SlideShare a Scribd company logo
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 5
EMS Research
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (Research)
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Competency
• Integrates comprehensive knowledge of EMS
systems, the safety and well-being of the
paramedic, and medical–legal and ethical issues,
which is intended to improve the health of EMS
personnel, patients, and the community.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Solid and objective research program will drive
EMS practices in the coming years.
• Outcomes-based research: determine whether
procedure, drug, treatment, strategy improves
patient outcomes (mortality, morbidity, quality of
life).
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• National EMS Research Agenda (2001)
– Develop EMS researchers; support them early in their
careers
– Collaboration between EMS researchers and other
disciplines
– Establish funding stream for EMS research within
government
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• National EMS Research Agenda (2001)
– Establish alternate funding source for EMS research
outside of government
– Recognize need for EMS research
– View research as necessary for improvement of patient
care
– Enhance ethical approaches to research
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Research
– Key to maintaining focus on improving health of
community in competitive and cost-conscious health
care market.
– Ensures best possible patient care provided in
prehospital and out-of-hospital settings.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Research and the Scientific Method
• Science: state or fact of knowledge derived
through scientific method.
• Research: use of scientific method to study given
issue.
• Scientific method: process by which scientists
construct accurate representation of world;
reliable, consistent, nonarbitrary.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Research and the Scientific Method
• Steps of Scientific Method
– Observe and ask questions.
– Collect, analyze, synthesize data.
– Construct hypothesis.
– Test hypothesis by experimentation.
– Analyze results and draw conclusions.
– Revise hypothesis.
– Report results.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 5-1 Steps of the scientific method.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Quantitative research: describes phenomena in
numbers.
• Qualitative research: describes phenomena in
words.
• Mixed research: combination of quantitative and
qualitative research; uses both numbers and
words to describe phenomena being studied.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-1 Summary of Research Types
Quantitative
Research
Mixed Research
Qualitative
Research
Scientific
method
Researcher tests the
hypothesis with data
(deductive approach)
The researcher generates
a hypothesis after
collecting data (inductive
approach)
Deductive and
inductive
Focus Narrow topic Variable topic Wide topic
Behavior
Studied under
controlled conditions
Studied in more than one
context
Studied in natural
environment
Nature of
reality
Objective
Commonsense
(pragmatic)
Subjective
Nature of data Numbers Numbers and words Words
Data analysis Statistical Statistical and words Words
Results Generalizable May be generalizable Nongeneralizable
Report Statistical Mixed Narrative
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Most medical research is quantitative.
• Retrospective research: examines information that
already exists.
• Prospective research: study starts now; examines
what happens from this point forward.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Quantitative versus Qualitative Research
– Quantitative research is objective and specific.
 Determines relationship between one thing (independent
variable) and another (dependent or outcome variable) and
describes it with numbers (statistics).
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Quantitative versus Qualitative Research
– Quantitative research is objective and specific.
 Independent variable: affects dependent variable under study.
 Dependent variable (outcome): variable being affected.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Quantitative versus Qualitative Research
– Nonexperimental quantitative research: independent
variables that cannot be manipulated for one reason or
another.
– Survey-quantitative research: reflects public opinion for
marketing and social science research.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Quantitative versus Qualitative Research
– Qualitative research relies on collection of qualitative
(nonnumeric) data.
 Seeks "why" and not "how" of phenomena being studied
 Occurs in natural setting
 Role in quality assurance
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Types of Research
• Prospective versus Retrospective Studies
– Retrospective studies: look at existing data.
– Prospective studies: use research form or instrument
specifically designed for study; objective, accurate,
complete.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Experimental study: both control group (group of
subjects who do not have manipulation of
independent variable) and treatment
(experimental) group.
– Subjects randomly assigned to one group
– Ensure demographics between groups similar
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Quasiexperimental study: scientist does not
randomly assign subjects to the study groups.
– Greater chance of having groups demographically
different, and of introduction of bias
– Considered less valid than experimental studies
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Observational study: does not have control group.
– Single or multiple groups studied without comparison to
control
– Scientist does not control variables.
– Less valid than experimental or quasiexperimental
studies
– Important role in medicine
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Meta-analysis of randomized controlled trials:
combined results of several prior studies.
– Randomized controlled trials (RCTs): subjects
randomized into treatment group and control group.
 Single or double blind study
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 5-2 Hierarchy of validity of study types. The most valid type of study is at the top of the
pyramid, the least valid at the bottom.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 5-3 Meta-analysis is an analysis of the combined results of several prior studies.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Nonrandomized controlled trials: control group and
treatment group; assignment to groups not
randomized.
– Also called quasiexperimental studies
– Less validity than RCT, but utility in some
circumstances
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Cohort study: observational; subjects who have certain
condition and/or who receive particular treatment
followed over time; compared with another group not
affected by condition.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 5-7 A cohort is a group of subjects who share a certain characteristic. For example, all
may be cancer patients. A cohort study observes and compares the cohort group with a group
whose members do not have the cohort characteristic.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Cross-sectional study (analysis): observational; various
groups compared without control; looks at single point
in time.
– Case series: looks at group of patients with similar
condition.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Case report: structured study of single patient who is
unique or interesting to medical community in general.
– Expert opinions, editorials, rational conjecture: suitable
for use before scientific research is available or while
scientific research is occurring.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Animal research (in vivo): understanding how certain
drugs and procedures affect biological systems.
 Findings in one species do not necessarily apply to other
species.
 Computer modeling starting to replace aspects of animal
research.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Specific Study Types
– Bench research (in vitro): scientific research at most
basic level; important in learning how universe
functions.
– Quality of research supporting clinical practice: stratify
scientific evidence based on type and validity of
experimental designs used.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Experimental Design
• Study Validity
– Validity: whether or how well study supports the
conclusions
– External validity : assures results can be generalized,
or possess generalizability
– Internal validity: ensures results can be attributed to the
cause
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Ethical Considerations
in Human Research
• While medical research essential, overriding
concern is rights of those who serve as subjects in
studies.
• Nuremburg Code of 1947: first code to guide
ethical practice in human research.
• Tuskegee University experiments
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Ethical Considerations
in Human Research
• Helsinki Declaration: subject makes informed
decision about participating in research;
assurance by researcher that patient's safety
protected.
• Ethical Principles and Guidelines for the
Protection of Human Subjects of Research
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Ethical Considerations
in Human Research
• Institutional Review Board (IRB)
– Committee that approves, monitors, reviews human
research
– Goal is to protect human subjects.
– Approves/disapproves study before it begins.
– Requires researchers to modify or terminate study if
subjects at risk.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Statistics: mathematics of collecting and analyzing
data to draw conclusions and make predictions.
– Descriptive statistics: describe basic features of data
obtained in a study.
– Inferential statistics: information from sampled
observations of population; make conclusions about
population.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Descriptive Statistics
– Describe nature of sample.
