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 libraries.

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Evidence Based Practice

  1. 1. <ul><li>Brown Bag Session </li></ul><ul><li>FAU Libraries </li></ul><ul><li>Jennifer Boxen </li></ul><ul><li>Kristy Padron (kpadron@fau.edu) </li></ul><ul><li>Tiffany Moxham (tmoxham@fau.edu) </li></ul>Evidence-Based Practice
  2. 2. Evidence-Based Practice Definition <ul><li>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 .” </li></ul>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. 3. History of EBP <ul><li>Evidence-Based Practice has its roots in Evidence Based Medicine (also referred to as Evidence –Based Health Care). </li></ul><ul><li>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. </li></ul><ul><li>At the same time, the medical literature in journals was being produced in record numbers, but at the same time was poorly organized. </li></ul>
  4. 4. The Evidence Based Practice Process <ul><li>The EBP process is comprised of 5 steps: </li></ul><ul><li>Defining a question that needs to be answered. </li></ul><ul><li>Acquiring the literature that will be analyzed. (building and executing the search) </li></ul><ul><li>Conducting a formal evaluation of the results, also referred to as critical appraisal. </li></ul><ul><li>Integrating the evaluated evidence into practice. </li></ul><ul><li>Re-evaluating the process to assess its efficacy and improve it in the future. </li></ul>
  5. 5. Defining the Question <ul><li>In EBM the question is defined in a specific way, referred to as a PICO question: </li></ul><ul><ul><li>P – Patient/Population </li></ul></ul><ul><ul><li>P – Problem (what issue exists) </li></ul></ul><ul><ul><li>I – Intervention (drug, diagnostic test, etc.) </li></ul></ul><ul><ul><li>C – Comparative Intervention (what, if anything are we comparing it to) </li></ul></ul><ul><ul><li>O – Outcome (what is our desired result) </li></ul></ul><ul><li>This can be modified for evidence based practice. </li></ul>
  6. 6. Differences Between EBP and Evidence-Based Medicine <ul><li>EBM/EBHC is primarily limited to the health care field and focuses on a specific patient or population. </li></ul><ul><li>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. </li></ul>
  7. 7. Traditional EBM <ul><li>In a 52 year old African American male with Type II diabetes, is metformin better than insulin at regulating blood sugar? </li></ul><ul><li>Patient - 52 year old African American male </li></ul><ul><li>Problem - Type II diabetes </li></ul><ul><li>Intervention – metformin </li></ul><ul><li>Comparative Intervention – insulin </li></ul><ul><li>Outcome – Blood sugar levels </li></ul>
  8. 8. Evidence Based Practice Applied to Library Patrons <ul><li>In a library with a decreased budget scenario which is more cost effective: self checkout or a circulation desk for checking out books? </li></ul><ul><li>Population – Library Patrons </li></ul><ul><li>Problem – Shrinking Budget </li></ul><ul><li>Intervention – Self Checkout </li></ul><ul><li>Comparative – Traditional Circulation Desk </li></ul><ul><li>Outcome – Cost effectiveness </li></ul>
  9. 9. <ul><li>Definition: </li></ul><ul><li>The process of carefully and systematically examining research to judge its validity, reliability, and the relevance to a particular context. </li></ul><ul><li>Considerations in Critical Appraisal: </li></ul><ul><li>Hierarchy (or “Ladder”) of Evidence </li></ul><ul><li>EB-Information Practices does not assume the innate superiority of any particular research design. </li></ul><ul><li>Hierarchies consist of varying levels of research, ranked by: </li></ul><ul><ul><li>Subject area </li></ul></ul><ul><ul><li>Type of research done within subject area </li></ul></ul><ul><ul><li>c. Committees / organizations who create guidelines. </li></ul></ul>Critical Appraisal
  10. 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. 11. Hierarchy of Research Methods, Social Work
  12. 12. Types of Study Designs <ul><li>Experimental / Observational </li></ul><ul><li>Quantitative / Qualitative </li></ul><ul><li>“ An appropriate study design will be determined by the nature of the question being answered.” </li></ul><ul><li>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. </li></ul>
  13. 13. Critical Appraisal : IMRAD <ul><li>For the convenience of readers, scholarly articles evolved to follow an IMRAD format (or something like it). </li></ul><ul><li>I = Introduction </li></ul><ul><ul><ul><ul><ul><li>Background, rationale, purpose </li></ul></ul></ul></ul></ul><ul><li>M = Methods </li></ul><ul><ul><ul><ul><ul><li>Study design, measurement instruments, rationale of use </li></ul></ul></ul></ul></ul><ul><li>R = Results </li></ul><ul><ul><ul><ul><ul><li>Describes results of study without repeating methodology </li></ul></ul></ul></ul></ul><ul><li>And </li></ul><ul><li>D = Discussion </li></ul><ul><ul><ul><ul><ul><li>Presents principles, relationships and generalizations shown by work; how results support (or refute) previous work; theoretical implications; conclusions. </li></ul></ul></ul></ul></ul>
