Evidence Based Practice

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What is evidence-based practice? Originating in medicine, EBP is being applied to other academic areas. FAU librarians Jennifer, Kristy, and Tiffany present information on EBP and what it means to …

What is evidence-based practice? Originating in medicine, EBP is being applied to other academic areas. FAU librarians Jennifer, Kristy, and Tiffany present information on EBP and what it means to libraries.

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  • 1.
    • Brown Bag Session
    • FAU Libraries
    • Jennifer Boxen
    • Kristy Padron (kpadron@fau.edu)
    • Tiffany Moxham (tmoxham@fau.edu)
    Evidence-Based Practice
  • 2. Evidence-Based Practice Definition
    • There are several definitions that could be considered. The most commonly cited is that EBP is “the conscientious, explicit, and judicious use of current best evidence in making decisions 1 .”
    1. Sackett DL, Rosenberg WMC, Gray MJA, et al. Evidence-based medicine: what it is and what it isn't. BMJ 1996;312:71-2.
  • 3. History of EBP
    • Evidence-Based Practice has its roots in Evidence Based Medicine (also referred to as Evidence –Based Health Care).
    • EBM was created in the 1980s and popularized in the early 1990s as a response to medical textbooks being unable to keep up with rapid changes in medicine and being frequently based on the interpretations of a small number of people in a respective field.
    • At the same time, the medical literature in journals was being produced in record numbers, but at the same time was poorly organized.
  • 4. The Evidence Based Practice Process
    • The EBP process is comprised of 5 steps:
    • Defining a question that needs to be answered.
    • Acquiring the literature that will be analyzed. (building and executing the search)
    • Conducting a formal evaluation of the results, also referred to as critical appraisal.
    • Integrating the evaluated evidence into practice.
    • Re-evaluating the process to assess its efficacy and improve it in the future.
  • 5. Defining the Question
    • In EBM the question is defined in a specific way, referred to as a PICO question:
      • P – Patient/Population
      • P – Problem (what issue exists)
      • I – Intervention (drug, diagnostic test, etc.)
      • C – Comparative Intervention (what, if anything are we comparing it to)
      • O – Outcome (what is our desired result)
    • This can be modified for evidence based practice.
  • 6. Differences Between EBP and Evidence-Based Medicine
    • EBM/EBHC is primarily limited to the health care field and focuses on a specific patient or population.
    • Evidence Based Practice can be applied to many fields. EBP is constantly being modified to best suit the subject that it is being applied to.
  • 7. Traditional EBM
    • In a 52 year old African American male with Type II diabetes, is metformin better than insulin at regulating blood sugar?
    • Patient - 52 year old African American male
    • Problem - Type II diabetes
    • Intervention – metformin
    • Comparative Intervention – insulin
    • Outcome – Blood sugar levels
  • 8. Evidence Based Practice Applied to Library Patrons
    • In a library with a decreased budget scenario which is more cost effective: self checkout or a circulation desk for checking out books?
    • Population – Library Patrons
    • Problem – Shrinking Budget
    • Intervention – Self Checkout
    • Comparative – Traditional Circulation Desk
    • Outcome – Cost effectiveness
  • 9.
    • Definition:
    • The process of carefully and systematically examining research to judge its validity, reliability, and the relevance to a particular context.
    • Considerations in Critical Appraisal:
    • Hierarchy (or “Ladder”) of Evidence
    • EB-Information Practices does not assume the innate superiority of any particular research design.
    • Hierarchies consist of varying levels of research, ranked by:
      • Subject area
      • Type of research done within subject area
      • c. Committees / organizations who create guidelines.
    Critical Appraisal
  • 10. Examples of Hierarchies Experimental Studies O b s e r v a t i o n a l S t u d i e s Pyramid of Evidence, Medicine
  • 11. Hierarchy of Research Methods, Social Work
  • 12. Types of Study Designs
    • Experimental / Observational
    • Quantitative / Qualitative
    • “ An appropriate study design will be determined by the nature of the question being answered.”
    • Take a look at the research methods of a given field to determine their study designs, and how (or if) evidence-based practice is utilized.
  • 13. Critical Appraisal : IMRAD
    • For the convenience of readers, scholarly articles evolved to follow an IMRAD format (or something like it).
    • I = Introduction
            • Background, rationale, purpose
    • M = Methods
            • Study design, measurement instruments, rationale of use
    • R = Results
            • Describes results of study without repeating methodology
    • And
    • D = Discussion
            • Presents principles, relationships and generalizations shown by work; how results support (or refute) previous work; theoretical implications; conclusions.
  • 14. Identifying Bias
    • Part of critical appraisal is to identify potential sources of biases in order to evaluate the validity of a study.
    • Common Types of Bias (Among Many):
    • Conflict of Interest Bias
    • Wrong Sample Size
    • Positive Results Bias
