Ebp rh-july2011g
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A brief summary of Evidence-based practice as it applies in health. Includes worked-through case study example and search hints and techniques.
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Ebp rh-july2011g
- 1. Evidence Based Practice Roger Hawcroft July 2011
- 3. INTRODUCTION
- 4. What is Evidence Based Practice? “ using the best research evidence available, along with clinical expertise and patient values to inform decisions regarding clinical practice” (Sackett, 2000)
- 5. Evidence-Based Practice CLINICAL SKILLS & EXPERIENCE PATIENT PREFERENCES, VALUES & CIRCUMSTANCES EVIDENCE EBP
- 9. STEPS IN EBP
- 12. STEP 1 – THE QUESTION
- 15. A clinical problem or question arises out of the care of the patient so start here. A 45 year old male with alcohol issues presents after his third relapse following GP counselling on a monthly basis. He has heard about cognitive and behavioural therapy and asks you whether this is a treatment option that decreases the likelihood of relapse. Consider How can this clinica problem be translated into a searchable format?
- 18. Translate the following question into PICO format A 45 year old male presents after his third relapse following GP counselling on a monthly basis for alcoholism. He has read about cognitive and behavioural therapy and asks you whether this is a treatment option that decreases the likelihood of relapse.
- 19. PICO Patient: 45 yr old Male Alcoholic Intervention: Cognitive Behaviour Therapy Comparison: Counselling Outcome: Abstinence
- 23. What are you aiming to find? Clinical Relevance High Low Validity Low High Vast bulk scientist to scientist - not YET so relevant to clinicians High quality relevant studies
- 24. Levels of evidence (4S & 5S) Clinical Evidence Up-To-Date Cochrane Library EBMR Medline PsychInfo Systems Synopses Syntheses Studies Computerised Decision Support Systems Evidence-based journal abstracts Systematic Reviews Original journal articles Evidence-based mental health Summaries Evidence-based textbooks
- 30. STEP 2. - FINDING THE EVIDENCE
- 38. Using Boolean operators All source material in the database on Rehabilitation All source material In the database On Cognitive Behaviour Therapy
- 39. Boolean operator: AND Rehabilitation AND Cognitive Behaviour Therapy FINDS Rehabilitation Cognitive Behviour Therapy
- 40. Boolean operator: OR Rehabilitation OR Cognitive Behaviour Therapy Rehabilitation Cognitive Behviour Therapy FINDS
- 41. Boolean operator: NOT Rehabilitation NOT Cognitive Behaviour Therapy FINDS Rehabilitation Cognitive Behviour Therapy
- 42. Sources
- 43. (Some) Sources for articles … GENERAL MENTAL HEALTH NURSING & ALLIED HEALTH PHARMACOLOGICAL Medline PsychInfo CINAHL Australian Medicines Handbook Embase PsychiatryOnline Medline Embase MD Consult Medline MD Consult Therapeutic Guidelines CINAHL MD Consult MIMS Harrisons CINAHL Medline MD Consult
- 44. (Some) Sources for clinical evidence… Available via CKN Cochrane PubMed Systematic Reviews PubMed Clinical Queries DARE Clinical Evidence Up To Date
- 47. STEP 3. CRITICAL APPRAISAL
- 51. STEP 4. INTEGRATE WITH PRACTICE
Editor's Notes
- Outcomes for the total HAU EBP and Clinical Standards Project
- 3 prong approach Each prong is equally important and as clinicians we must consider all.
- EBP is about AHPs USING research, not DOING research! However although it is about USING research the gaps that are identified through this process of using the literature may inform research and motivate clinician’s towards research. This cycle ultimately leads to more effective and evidence based practice.
- There are 5 steps to consider in EBP. Discuss briefly the 5 steps. We will be discussing in more detail today Step 1. – converting the need for information into an answerable question.
- This is probably THE most important part of the process and therefore it is important to spend some time getting the question as best as we possible can. Focusing on the question will help us to focus our ideas, determine exactly what it is we wish to know about. It can also contribute to a more efficient and effective search if we have asked the right question.
- This is probably THE most important part of the process and therefore it is important to spend some time getting the question as best as we possible can. Focusing on the question will help us to focus our ideas, determine exactly what it is we wish to know about. It can also contribute to a more efficient and effective search if we have asked the right question.
- Discuss this patient scenario. Highlight that clinical questions start with a patient or clinical problem pertinent to a group of patients.
- So when designing your answerable question it is useful to structure your question into 4 parts. Highlight the four aspects of a PICO question (discussed in more detail next slide) Note that there is not always a comparator or sometimes the comparator may be standard or usual practice. This term in itself is a poor choice as what is standard or usual practice at PAH may be different to standard or usual practice in Atherton or Longreach etc. so this term does need to be used with care. It is possible to have your clinical question with not all the 4 parts.
- Discuss the four parts of a PICO question
- Discuss this patient scenario. Highlight that clinical questions start with a patient or clinical problem pertinent to a group of patients.
- So when designing your answerable question it is useful to structure your question into 4 parts. Highlight the four aspects of a PICO question (discussed in more detail next slide) Note that there is not always a comparator or sometimes the comparator may be standard or usual practice. This term in itself is a poor choice as what is standard or usual practice at PAH may be different to standard or usual practice in Atherton or Longreach etc. so this term does need to be used with care. It is possible to have your clinical question with not all the 4 parts.
- Have a series of clinical questions relevant to a few disciplines.
- This is probably THE most important part of the process and therefore it is important to spend some time getting the question as best as we possible can. Focusing on the question will help us to focus our ideas, determine exactly what it is we wish to know about. It can also contribute to a more efficient and effective search if we have asked the right question.