- Evidence-based practice involves making clinical decisions based on the best available evidence from research studies while also considering patient preferences and clinical expertise.
- There are five key steps to evidence-based practice: asking questions, finding evidence, critically appraising evidence, applying evidence to individual patients, and evaluating outcomes.
- Efficacy studies examine treatment effects under ideal laboratory conditions while effectiveness studies examine real-world outcomes, which are ultimately more important for evidence-based practice.
A pilot study as on experimental exploratory, test , preliminary , trial or try out investigation.
A trial study carried out before a research design is finalized to assist in defining the research questions or to test the feasibility, reliability and validity of proposed study design.
A small scale study conducted to test the plan and method of a research study.
Challenges in commissioning research on what works in integrated careHTAi Bilbao 2012
Challenges in commissioning research on what works in integrated care.
Tara Lamont, Scientific Adviser
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC)
www.netscc.ac.uk
A pilot study as on experimental exploratory, test , preliminary , trial or try out investigation.
A trial study carried out before a research design is finalized to assist in defining the research questions or to test the feasibility, reliability and validity of proposed study design.
A small scale study conducted to test the plan and method of a research study.
Challenges in commissioning research on what works in integrated careHTAi Bilbao 2012
Challenges in commissioning research on what works in integrated care.
Tara Lamont, Scientific Adviser
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC)
www.netscc.ac.uk
Auditory brainstem response (ABR)
Approximately 1 of every 1000 children is born deaf. Many more are born with less severe degrees of hearing impairment, while others may acquire hearing loss during early childhood.
combination of technological advances in ABR and otoacoustic emissions (OAE) testing methods are used for evaluation of hearing in newborns.
RESEARCHQUIET TIME IN NEURO ICU 5Running Head RESEARCH ICU QU.docxdebishakespeare
RESEARCH:QUIET TIME IN NEURO ICU 5
Running Head: RESEARCH: ICU QUIET TIME 1
Researchable Topic: ICU Quiet time
Ese Nosakhare
Nurs-6052N Essentials of Evidence-Based Practice
June 13, 2015
Researchable Topic: ICU Quiet time DS Dr. Sullivan Title needed when you begin on page two. This title should be the same as the title page, centered and not bolded
The identification of research problem is the first and foremost step that every researcher has to undertake. What is hard for a nurse to do in evidence-based practice (EBP) is coming up with a clinical question that can be answered with research evidence (Polit & Beck, 2012). Knowing this, a clinical question that is patient focuseds and important significant to nursing can help obtain the knowledge needed to addressing the needs of certain patient populations (Thibane, Thomas & and Ye, 2009). A nurse making a clinical question that can be answered requires a game plan that can identify pertinent nursing issues. Furthermore, the nurse must put that nursing issue into an easy format to research. Doing so will endure allow the best evidence to realize EBP (Richardson, 2009). Analyzing present issues in nursing connected to evidence based practices for ICU delirium, a nurse should have the capability to identify certain steps in making a well-rounded clinical question that is structured and focusesd on the key features to help complete evidence based practice DS Dr. Sullivan Your introductory paragraph is good but you could make it better by including one sentence that clearly defines the purpose of the paper. This is usually the last sentence in the introductory paragraph.
.
Developing a research problem is a creative process (Polit and Beck, 2012, p.76). Neuro-trauma ICU patients typically have an increased need for sleep. However, the ICU setting predisposes ICU patients to sleep deprivation due to exposure to bright lights, high noise levels, regular intrusion of staff and visitors, and patient care activities. Current evidence suggests that a relationship exists among sleep, delirium, and mortality DS Dr. Sullivan Use of resources or references would have added credibility to your discussion
. Delirium is commonly linked to higher medical costs, increased risk for death and extended stays DS Dr. Sullivan Need a citation . There has not been a direct link between lack of sleep and delirium has yet to be proven. Current knowledge that sleep deprivation affects cognitive function, points to a very direct connection between the two. Extended hospital stays, increased medical costs, and high risk for mortality have been associated with delirium DS Dr. Sullivan Need a citation . Nurses can assist with decreasing the incidence delirium in ICU patients by using simple methods and hence help improve health outcomes. Some of these methods include turning off lights or dimming them, reducing noise levels, reducing the number of visits/intrusions, proper positioning of ...