– Mean (average): add values, then divide sum by
number of values involved.
– Median: put the values into numerical order, then find
middle value.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Descriptive Statistics
– Mean and median: measures of central tendency;
indicate center of group.
– Variance: take each value, then subtract mean from it.
– Standard deviation (SD or σ): take square root of
variance.
– Mode: most common value in set of data.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Inferential Statistics
– Estimating parameters of population.
– Sampling error: estimation of difference between value
obtained from sample and value that would be
obtained from entire population.
– Confidence interval: variability added or subtracted to
original proportion.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Quantitative and Qualitative Statistics
– Qualitative statistics: data nonnumeric in nature;
assigned number indicating ranking or ordering of
importance or severity.
 Nominal or ordinal data
– Quantitative statistics: numerical in nature.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
An Overview of Statistics
• Other Types of Data
– T test
– Analysis of variance (ANOVA)
– Chi square test
– Odds ratio: how strong association is between risk
factor and condition it is associated with.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Format of a Research Paper
• Abstract: need for study, research methods used,
results encountered.
• Introduction: description of pertinent, previously
published papers on subject of investigation.
– Why undertaken; purpose of study; what hypothesis
authors wanted to test
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-2 Research Paper Format for Some Emergency Medicine Journals
Prehospital
Emergency Care
Annals of
Emergency Medicine
Academic
Emergency Medicine
Abstract
Introduction
Methods
Results
Discussion
Conclusions
References
Abstract
Introduction
Methods
Results
Limitations
Discussion
References
Abstract
Introduction
Methods
Results
Discussion
Limitations
Conclusions
References
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Format of a Research Paper
• Methods section: how authors conducted study.
• Results: researchers provide data (summary).
• Discussion section: authors interpret findings;
describe significance.
• Summary (conclusion): brief recap of main
findings of study.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
How a Research Paper Is Published
• Submit to scientific journal for publication.
• All peer-reviewed journals follow same general
procedure.
• After receiving paper, editor sends to one or more
members of review board.
• Reviewers blinded as to names of authors and
affiliated institutions.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
How a Research Paper Is Published
• Reviewers read paper; evaluate for adherence to
standards of research methods, pertinence to
field, value for practitioners.
• Reviewers send comments to editor, who then
decides whether to publish it, send it back for
revisions, or reject it.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Accessing the Scientific Literature
• Journal publishers have archived their
publications online.
– Can be downloaded as portable document files (PDFs)
or directly.
– Most journals require subscription or library affiliation to
access.
– Some are free (open-access journals).
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Accessing the Scientific Literature
• National Libraries of Medicine: accessible
database of medical and scientific literature
(PubMed).
• Loansome Doc: document retrieval service
accessed through web.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
What to Look for When
Reviewing a Study
• Was research peer reviewed?
• Was there a clear hypothesis or study purpose?
• Was study approved by IRB, and was it conducted
ethically?
• Was study type appropriate?
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
What to Look for When
Reviewing a Study
• What population were the researchers studying?
• What inclusion and exclusion criteria did
researchers use?
• How did investigators draw their sample?
• How many groups were patients divided into; were
patients assigned to control and study groups
properly?
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
What to Look for When
Reviewing a Study
• Were control and study groups the proper size?
• Were effects of confounding variables (other
things that may have affected study outcome)
taken into account?
• What kind of data did investigators collect; did
they analyze data with proper statistical tests?
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
What to Look for When
Reviewing a Study
• Were results reported properly?
• How likely is it that the study results would occur
by chance alone?
• Are author's conclusions logical and based on the
data?
• How good was EMS system in which study was
done?
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Applying Study Results to Your Practice
• Evaluate the field and its knowledge base to make
informed decision about how to interpret a piece
of research.
• Distinguish between statistical and clinical
significance of the study.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Applying Study Results to Your Practice
• Be sure patient similar enough to study group to
benefit from intervention.
• Speak to management of your organization,
especially medical director.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Participating in Research
• Determine the question.
• Prepare hypotheses (null/research).
• Decide what you wish to measure and how you
will do it.
• Define population.
• Identify limitations of your study.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Participating in Research
• Get approval of proper authorities (IRB/principal
investigator [PI]).
• Determine how you will get informed consent from
study subjects.
• Gather and analyze data.
• Determine what you will do with results.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Evidence-Based Decision Making
• Use of best practices and clinical pathways based
on clinical and scientific evidence ensures care is
safe, efficacious, cost-effective.
• Formulate question about appropriate treatments.
• Medical literature searched and organized.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Evidence-Based Decision Making
• Scientific evidence stratified based on validity and
reliability.
• If evidence supports change in practice, change is
made.
• Once practice changed, ongoing evaluation must
be carried out.
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-5 Applying Classification of Recommendations and Level of Evidence (1 of 4)
Size of Treatment Effect
Class I Class IIa Class IIb Class III
EstimateofCertainty(Precision)of
TreatmentEffect
Benefit >>> Risk
Procedure/
Treatment
SHOULD be
performed/
Administered
Benefit >> Risk
Additional studies
with focused
objectives
needed
IT IS
REASONABLE
to perform
procedure/
administer
treatment
Benefit ≥ Risk
Additional studies
with
broad objectives
needed;
Additional registry
data would be
helpful
IT IS NOT
UNREASONABL
E to perform
procedure/
administer
treatment
Risk ≥ Benefit
No additional
studies needed
Procedure/
Treatment
should NOT be
performed/admi
nistered SINCE
IT IS NOT
HELPFUL AND
MAY BE
HARMFUL
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence
(2 of 4)
Size of Treatment Effect
Class I Class IIa Class IIb Class III
EstimateofCertainty(Precision)of
TreatmentEffect
Level A
Multiple (3–5)
population risk
strata
evaluated
General
consistency of
direction and
magnitude of
effect
• Recommendati
on that
procedure or
treatment is
useful/effective
• Sufficient
evidence from
multiple
randomized
trials or meta-
analyses
• Recommendati
on in favor of
treatment or
procedure
being
useful/effective
• Some
conflicting
evidence from
multiple
randomized
trials or meta-
analyses
• Recommendation's
usefulness/ efficacy
less well
established
• Greater conflicting
evidence from
multiple
randomized trials
or meta-analyses
• Recommend-
ation that
procedure or
treatment not
useful/effective
and may be
harmful
• Sufficient
evidence from
multiple
randomized
trials or meta-
analyses
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence
(3 of 4)
Size of Treatment Effect
Class I Class IIa Class IIb Class III
EstimateofCertainty(Precision)of
TreatmentEffect
Level B
Limited (2–3)
population
risk strata
evaluated
• Recommend-
ation that
procedure or
treatment is
useful/effective
• Limited
evidence from
single
randomized
trial or non-
randomized
studies
• Recommend-
ation in favor of
treatment or
procedure being
useful/effective
• Some conflicting
evidence from
single
randomized trial
or
nonrandomized
studies
• Recommendation's
usefulness/efficacy
less well established
• Greater conflicting
evidence from single
randomized trial or
nonrandomized
studies
• Recommendati
on that
procedure or
treatment not
useful/effective
and may be
harmful
• Limited
evidence from
single
randomized trial
or non-
randomized
studies
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence
(4 of 4)
Size of Treatment Effect
Class I Class IIa Class IIb Class III
EstimateofCertainty(Precision)of
TreatmentEffect
Level C
Very limited
(1–2)
population
risk strata
evaluated
• Recommendati
on that
procedure or
treatment is
useful/effective
• Only expert
opinion, case
studies, or
standard of
care
• Recommendati
on in favor of
treatment or
procedure being
useful/effective
• Only diverging
expert opinion,
case studies, or
standard of care
• Recommendatio
n's
usefulness/effica
cy less well
established
• Only diverging
expert opinion,
case studies, or
standard of care
• Recommendati
on that
procedure or
treatment not
useful/effective
and may be
harmful
• Only expert
opinion, case
studies, or
standard of care
Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Solid, well-conducted scientific research is key to
improving prehospital care.
• It is essential to prove paramedics make a
difference in terms of reducing mortality, morbidity,
pain, and suffering.
• Benefit: increased revenue stream.
• Future of EMS depends on aggressive research
program.

