Can a hearing aid help tinnitus patients ?Knowing the best current evidence on a topic provides justification for a clinician’s recommendations…….
  • The basic principle behind evidence-based practice is that ...it tackles one problem and one patient at a time
  • There is a widely accepted five-step agenda for tackling each problem
  • I will go through this five-step agenda shortly……[click] but please remember Mrs. Tribett who had a hard time following conversation. Her family wanted to know if the new hearing aid could help Mrs. Tribett more. This new hearing aid could for example be mind440….. The approach to evidence-based practice is….. [click] Formulate a focused and answerable question…. [click] Search for the best available evidence……[click] Evaluate evidence for validity and relevance……. [click] make recommendations by combining collected evidence, clinical expertise and user requirements……….. [click] evaluate the results and determine ways to improve……If we take a closer look at how to evaluate evidence……[click][click] an option is to categorise according to efficacy, which is evidence measured under ideal conditions …like laboratory conditions…….…. [click] or according to effectiveness, which is evidence measured in the real world.I will now explain the terminology efficacy and effectiveness in more details…….
  • The efficacy of a treatment is how well a feature or hearing aid CAN work given the best possible scenario………
  • This is an example of an efficacy set-up. We want to make a comparison between an adaptive directional microphone system and an omnidirectional microphone. [click] The hearing impaired person is placed in an anechoic room [click] with a speaker in front playing speech [click] and a speaker behind playing noise. The omnicirectional microphone will pick up noise and speech, whereas the directional microphone system will be able to zoom in on the speech from in front and dampen the noise.
  • The effectiveness of a treatment is how well a feature or hearing aid works in the real world.
  • In the effectiveness set-up, the hearing impaired is asked to try out both settings in real life situations. [click] The hearing impaired is in this case trying to follow a conversation from an actual speaker [click] in everyday sounds and noises [click]….[click] Finally he is asked to fill out a questionnaire to evaluate whether the adaptive directional michrophone helps when trying to follow a conversation in a noisy environment.
  • It’s important to remember that a treatment with acceptable efficacy is not necessarily effective in the real world with real patients…..and in the final analysis, treatment effectiveness is more important than treatment efficacy for evidence-based practice.
  • So - just to summarise the essentials of this presentation:The fundamental elements in evidence-based practice link best available evidence with patient choice and individual clinical judgment...The different steps of evidence-based practice is a five step agenda.Effectiveness is defined by how well a feature or hearing aid works in real life situations and efficacy by how well it can work under ideal conditions.

Evidence Based Practice Evidence Based Practice Presentation Transcript

  • Evidence-based practice
  • Learning objectives
    • Explain the fundamental elements in evidence-based practice
    • Identify the different steps of evidence-based practice
    • Describe the difference between effectiveness and efficacy studies
    • After completing this presentation you will be able to:
  • It’s all about decisions in the selection and fitting process…….
    Case:
    Ethel Tibbet is 75 years old and lives alone. She has bilateral moderate presbycusis. She has worn hearing aids for 10 years. She has a hard time following conversation, which is increasingly annoying for her family. Her family wants to know if the ”new” hearing aids will help Mrs. Tribett more ……… (ref: Cox et al, 2004)
    What should be the clinical recommendation and decisions??
  • Decision-making……
    Hearing aid choice
    Widex’ focus is on providing the best possible starting point for making the clinical decisions involved in helping the client.
    We follow evidence-based practice (EBP) that links best available evidence with patient choice and individual clinical judgment
    (ref: Thorne, P.R 2002)
    Hearing aid choice
    Decision - making
  • Traditional vs. EBP
    Differences
    To determine what treatment to use for a particular patient…
    Traditional approach:
    ……clinicians rely on their past experience or their knowledge of hearing disorders, check in a textbook, or ask an expert for advice.
    EBP approach:
    ....the choice of treatment for an individual should be based
    whenever possible on specifically relevant current data.
  • Do we have evidence to …
    …answer any of these questions:
    Is adaptive directional technology better than fixed polar pattern?
    Does digital noise reduction provide patient benefit?
    Can a hearing aid help tinnitus patients?
    Are low knee-points better than high?
    Is frequency transposition better than frequency compression?
  • Evidence-based practice
    Basic principle
    Evidence-based practice tackles one problem and one patient at a time…..
  • Evidence-based practice
    Approach
    There is a widely accepted five-step agenda for tackling each problem….
    (ref: Cox et al . 2004)
  • Evidence-based practice
  • Efficacy…..
    Evidence measured under laboratory or ideal conditions
    The efficacy of a treatment is how well it can work given the best possible scenario.
  • Efficacy…..
    Example:
    Comparison between an adaptive directional microphone system and an omnidirectional microphone in an anechoic room.
    Speech
    Noise
  • Effectiveness…..
    Evidence measured in the ”real world”
    The effectiveness of a treatment is how well it works in the real world.
  • Effectiveness…..
    Example
    Comparison between an adaptive directional microphone and an omnidirectional microphone in real life situations.
    Questionnaire
  • Treatment efficacy vs. effectiveness
    Most important treatment
    A treatment with acceptable efficacy is not necessarily effective in the real world with real patients……
    …….In the final analysis, treatment effectiveness is more important than treatment efficacy for evidence-based practice.
  • Evidence-based practice
    What to remember from this presentation