Evidence Based Practice
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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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Evidence Based Practice Evidence Based Practice Presentation Transcript

    • Brown Bag Session
    • FAU Libraries
    • Jennifer Boxen
    • Kristy Padron (kpadron@fau.edu)
    • Tiffany Moxham (tmoxham@fau.edu)
    Evidence-Based Practice
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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
  • 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
    • 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
  • 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
  • Hierarchy of Research Methods, Social Work
  • 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.
  • 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.
  • 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
    • 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
  • 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/
  • Evidence Based Practice & Resources in Other Fields
    • Examples of evidence based resources in social work, criminal justice, and education outside of the library databases
  • 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
  • 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/
  • 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
  • Discussion Thank you for coming!
  • 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