More Related Content

Viewers also liked

Cabrera actividad 2
Cabrera actividad 2Cabrera actividad 2
Cabrera actividad 2
lecayu
 
Sliderhare
SliderhareSliderhare
Sliderhare
tuliobaeza2015
 
Chu de02 tunghiencuu_nhom07
Chu de02 tunghiencuu_nhom07Chu de02 tunghiencuu_nhom07
Chu de02 tunghiencuu_nhom07
Nguyen Linh Tam
 
Zachery Lake Resume 2016
Zachery Lake Resume 2016Zachery Lake Resume 2016
Zachery Lake Resume 2016Zachery Lake
 
5 Cool Predator Motorcycle Helmets
5 Cool Predator Motorcycle Helmets5 Cool Predator Motorcycle Helmets
5 Cool Predator Motorcycle Helmets
BuyCustomHelmets
 
Takwim sekolah sesi 2013
Takwim sekolah sesi 2013Takwim sekolah sesi 2013
Takwim sekolah sesi 2013
Firdausz_Ganu
 
120.careers in web development
120.careers in web development120.careers in web development
120.careers in web development
entranzz123
 
270601003 (1)
270601003 (1)270601003 (1)
270601003 (1)
Carlos Perez Sepulveda
 
Carga de la enfermedad en México
Carga de la enfermedad en MéxicoCarga de la enfermedad en México
Carga de la enfermedad en México
Jose Luis Charles
 
El estudio química orgánica modulo 11
El estudio  química  orgánica    modulo 11 El estudio  química  orgánica    modulo 11
El estudio química orgánica modulo 11
Ramiro Muñoz
 

Viewers also liked (13)

Cabrera actividad 2
Cabrera actividad 2Cabrera actividad 2
Cabrera actividad 2
 
Sliderhare
SliderhareSliderhare
Sliderhare
 
Scan0006
Scan0006Scan0006
Scan0006
 
Chu de02 tunghiencuu_nhom07
Chu de02 tunghiencuu_nhom07Chu de02 tunghiencuu_nhom07
Chu de02 tunghiencuu_nhom07
 
Zachery Lake Resume 2016
Zachery Lake Resume 2016Zachery Lake Resume 2016
Zachery Lake Resume 2016
 
5 Cool Predator Motorcycle Helmets
5 Cool Predator Motorcycle Helmets5 Cool Predator Motorcycle Helmets
5 Cool Predator Motorcycle Helmets
 
Takwim sekolah sesi 2013
Takwim sekolah sesi 2013Takwim sekolah sesi 2013
Takwim sekolah sesi 2013
 
120.careers in web development
120.careers in web development120.careers in web development
120.careers in web development
 
ital3072 saggio
ital3072 saggioital3072 saggio
ital3072 saggio
 
270601003 (1)
270601003 (1)270601003 (1)
270601003 (1)
 
Carga de la enfermedad en México
Carga de la enfermedad en MéxicoCarga de la enfermedad en México
Carga de la enfermedad en México
 
El estudio química orgánica modulo 11
El estudio  química  orgánica    modulo 11 El estudio  química  orgánica    modulo 11
El estudio química orgánica modulo 11
 