    • Correlation Bias
    • Missing Clinical Data Bias
  • 15.
    • Cochrane Collaboration, The Cochrane Library, and the Hierarchy of Evidence : http://www.cochrane.org/
    • The Cochrane Library is comprised of 6 different databases that provide information supporting the top three levels of the hierarchy of evidence:
    • Systematic Reviews/Meta Analysis :
      • CDSR: Cochrane Database of Systematic Reviews
      • Health Technology Assessment
      • NHS EED (economic evaluations)
    • Critically Appraised Topics (Reviews of Evidence)
    • DARE (Databases of Abstracts of Reviews of Effects)
    • Randomized Controlled Trials
    • CENTRAL: The Cochrane Central Register of Controlled Trials
    • Additional Cochrane Library database: Methods Studies
    Sources of Evidence: Health Sciences
  • 16. PubMed, CINAHL and Limiting searches in EBM
    • CINAHL: Via EBSCOhost
      • Limiters
      • Evidence-Based Practice : obtain articles from evidence-based practice journals, articles about evidence-based practice, research articles, and commentaries on research studies.
      • Clinical Queries : therapy, prognosis, review, qualitative, etiology
      • Randomized Controlled Trials
    • PubMed: http://www.ncbi.nlm.nih.gov/pubmed/
      • Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical
      • Therapy, Diagnosis, Etiology, Prognosis, Systematic Reviews, and Clinical Prediction Guides
    • National Guideline Clearinghouse: http://www.guidelines.gov/
  • 17. Evidence Based Practice & Resources in Other Fields
    • Examples of evidence based resources in social work, criminal justice, and education outside of the library databases
  • 18. Evidence Based Practice in Social Work
    • The Campbell Collaboration: Library http://www.campbellcollaboration.org/library.php The organization's systematic reviews in the fields of education, criminal justice and social welfare are freely available online.
    • Matrix of Children’s Evidence-Based Interventions
    • http://www.nri-inc.org/reports_pubs/2006/EBPChildrensMatrix2006.pdf The NRI Center for Mental Health Quality and Accountability literature reviews on prevention, intervention, and/or treatment programs that can be applied to child and adolescent mental health services.
    • SAMHSA: Evidence-Based Practice Implementation Resource Kits for Mental Health http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/about.asp Six Evidence-Based Practice Implementation Resource Kits to encourage the use of evidence-based practices in mental health.
    • Journal of Evidence-Based Social Work : http://www.tandf.co.uk/journals/WEBS
  • 19. Evidence Based Practice in Criminal Justice
    • National Institute of Corrections
    • http ://nicic.gov/Library/024397
    • Evidence-Based Practice Skills Assessment for Criminal Justice Organizations
    • The Campbell Collaboration: Library
    • http:// www.campbellcollaboration.org/library.php
    • The organization's systematic reviews in the fields of education, criminal justice and social welfare are freely available online
    • Crime and Justice Institute [EBP Integrated Model]
    • http://www.cjinstitute.org/projects/integratedmodel
    • National Criminal Justice Reference Center
    • http://www.ncjrs.gov/
    • Federally funded resource offering justice and substance abuse information to support research, policy, and program development worldwide
    • Criminal Justice Policy Review
    • http://cjp.sagepub.com/
  • 20. Evidence Based Practice in Education
    • What Works Clearinghouse: Institute of Education Sciences
      • http://ies.ed.gov/ncee/wwc/
      • Includes The Registry of Randomized Controlled Trials.
    • Doing What Works:
    • http://dww.ed.gov/index.cfm
    • Practice guidelines based on research and suggestions for implementation
    • Journal of Evidence-Based Practices for Schools (JEBPS):
      • http://www.rowmaneducation.com/journals/JEBP/Index.shtml
  • 21. Discussion Thank you for coming!
  • 22. Recommended Resources
    • Booth, A. & Brice, A. (2004). Evidence based practice for information professionals. Bodmin, Cornwall (UK): Facet Publishing.
    • Burts, A. (2009). What is critical appraisal? Evidence-based medicine (online). Accessed 2011 February 25 at http://www.medicine.ox.ac/uk/bandolier/painres/download/whatis?What_is_Critical_Appraisal.pdf .
    • Centre for Evidence Based Medicine (2011). EBM tools overview (online). Accessed 2011 March 1 at http://www.cebm.net/index.aspx?o=1023 .
    • Day, R.A. (1998). How to write and publish a scientific paper, 5 th edition . Phoenix: AZ: Oryx Press.
    • Penn State University Libraries. (2010) Evidence based practice tutorial for nurses (online). Accessed 2011 March 1 at http://www.libraries.psu.edu/psul/tutorials/ebpt.html .
    • Sackett, D.L. & Wennberg (1999). Choosing the best research design for each question. BMJ , 315 (1636).
    • Sollaci, L.B. & Pereira, M. (2004). The introduction, methods, results and discussion (IMRAD) structure: a fifty-year survey. Journal of the Medical Library Association, 92 (3): 364-367.
    • University of Minnesota Libraries, Bio-Medical Library (2010). Understanding research study designs. (Online). Accessed 2011 1 March at http://www.biomed.lib.umn.edu/sites/default/files/Understanding%20Research%20Studies%202010.pdf .
    • University of Minnesota Libraries, Bio-Medical Library. Evidence Based Practice Tutorial. Accessed 2011 1 March at http:// ww.biomed.lib.umn.edu/learn/ebp/mod01/step5.html