  14. 14. Identifying Bias <ul><li>Part of critical appraisal is to identify potential sources of biases in order to evaluate the validity of a study. </li></ul><ul><li>Common Types of Bias (Among Many): </li></ul><ul><li>Conflict of Interest Bias </li></ul><ul><li>Wrong Sample Size </li></ul><ul><li>Positive Results Bias </li></ul><ul><li>Correlation Bias </li></ul><ul><li>Missing Clinical Data Bias </li></ul>
  15. 15. <ul><li>Cochrane Collaboration, The Cochrane Library, and the Hierarchy of Evidence : http://www.cochrane.org/ </li></ul><ul><li>The Cochrane Library is comprised of 6 different databases that provide information supporting the top three levels of the hierarchy of evidence: </li></ul><ul><li>Systematic Reviews/Meta Analysis : </li></ul><ul><ul><li>CDSR: Cochrane Database of Systematic Reviews </li></ul></ul><ul><ul><li>Health Technology Assessment </li></ul></ul><ul><ul><li>NHS EED (economic evaluations) </li></ul></ul><ul><li>Critically Appraised Topics (Reviews of Evidence) </li></ul><ul><li> DARE (Databases of Abstracts of Reviews of Effects) </li></ul><ul><li>Randomized Controlled Trials </li></ul><ul><li>CENTRAL: The Cochrane Central Register of Controlled Trials </li></ul><ul><li>Additional Cochrane Library database: Methods Studies </li></ul>Sources of Evidence: Health Sciences
  16. 16. PubMed, CINAHL and Limiting searches in EBM <ul><li>CINAHL: Via EBSCOhost </li></ul><ul><ul><li>Limiters </li></ul></ul><ul><ul><li>Evidence-Based Practice : obtain articles from evidence-based practice journals, articles about evidence-based practice, research articles, and commentaries on research studies. </li></ul></ul><ul><ul><li>Clinical Queries : therapy, prognosis, review, qualitative, etiology </li></ul></ul><ul><ul><li>Randomized Controlled Trials </li></ul></ul><ul><li>PubMed: http://www.ncbi.nlm.nih.gov/pubmed/ </li></ul><ul><ul><li>Clinical Queries: http://www.ncbi.nlm.nih.gov/pubmed/clinical </li></ul></ul><ul><ul><li>Therapy, Diagnosis, Etiology, Prognosis, Systematic Reviews, and Clinical Prediction Guides </li></ul></ul><ul><li>National Guideline Clearinghouse: http://www.guidelines.gov/ </li></ul>
  17. 17. Evidence Based Practice & Resources in Other Fields <ul><li>Examples of evidence based resources in social work, criminal justice, and education outside of the library databases </li></ul>
  18. 18. Evidence Based Practice in Social Work <ul><li>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. </li></ul><ul><li>Matrix of Children’s Evidence-Based Interventions </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Journal of Evidence-Based Social Work : http://www.tandf.co.uk/journals/WEBS </li></ul>
  19. 19. Evidence Based Practice in Criminal Justice <ul><li>National Institute of Corrections </li></ul><ul><li>http ://nicic.gov/Library/024397 </li></ul><ul><li>Evidence-Based Practice Skills Assessment for Criminal Justice Organizations </li></ul><ul><li>The Campbell Collaboration: Library </li></ul><ul><li>http:// www.campbellcollaboration.org/library.php </li></ul><ul><li>The organization's systematic reviews in the fields of education, criminal justice and social welfare are freely available online </li></ul><ul><li>Crime and Justice Institute [EBP Integrated Model] </li></ul><ul><li>http://www.cjinstitute.org/projects/integratedmodel </li></ul><ul><li>National Criminal Justice Reference Center </li></ul><ul><li>http://www.ncjrs.gov/ </li></ul><ul><li>Federally funded resource offering justice and substance abuse information to support research, policy, and program development worldwide </li></ul><ul><li>Criminal Justice Policy Review </li></ul><ul><li>http://cjp.sagepub.com/ </li></ul>
  20. 20. Evidence Based Practice in Education <ul><li>What Works Clearinghouse: Institute of Education Sciences </li></ul><ul><ul><li>http://ies.ed.gov/ncee/wwc/ </li></ul></ul><ul><ul><li>Includes The Registry of Randomized Controlled Trials. </li></ul></ul><ul><li>Doing What Works: </li></ul><ul><li>http://dww.ed.gov/index.cfm </li></ul><ul><li>Practice guidelines based on research and suggestions for implementation </li></ul><ul><li>Journal of Evidence-Based Practices for Schools (JEBPS): </li></ul><ul><ul><li>http://www.rowmaneducation.com/journals/JEBP/Index.shtml </li></ul></ul>
  21. 21. Discussion Thank you for coming!
  22. 22. Recommended Resources <ul><li>Booth, A. & Brice, A. (2004). Evidence based practice for information professionals. Bodmin, Cornwall (UK): Facet Publishing. </li></ul><ul><li>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 . </li></ul><ul><li>Centre for Evidence Based Medicine (2011). EBM tools overview (online). Accessed 2011 March 1 at http://www.cebm.net/index.aspx?o=1023 . </li></ul><ul><li>Day, R.A. (1998). How to write and publish a scientific paper, 5 th edition . Phoenix: AZ: Oryx Press. </li></ul><ul><li>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 . </li></ul><ul><li>Sackett, D.L. & Wennberg (1999). Choosing the best research design for each question. BMJ , 315 (1636). </li></ul><ul><li>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. </li></ul><ul><li>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 . </li></ul><ul><li>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 </li></ul>