Cv marius 2014
Cv   marius 2014Cv   marius 2014
Cv marius 2014
 

Similar to Bledsoe v1 ch05_lecture

Pathopart1
Pathopart1Pathopart1
Pathopart1
djorgenmorris
 
Bledsoe v1 ch06_lecture
Bledsoe v1 ch06_lectureBledsoe v1 ch06_lecture
Bledsoe v1 ch06_lecture
Allen Welch
 
Bledsoe v1 ch03_lecture
Bledsoe v1 ch03_lectureBledsoe v1 ch03_lecture
Bledsoe v1 ch03_lecture
djorgenmorris
 
Framing Questions for Research with Minimal Risk
Framing Questions for Research with Minimal RiskFraming Questions for Research with Minimal Risk
Framing Questions for Research with Minimal Risk
SeanCubero
 
R m 7777
R m 7777R m 7777
R m 7777
Magdy Mahdy
 
Ethics in research is extremely critical to protectin.docx
Ethics in research is extremely critical to protectin.docxEthics in research is extremely critical to protectin.docx
Ethics in research is extremely critical to protectin.docx
humphrieskalyn
 
7 rules for writing in plain english
7 rules for writing in plain english7 rules for writing in plain english
Clinical Research Informatics Year-in-Review
Clinical Research Informatics Year-in-ReviewClinical Research Informatics Year-in-Review
Clinical Research Informatics Year-in-Review
Peter Embi
 
Admission Assessment Exam Review FOURTH EDITION HESI Editors
Admission Assessment Exam Review FOURTH EDITION HESI EditorsAdmission Assessment Exam Review FOURTH EDITION HESI Editors
Admission Assessment Exam Review FOURTH EDITION HESI Editors
Nat Rice
 
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
Nader Ale Ebrahim
 
Module 2: Evidence-Based Dental Public Health
Module 2: Evidence-Based Dental Public HealthModule 2: Evidence-Based Dental Public Health
Module 2: Evidence-Based Dental Public Health
Kelley Minars
 
Chapter 2The problemThe heart of the research process.docx
Chapter 2The problemThe heart of the research process.docxChapter 2The problemThe heart of the research process.docx
Chapter 2The problemThe heart of the research process.docx
christinemaritza
 
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docxOVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
karlacauq0
 
STU Dissertation Presentation - Chapter 3 Introduction
STU Dissertation Presentation - Chapter 3 IntroductionSTU Dissertation Presentation - Chapter 3 Introduction
STU Dissertation Presentation - Chapter 3 Introduction
Tim Stafford, PhD
 
Share Scientific Data to Improve Research Visibility and Impact
Share Scientific Data to Improve Research Visibility and ImpactShare Scientific Data to Improve Research Visibility and Impact
Share Scientific Data to Improve Research Visibility and Impact
Nader Ale Ebrahim
 
Unpacking Nutrition Research and being an effective Science Communicator
Unpacking Nutrition Research and being an effective Science CommunicatorUnpacking Nutrition Research and being an effective Science Communicator
Unpacking Nutrition Research and being an effective Science Communicator
Tim Crowe
 
Correlational n survey research
Correlational n survey researchCorrelational n survey research
Correlational n survey researchNoor Hasmida
 

Similar to Bledsoe v1 ch05_lecture (20)

Pathopart1
Pathopart1Pathopart1
Pathopart1
 
Bledsoe v1 ch06_lecture
Bledsoe v1 ch06_lectureBledsoe v1 ch06_lecture
Bledsoe v1 ch06_lecture
 
Bledsoe v1 ch03_lecture
Bledsoe v1 ch03_lectureBledsoe v1 ch03_lecture
Bledsoe v1 ch03_lecture
 
Framing Questions for Research with Minimal Risk
Framing Questions for Research with Minimal RiskFraming Questions for Research with Minimal Risk
Framing Questions for Research with Minimal Risk
 
R m 7777
R m 7777R m 7777
R m 7777
 
IHPSR wrap-up
IHPSR wrap-upIHPSR wrap-up
IHPSR wrap-up
 
Chapter 01 ncc STAT
Chapter 01 ncc STAT Chapter 01 ncc STAT
Chapter 01 ncc STAT
 
Ethics in research is extremely critical to protectin.docx
Ethics in research is extremely critical to protectin.docxEthics in research is extremely critical to protectin.docx
Ethics in research is extremely critical to protectin.docx
 
7 rules for writing in plain english
7 rules for writing in plain english7 rules for writing in plain english
7 rules for writing in plain english
 
Clinical Research Informatics Year-in-Review
Clinical Research Informatics Year-in-ReviewClinical Research Informatics Year-in-Review
Clinical Research Informatics Year-in-Review
 
Admission Assessment Exam Review FOURTH EDITION HESI Editors
Admission Assessment Exam Review FOURTH EDITION HESI EditorsAdmission Assessment Exam Review FOURTH EDITION HESI Editors
Admission Assessment Exam Review FOURTH EDITION HESI Editors
 
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
33 ways to maximize articles’ citation frequency by Dr. Nader Ale Ebrahim
 
Module 2: Evidence-Based Dental Public Health
Module 2: Evidence-Based Dental Public HealthModule 2: Evidence-Based Dental Public Health
Module 2: Evidence-Based Dental Public Health
 
Chapter 2The problemThe heart of the research process.docx
Chapter 2The problemThe heart of the research process.docxChapter 2The problemThe heart of the research process.docx
Chapter 2The problemThe heart of the research process.docx
 
Rigour and ethics
Rigour and ethicsRigour and ethics
Rigour and ethics
 
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docxOVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
OVERVIEWWrite a 5–7-page assessment in which you examine the con.docx
 
STU Dissertation Presentation - Chapter 3 Introduction
STU Dissertation Presentation - Chapter 3 IntroductionSTU Dissertation Presentation - Chapter 3 Introduction
STU Dissertation Presentation - Chapter 3 Introduction
 
Share Scientific Data to Improve Research Visibility and Impact
Share Scientific Data to Improve Research Visibility and ImpactShare Scientific Data to Improve Research Visibility and Impact
Share Scientific Data to Improve Research Visibility and Impact
 
