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Evidence-based practice
or
Practice-based evidence?
Roger Watson
4/19/2
© The University of Sheffield / Department of Marketing and Communications
13
Evidence-based practice is your busin...
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
14
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
15
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
16
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
17
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
18
Evidence-based pratice
• Why do we need evidence?
• What is evidence?
• What counts as evidence?
• Where do we find eviden...
Why do we need evidence?
• Opinion
• Experience
• Authority
• Expertise
• Commercial companies
• Budgets
We used to be certain about
• Blood letting
• Grommets for “glue ear”
• Episiotomy
• Lignocaine to prevent cardiac arrest ...
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
23
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
24
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
25
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
26
Pressure sore treatment
(consecutive)
• 1 patient heals
• 2 “ “
• 3 “ “
• 4 “ “
• 5 “ “
• 6 “ “
• 7 “ “
• 8 “ “
• 9 “ “
• ...
Pressure sore treatment
(simultaneous)
• 9 out of ten improve
• 8“ “
• 7“ “
• 6“ “
• 5“ “
• 4“ “
• 3“ “
• 2“ “
• 1 “ “
Probability
• 10 out of ten improve
• What about the 11th
time?
What is evidence?
• a thing or things helpful in forming a conclusion or judgment
• that which tends to prove or disprove ...
What counts as evidence?
• The outcome of systematic enquiry
Randomised Controlled Trials
The cardinal features of an RCT
RANDOMISATION
CONROL
BLINDING
The cardinal features of an RCT
• Randomisation
• Control
• Blinding
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
38
Intervention
Control group
Meta analysis
• Meta-analysis is a statistical procedure that integrates the
results of several independent studies consid...
Meta-analysis
Systematic reviews
Relationship between systematic reviews and meta-analyses
4/19/2016
© The University of Sheffield / Department of Marketing and Communications
41
Regression towards the mean
• In statistics, regression toward (or to) the mean is the
phenomenon that if a variable is ex...
Evidence-based practice
• the practice of health care in which the practitioner
systematically finds, appraises, and uses ...
Evidence-based medicine
• The judicious use of the best current evidence in making
decisions about the care of the individ...
Acceptable definition of EBP?
• an approach to decision making in which the clinician uses
the best evidence available, in...
Where do we find evidence?
• Evidence synthesis databases
4/19/2
© The University of Sheffield / Department of Marketing and Communications
51
4/19/2
© The University of Sheffield / Department of Marketing and Communications
52
4/19/2
© The University of Sheffield / Department of Marketing and Communications
54
4/19/2
© The University of Sheffield / Department of Marketing and Communications
55
Ask
Answerable
Question
Acquire the
Evidence
Appraise
the
Evidence
Apply the
Evidence
Assess the
Effect
r.watson@hull.ac.uk
0000-0001-8040-7625
@rwatson1955
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
Evidence-based practice or practice-based evidence
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Evidence-based practice or practice-based evidence

  1. 1. Evidence-based practice or Practice-based evidence? Roger Watson
  2. 2. 4/19/2 © The University of Sheffield / Department of Marketing and Communications 13 Evidence-based practice is your business
  3. 3. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 14
  4. 4. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 15
  5. 5. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 16
  6. 6. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 17
  7. 7. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 18
  8. 8. Evidence-based pratice • Why do we need evidence? • What is evidence? • What counts as evidence? • Where do we find evidence?
  9. 9. Why do we need evidence? • Opinion • Experience • Authority • Expertise • Commercial companies • Budgets
  10. 10. We used to be certain about • Blood letting • Grommets for “glue ear” • Episiotomy • Lignocaine to prevent cardiac arrest post heart attack • Egg white and Oxygen to heal pressure sores • Vigorous rubbing of the buttocks with alcohol to prevent pressure sores
  11. 11. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 23
  12. 12. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 24
  13. 13. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 25
  14. 14. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 26
  15. 15. Pressure sore treatment (consecutive) • 1 patient heals • 2 “ “ • 3 “ “ • 4 “ “ • 5 “ “ • 6 “ “ • 7 “ “ • 8 “ “ • 9 “ “ • 10 “ “
  16. 16. Pressure sore treatment (simultaneous) • 9 out of ten improve • 8“ “ • 7“ “ • 6“ “ • 5“ “ • 4“ “ • 3“ “ • 2“ “ • 1 “ “
  17. 17. Probability • 10 out of ten improve • What about the 11th time?
  18. 18. What is evidence? • a thing or things helpful in forming a conclusion or judgment • that which tends to prove or disprove something; ground for belief; proof. • something that makes plain or clear; an indication or sign
  19. 19. What counts as evidence? • The outcome of systematic enquiry
  20. 20. Randomised Controlled Trials
  21. 21. The cardinal features of an RCT
  22. 22. RANDOMISATION CONROL BLINDING
  23. 23. The cardinal features of an RCT • Randomisation • Control • Blinding
  24. 24. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 38 Intervention Control group
  25. 25. Meta analysis • Meta-analysis is a statistical procedure that integrates the results of several independent studies considered to be “combinable.” • Well conducted meta-analyses allow a more objective appraisal of the evidence than traditional narrative reviews, provide a more precise estimate of a treatment effect, and may explain heterogeneity between the results of individual studies. • Ill conducted meta-analyses, on the other hand, may be biased owing to exclusion of relevant studies or inclusion of inadequate studies.
  26. 26. Meta-analysis Systematic reviews Relationship between systematic reviews and meta-analyses
  27. 27. 4/19/2016 © The University of Sheffield / Department of Marketing and Communications 41
  28. 28. Regression towards the mean • In statistics, regression toward (or to) the mean is the phenomenon that if a variable is extreme on its first measurement, it will tend to be closer to the average on its second measurement—and if it is extreme on its second measurement, it will tend to have been closer to the average on its first.
  29. 29. Evidence-based practice • the practice of health care in which the practitioner systematically finds, appraises, and uses the most current and valid research findings as the basis for clinical decisions. The term is sometimes used to denote evidence-based medicine specifically but can also include other specialties, such as evidence- based nursing, pharmacy, and dentistry.
  30. 30. Evidence-based medicine • The judicious use of the best current evidence in making decisions about the care of the individual patient.
  31. 31. Acceptable definition of EBP? • an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best. (Muir Gray)
  32. 32. Where do we find evidence? • Evidence synthesis databases
  33. 33. 4/19/2 © The University of Sheffield / Department of Marketing and Communications 51
  34. 34. 4/19/2 © The University of Sheffield / Department of Marketing and Communications 52
  35. 35. 4/19/2 © The University of Sheffield / Department of Marketing and Communications 54
  36. 36. 4/19/2 © The University of Sheffield / Department of Marketing and Communications 55
  37. 37. Ask Answerable Question Acquire the Evidence Appraise the Evidence Apply the Evidence Assess the Effect
  38. 38. r.watson@hull.ac.uk 0000-0001-8040-7625 @rwatson1955
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    May. 26, 2016

An outline of EBP and where to find evidence

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