Unpacking Nutrition Research and being an effective Science Communicator
Unpacking Nutrition Research and being an effective Science CommunicatorUnpacking Nutrition Research and being an effective Science Communicator
Unpacking Nutrition Research and being an effective Science Communicator
 
Correlational n survey research
Correlational n survey researchCorrelational n survey research
Correlational n survey research
 

Recently uploaded

How to Make a Field invisible in Odoo 17
How to Make a Field invisible in Odoo 17How to Make a Field invisible in Odoo 17
How to Make a Field invisible in Odoo 17
Celine George
 
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
siemaillard
 
How to Split Bills in the Odoo 17 POS Module
How to Split Bills in the Odoo 17 POS ModuleHow to Split Bills in the Odoo 17 POS Module
How to Split Bills in the Odoo 17 POS Module
Celine George
 
Language Across the Curriculm LAC B.Ed.
Language Across the  Curriculm LAC B.Ed.Language Across the  Curriculm LAC B.Ed.
Language Across the Curriculm LAC B.Ed.
Atul Kumar Singh
 
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCECLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
BhavyaRajput3
 
Instructions for Submissions thorugh G- Classroom.pptx
Instructions for Submissions thorugh G- Classroom.pptxInstructions for Submissions thorugh G- Classroom.pptx
Instructions for Submissions thorugh G- Classroom.pptx
Jheel Barad
 
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXXPhrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
MIRIAMSALINAS13
 
Operation Blue Star - Saka Neela Tara
Operation Blue Star   -  Saka Neela TaraOperation Blue Star   -  Saka Neela Tara
Operation Blue Star - Saka Neela Tara
Balvir Singh
 
The Roman Empire A Historical Colossus.pdf
The Roman Empire A Historical Colossus.pdfThe Roman Empire A Historical Colossus.pdf
The Roman Empire A Historical Colossus.pdf
kaushalkr1407
 
The Art Pastor's Guide to Sabbath | Steve Thomason
The Art Pastor's Guide to Sabbath | Steve ThomasonThe Art Pastor's Guide to Sabbath | Steve Thomason
The Art Pastor's Guide to Sabbath | Steve Thomason
Steve Thomason
 
2024.06.01 Introducing a competency framework for languag learning materials ...
2024.06.01 Introducing a competency framework for languag learning materials ...2024.06.01 Introducing a competency framework for languag learning materials ...
2024.06.01 Introducing a competency framework for languag learning materials ...
Sandy Millin
 
Template Jadual Bertugas Kelas (Boleh Edit)
Template Jadual Bertugas Kelas (Boleh Edit)Template Jadual Bertugas Kelas (Boleh Edit)
Template Jadual Bertugas Kelas (Boleh Edit)
rosedainty
 
Ethnobotany and Ethnopharmacology ......
Ethnobotany and Ethnopharmacology ......Ethnobotany and Ethnopharmacology ......
Ethnobotany and Ethnopharmacology ......
Ashokrao Mane college of Pharmacy Peth-Vadgaon
 
Additional Benefits for Employee Website.pdf
Additional Benefits for Employee Website.pdfAdditional Benefits for Employee Website.pdf
Additional Benefits for Employee Website.pdf
joachimlavalley1
 
Synthetic Fiber Construction in lab .pptx
Synthetic Fiber Construction in lab .pptxSynthetic Fiber Construction in lab .pptx
Synthetic Fiber Construction in lab .pptx
Pavel ( NSTU)
 
MARUTI SUZUKI- A Successful Joint Venture in India.pptx
MARUTI SUZUKI- A Successful Joint Venture in India.pptxMARUTI SUZUKI- A Successful Joint Venture in India.pptx
MARUTI SUZUKI- A Successful Joint Venture in India.pptx
bennyroshan06
 
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
Nguyen Thanh Tu Collection
 
The approach at University of Liverpool.pptx
The approach at University of Liverpool.pptxThe approach at University of Liverpool.pptx
The approach at University of Liverpool.pptx
Jisc
 
Basic phrases for greeting and assisting costumers
Basic phrases for greeting and assisting costumersBasic phrases for greeting and assisting costumers
Basic phrases for greeting and assisting costumers
PedroFerreira53928
 
Introduction to Quality Improvement Essentials
Introduction to Quality Improvement EssentialsIntroduction to Quality Improvement Essentials
Introduction to Quality Improvement Essentials
Excellence Foundation for South Sudan
 

Recently uploaded (20)

How to Make a Field invisible in Odoo 17
How to Make a Field invisible in Odoo 17How to Make a Field invisible in Odoo 17
How to Make a Field invisible in Odoo 17
 
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
 
How to Split Bills in the Odoo 17 POS Module
How to Split Bills in the Odoo 17 POS ModuleHow to Split Bills in the Odoo 17 POS Module
How to Split Bills in the Odoo 17 POS Module
 
Language Across the Curriculm LAC B.Ed.
Language Across the  Curriculm LAC B.Ed.Language Across the  Curriculm LAC B.Ed.
Language Across the Curriculm LAC B.Ed.
 
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCECLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
CLASS 11 CBSE B.St Project AIDS TO TRADE - INSURANCE
 
Instructions for Submissions thorugh G- Classroom.pptx
Instructions for Submissions thorugh G- Classroom.pptxInstructions for Submissions thorugh G- Classroom.pptx
Instructions for Submissions thorugh G- Classroom.pptx
 
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXXPhrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
Phrasal Verbs.XXXXXXXXXXXXXXXXXXXXXXXXXX
 
Operation Blue Star - Saka Neela Tara
Operation Blue Star   -  Saka Neela TaraOperation Blue Star   -  Saka Neela Tara
Operation Blue Star - Saka Neela Tara
 
The Roman Empire A Historical Colossus.pdf
The Roman Empire A Historical Colossus.pdfThe Roman Empire A Historical Colossus.pdf
The Roman Empire A Historical Colossus.pdf
 
The Art Pastor's Guide to Sabbath | Steve Thomason
The Art Pastor's Guide to Sabbath | Steve ThomasonThe Art Pastor's Guide to Sabbath | Steve Thomason
The Art Pastor's Guide to Sabbath | Steve Thomason
 
2024.06.01 Introducing a competency framework for languag learning materials ...
2024.06.01 Introducing a competency framework for languag learning materials ...2024.06.01 Introducing a competency framework for languag learning materials ...
2024.06.01 Introducing a competency framework for languag learning materials ...
 
Template Jadual Bertugas Kelas (Boleh Edit)
Template Jadual Bertugas Kelas (Boleh Edit)Template Jadual Bertugas Kelas (Boleh Edit)
Template Jadual Bertugas Kelas (Boleh Edit)
 
Ethnobotany and Ethnopharmacology ......
Ethnobotany and Ethnopharmacology ......Ethnobotany and Ethnopharmacology ......
Ethnobotany and Ethnopharmacology ......
 
Additional Benefits for Employee Website.pdf
Additional Benefits for Employee Website.pdfAdditional Benefits for Employee Website.pdf
Additional Benefits for Employee Website.pdf
 
Synthetic Fiber Construction in lab .pptx
Synthetic Fiber Construction in lab .pptxSynthetic Fiber Construction in lab .pptx
Synthetic Fiber Construction in lab .pptx
 
MARUTI SUZUKI- A Successful Joint Venture in India.pptx
MARUTI SUZUKI- A Successful Joint Venture in India.pptxMARUTI SUZUKI- A Successful Joint Venture in India.pptx
MARUTI SUZUKI- A Successful Joint Venture in India.pptx
 
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
GIÁO ÁN DẠY THÊM (KẾ HOẠCH BÀI BUỔI 2) - TIẾNG ANH 8 GLOBAL SUCCESS (2 CỘT) N...
 
The approach at University of Liverpool.pptx
The approach at University of Liverpool.pptxThe approach at University of Liverpool.pptx
The approach at University of Liverpool.pptx
 
Basic phrases for greeting and assisting costumers
Basic phrases for greeting and assisting costumersBasic phrases for greeting and assisting costumers
Basic phrases for greeting and assisting costumers
 
Introduction to Quality Improvement Essentials
Introduction to Quality Improvement EssentialsIntroduction to Quality Improvement Essentials
Introduction to Quality Improvement Essentials
 

Bledsoe v1 ch05_lecture

  • 1. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Paramedic Care: Principles & Practice Volume 1, 5e Chapter 5 EMS Research
  • 2. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Standard • Preparatory (Research)
  • 3. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Competency • Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical–legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.
  • 4. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Solid and objective research program will drive EMS practices in the coming years. • Outcomes-based research: determine whether procedure, drug, treatment, strategy improves patient outcomes (mortality, morbidity, quality of life).
  • 5. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • National EMS Research Agenda (2001) – Develop EMS researchers; support them early in their careers – Collaboration between EMS researchers and other disciplines – Establish funding stream for EMS research within government
  • 6. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • National EMS Research Agenda (2001) – Establish alternate funding source for EMS research outside of government – Recognize need for EMS research – View research as necessary for improvement of patient care – Enhance ethical approaches to research
  • 7. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Introduction • Research – Key to maintaining focus on improving health of community in competitive and cost-conscious health care market. – Ensures best possible patient care provided in prehospital and out-of-hospital settings.
  • 8. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Research and the Scientific Method • Science: state or fact of knowledge derived through scientific method. • Research: use of scientific method to study given issue. • Scientific method: process by which scientists construct accurate representation of world; reliable, consistent, nonarbitrary.
  • 9. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Research and the Scientific Method • Steps of Scientific Method – Observe and ask questions. – Collect, analyze, synthesize data. – Construct hypothesis. – Test hypothesis by experimentation. – Analyze results and draw conclusions. – Revise hypothesis. – Report results.
  • 10. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 5-1 Steps of the scientific method.
  • 11. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Quantitative research: describes phenomena in numbers. • Qualitative research: describes phenomena in words. • Mixed research: combination of quantitative and qualitative research; uses both numbers and words to describe phenomena being studied.
  • 12. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-1 Summary of Research Types Quantitative Research Mixed Research Qualitative Research Scientific method Researcher tests the hypothesis with data (deductive approach) The researcher generates a hypothesis after collecting data (inductive approach) Deductive and inductive Focus Narrow topic Variable topic Wide topic Behavior Studied under controlled conditions Studied in more than one context Studied in natural environment Nature of reality Objective Commonsense (pragmatic) Subjective Nature of data Numbers Numbers and words Words Data analysis Statistical Statistical and words Words Results Generalizable May be generalizable Nongeneralizable Report Statistical Mixed Narrative
  • 13. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Most medical research is quantitative. • Retrospective research: examines information that already exists. • Prospective research: study starts now; examines what happens from this point forward.
  • 14. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Quantitative versus Qualitative Research – Quantitative research is objective and specific.  Determines relationship between one thing (independent variable) and another (dependent or outcome variable) and describes it with numbers (statistics).
  • 15. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Quantitative versus Qualitative Research – Quantitative research is objective and specific.  Independent variable: affects dependent variable under study.  Dependent variable (outcome): variable being affected.
  • 16. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Quantitative versus Qualitative Research – Nonexperimental quantitative research: independent variables that cannot be manipulated for one reason or another. – Survey-quantitative research: reflects public opinion for marketing and social science research.
  • 17. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Quantitative versus Qualitative Research – Qualitative research relies on collection of qualitative (nonnumeric) data.  Seeks "why" and not "how" of phenomena being studied  Occurs in natural setting  Role in quality assurance
  • 18. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Types of Research • Prospective versus Retrospective Studies – Retrospective studies: look at existing data. – Prospective studies: use research form or instrument specifically designed for study; objective, accurate, complete.
  • 19. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Experimental study: both control group (group of subjects who do not have manipulation of independent variable) and treatment (experimental) group. – Subjects randomly assigned to one group – Ensure demographics between groups similar
  • 20. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Quasiexperimental study: scientist does not randomly assign subjects to the study groups. – Greater chance of having groups demographically different, and of introduction of bias – Considered less valid than experimental studies
  • 21. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Observational study: does not have control group. – Single or multiple groups studied without comparison to control – Scientist does not control variables. – Less valid than experimental or quasiexperimental studies – Important role in medicine
  • 22. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Meta-analysis of randomized controlled trials: combined results of several prior studies. – Randomized controlled trials (RCTs): subjects randomized into treatment group and control group.  Single or double blind study
  • 23. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 5-2 Hierarchy of validity of study types. The most valid type of study is at the top of the pyramid, the least valid at the bottom.
  • 24. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 5-3 Meta-analysis is an analysis of the combined results of several prior studies.
  • 25. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Nonrandomized controlled trials: control group and treatment group; assignment to groups not randomized. – Also called quasiexperimental studies – Less validity than RCT, but utility in some circumstances
  • 26. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Cohort study: observational; subjects who have certain condition and/or who receive particular treatment followed over time; compared with another group not affected by condition.
  • 27. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Figure 5-7 A cohort is a group of subjects who share a certain characteristic. For example, all may be cancer patients. A cohort study observes and compares the cohort group with a group whose members do not have the cohort characteristic.
  • 28. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Cross-sectional study (analysis): observational; various groups compared without control; looks at single point in time. – Case series: looks at group of patients with similar condition.
  • 29. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Case report: structured study of single patient who is unique or interesting to medical community in general. – Expert opinions, editorials, rational conjecture: suitable for use before scientific research is available or while scientific research is occurring.
  • 30. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Animal research (in vivo): understanding how certain drugs and procedures affect biological systems.  Findings in one species do not necessarily apply to other species.  Computer modeling starting to replace aspects of animal research.
  • 31. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Specific Study Types – Bench research (in vitro): scientific research at most basic level; important in learning how universe functions. – Quality of research supporting clinical practice: stratify scientific evidence based on type and validity of experimental designs used.
  • 32. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Experimental Design • Study Validity – Validity: whether or how well study supports the conclusions – External validity : assures results can be generalized, or possess generalizability – Internal validity: ensures results can be attributed to the cause
  • 33. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Ethical Considerations in Human Research • While medical research essential, overriding concern is rights of those who serve as subjects in studies. • Nuremburg Code of 1947: first code to guide ethical practice in human research. • Tuskegee University experiments
  • 34. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Ethical Considerations in Human Research • Helsinki Declaration: subject makes informed decision about participating in research; assurance by researcher that patient's safety protected. • Ethical Principles and Guidelines for the Protection of Human Subjects of Research
  • 35. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Ethical Considerations in Human Research • Institutional Review Board (IRB) – Committee that approves, monitors, reviews human research – Goal is to protect human subjects. – Approves/disapproves study before it begins. – Requires researchers to modify or terminate study if subjects at risk.
  • 36. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Statistics: mathematics of collecting and analyzing data to draw conclusions and make predictions. – Descriptive statistics: describe basic features of data obtained in a study. – Inferential statistics: information from sampled observations of population; make conclusions about population.
  • 37. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Descriptive Statistics – Describe nature of sample. – Mean (average): add values, then divide sum by number of values involved. – Median: put the values into numerical order, then find middle value.
  • 38. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Descriptive Statistics – Mean and median: measures of central tendency; indicate center of group. – Variance: take each value, then subtract mean from it. – Standard deviation (SD or σ): take square root of variance. – Mode: most common value in set of data.
  • 39. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Inferential Statistics – Estimating parameters of population. – Sampling error: estimation of difference between value obtained from sample and value that would be obtained from entire population. – Confidence interval: variability added or subtracted to original proportion.
  • 40. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Quantitative and Qualitative Statistics – Qualitative statistics: data nonnumeric in nature; assigned number indicating ranking or ordering of importance or severity.  Nominal or ordinal data – Quantitative statistics: numerical in nature.
  • 41. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter An Overview of Statistics • Other Types of Data – T test – Analysis of variance (ANOVA) – Chi square test – Odds ratio: how strong association is between risk factor and condition it is associated with.
  • 42. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Format of a Research Paper • Abstract: need for study, research methods used, results encountered. • Introduction: description of pertinent, previously published papers on subject of investigation. – Why undertaken; purpose of study; what hypothesis authors wanted to test
  • 43. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-2 Research Paper Format for Some Emergency Medicine Journals Prehospital Emergency Care Annals of Emergency Medicine Academic Emergency Medicine Abstract Introduction Methods Results Discussion Conclusions References Abstract Introduction Methods Results Limitations Discussion References Abstract Introduction Methods Results Discussion Limitations Conclusions References
  • 44. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Format of a Research Paper • Methods section: how authors conducted study. • Results: researchers provide data (summary). • Discussion section: authors interpret findings; describe significance. • Summary (conclusion): brief recap of main findings of study.
  • 45. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter How a Research Paper Is Published • Submit to scientific journal for publication. • All peer-reviewed journals follow same general procedure. • After receiving paper, editor sends to one or more members of review board. • Reviewers blinded as to names of authors and affiliated institutions.
  • 46. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter How a Research Paper Is Published • Reviewers read paper; evaluate for adherence to standards of research methods, pertinence to field, value for practitioners. • Reviewers send comments to editor, who then decides whether to publish it, send it back for revisions, or reject it.
  • 47. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Accessing the Scientific Literature • Journal publishers have archived their publications online. – Can be downloaded as portable document files (PDFs) or directly. – Most journals require subscription or library affiliation to access. – Some are free (open-access journals).
  • 48. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Accessing the Scientific Literature • National Libraries of Medicine: accessible database of medical and scientific literature (PubMed). • Loansome Doc: document retrieval service accessed through web.
  • 49. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter What to Look for When Reviewing a Study • Was research peer reviewed? • Was there a clear hypothesis or study purpose? • Was study approved by IRB, and was it conducted ethically? • Was study type appropriate?
  • 50. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter What to Look for When Reviewing a Study • What population were the researchers studying? • What inclusion and exclusion criteria did researchers use? • How did investigators draw their sample? • How many groups were patients divided into; were patients assigned to control and study groups properly?
  • 51. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter What to Look for When Reviewing a Study • Were control and study groups the proper size? • Were effects of confounding variables (other things that may have affected study outcome) taken into account? • What kind of data did investigators collect; did they analyze data with proper statistical tests?
  • 52. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter What to Look for When Reviewing a Study • Were results reported properly? • How likely is it that the study results would occur by chance alone? • Are author's conclusions logical and based on the data? • How good was EMS system in which study was done?
  • 53. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Applying Study Results to Your Practice • Evaluate the field and its knowledge base to make informed decision about how to interpret a piece of research. • Distinguish between statistical and clinical significance of the study.
  • 54. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Applying Study Results to Your Practice • Be sure patient similar enough to study group to benefit from intervention. • Speak to management of your organization, especially medical director.
  • 55. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Participating in Research • Determine the question. • Prepare hypotheses (null/research). • Decide what you wish to measure and how you will do it. • Define population. • Identify limitations of your study.
  • 56. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Participating in Research • Get approval of proper authorities (IRB/principal investigator [PI]). • Determine how you will get informed consent from study subjects. • Gather and analyze data. • Determine what you will do with results.
  • 57. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Evidence-Based Decision Making • Use of best practices and clinical pathways based on clinical and scientific evidence ensures care is safe, efficacious, cost-effective. • Formulate question about appropriate treatments. • Medical literature searched and organized.
  • 58. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Evidence-Based Decision Making • Scientific evidence stratified based on validity and reliability. • If evidence supports change in practice, change is made. • Once practice changed, ongoing evaluation must be carried out.
  • 59. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-5 Applying Classification of Recommendations and Level of Evidence (1 of 4) Size of Treatment Effect Class I Class IIa Class IIb Class III EstimateofCertainty(Precision)of TreatmentEffect Benefit >>> Risk Procedure/ Treatment SHOULD be performed/ Administered Benefit >> Risk Additional studies with focused objectives needed IT IS REASONABLE to perform procedure/ administer treatment Benefit ≥ Risk Additional studies with broad objectives needed; Additional registry data would be helpful IT IS NOT UNREASONABL E to perform procedure/ administer treatment Risk ≥ Benefit No additional studies needed Procedure/ Treatment should NOT be performed/admi nistered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL
  • 60. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence (2 of 4) Size of Treatment Effect Class I Class IIa Class IIb Class III EstimateofCertainty(Precision)of TreatmentEffect Level A Multiple (3–5) population risk strata evaluated General consistency of direction and magnitude of effect • Recommendati on that procedure or treatment is useful/effective • Sufficient evidence from multiple randomized trials or meta- analyses • Recommendati on in favor of treatment or procedure being useful/effective • Some conflicting evidence from multiple randomized trials or meta- analyses • Recommendation's usefulness/ efficacy less well established • Greater conflicting evidence from multiple randomized trials or meta-analyses • Recommend- ation that procedure or treatment not useful/effective and may be harmful • Sufficient evidence from multiple randomized trials or meta- analyses
  • 61. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence (3 of 4) Size of Treatment Effect Class I Class IIa Class IIb Class III EstimateofCertainty(Precision)of TreatmentEffect Level B Limited (2–3) population risk strata evaluated • Recommend- ation that procedure or treatment is useful/effective • Limited evidence from single randomized trial or non- randomized studies • Recommend- ation in favor of treatment or procedure being useful/effective • Some conflicting evidence from single randomized trial or nonrandomized studies • Recommendation's usefulness/efficacy less well established • Greater conflicting evidence from single randomized trial or nonrandomized studies • Recommendati on that procedure or treatment not useful/effective and may be harmful • Limited evidence from single randomized trial or non- randomized studies
  • 62. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Table 5-5 (continued) Applying Classification of Recommendations and Level of Evidence (4 of 4) Size of Treatment Effect Class I Class IIa Class IIb Class III EstimateofCertainty(Precision)of TreatmentEffect Level C Very limited (1–2) population risk strata evaluated • Recommendati on that procedure or treatment is useful/effective • Only expert opinion, case studies, or standard of care • Recommendati on in favor of treatment or procedure being useful/effective • Only diverging expert opinion, case studies, or standard of care • Recommendatio n's usefulness/effica cy less well established • Only diverging expert opinion, case studies, or standard of care • Recommendati on that procedure or treatment not useful/effective and may be harmful • Only expert opinion, case studies, or standard of care
  • 63. Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved. Bryan E. Bledsoe Richard A. Cherry Robert S. Porter Summary • Solid, well-conducted scientific research is key to improving prehospital care. • It is essential to prove paramedics make a difference in terms of reducing mortality, morbidity, pain, and suffering. • Benefit: increased revenue stream. • Future of EMS depends on aggressive research program.

Editor's Notes

  1. Discussion Topics Using an example of a research topic, take students through the scientific method.
  2. Points to Emphasize Explain to the students the importance of all types of research, and how EMS applies these types to the current research.
  3. Class Activities With the class, write out an independent variable that the students can research. This could be the 10-minute scene time for major trauma, 8-minute ALS response time, etc. Have the students decide what type of research would allow the most reliable information.
  4. Discussion Topics Discuss with the students the different types of studies. Use these to have the students come to conclusions on which studies would be safest for the patient.
  5. Discussion Topics Discuss with the students the Nuremburg Code of 1947 and the Tuskegee University studies.
  6. Knowledge Application Give the students the key terms and assign the definitions for homework. In addition, have them give an example for each term.
  7. Knowledge Application For homework, have the students write out the format of a research paper on the subject of your choice.
  8. Discussion Topics Bring in a scientific journal (JEMS, etc.) so that the students can review a published study. Discuss the findings as a group.
  9. Class Activities Go online with the students to PubMed to look up a research paper of your choice.
  10. Discussion Topics Discuss with your students the information in Table 5-3 of this chapter. Allow them to respond to the questions with yes or no. Then lead a discussion on why the research may not be valid with negative answers.
  11. Class Activities As a group, write out a "mock" consent form for research study participants.
  12. Source: Circulation. http://circ.ahajournals.org/manual/manual_IIstep6.shtml