Baker what to do when people disagree che york seminar jan 2019 v2cheweb1
Public values, plurality and health care resource allocation: What should we do when people disagree? (..and should economists care about reasons as well as choices?) CHE Seminar 21 January 2019
Context matters in the practice of interpreting but too often the complexities and implications of context are not adequately defined in interpreter training. Instead, learning about the many and varied contexts that interpreters are called into is left to on-the-job experience.
Over the last twenty years, Robyn Dean and Robert Pollard have offered practitioners, educators, and trainers ways to identify and talk about the interpreting context and how to more effectively prepare interpreters for working in those contexts. Much of that work has been devoted to the contexts of medical and mental health.
This presentation explains how medical interpreting educators can help to not only define context but teach it and assess practitioners’ ability to understand and apply it in professional practice. As medical education has worked to improve the clinical skills of providers so too should medical interpreter education. This can happen by bringing interpreter practitioners incrementally closer to the medical contexts, that is to improve and assess their clinical skills.
Auditory brainstem response (ABR)
Approximately 1 of every 1000 children is born deaf. Many more are born with less severe degrees of hearing impairment, while others may acquire hearing loss during early childhood.
combination of technological advances in ABR and otoacoustic emissions (OAE) testing methods are used for evaluation of hearing in newborns.
RESEARCHQUIET TIME IN NEURO ICU 5Running Head RESEARCH ICU QU.docxdebishakespeare
RESEARCH:QUIET TIME IN NEURO ICU 5
Running Head: RESEARCH: ICU QUIET TIME 1
Researchable Topic: ICU Quiet time
Ese Nosakhare
Nurs-6052N Essentials of Evidence-Based Practice
June 13, 2015
Researchable Topic: ICU Quiet time DS Dr. Sullivan Title needed when you begin on page two. This title should be the same as the title page, centered and not bolded
The identification of research problem is the first and foremost step that every researcher has to undertake. What is hard for a nurse to do in evidence-based practice (EBP) is coming up with a clinical question that can be answered with research evidence (Polit & Beck, 2012). Knowing this, a clinical question that is patient focuseds and important significant to nursing can help obtain the knowledge needed to addressing the needs of certain patient populations (Thibane, Thomas & and Ye, 2009). A nurse making a clinical question that can be answered requires a game plan that can identify pertinent nursing issues. Furthermore, the nurse must put that nursing issue into an easy format to research. Doing so will endure allow the best evidence to realize EBP (Richardson, 2009). Analyzing present issues in nursing connected to evidence based practices for ICU delirium, a nurse should have the capability to identify certain steps in making a well-rounded clinical question that is structured and focusesd on the key features to help complete evidence based practice DS Dr. Sullivan Your introductory paragraph is good but you could make it better by including one sentence that clearly defines the purpose of the paper. This is usually the last sentence in the introductory paragraph.
.
Developing a research problem is a creative process (Polit and Beck, 2012, p.76). Neuro-trauma ICU patients typically have an increased need for sleep. However, the ICU setting predisposes ICU patients to sleep deprivation due to exposure to bright lights, high noise levels, regular intrusion of staff and visitors, and patient care activities. Current evidence suggests that a relationship exists among sleep, delirium, and mortality DS Dr. Sullivan Use of resources or references would have added credibility to your discussion
. Delirium is commonly linked to higher medical costs, increased risk for death and extended stays DS Dr. Sullivan Need a citation . There has not been a direct link between lack of sleep and delirium has yet to be proven. Current knowledge that sleep deprivation affects cognitive function, points to a very direct connection between the two. Extended hospital stays, increased medical costs, and high risk for mortality have been associated with delirium DS Dr. Sullivan Need a citation . Nurses can assist with decreasing the incidence delirium in ICU patients by using simple methods and hence help improve health outcomes. Some of these methods include turning off lights or dimming them, reducing noise levels, reducing the number of visits/intrusions, proper positioning of ...
Baker what to do when people disagree che york seminar jan 2019 v2cheweb1
Public values, plurality and health care resource allocation: What should we do when people disagree? (..and should economists care about reasons as well as choices?) CHE Seminar 21 January 2019
Context matters in the practice of interpreting but too often the complexities and implications of context are not adequately defined in interpreter training. Instead, learning about the many and varied contexts that interpreters are called into is left to on-the-job experience.
Over the last twenty years, Robyn Dean and Robert Pollard have offered practitioners, educators, and trainers ways to identify and talk about the interpreting context and how to more effectively prepare interpreters for working in those contexts. Much of that work has been devoted to the contexts of medical and mental health.
This presentation explains how medical interpreting educators can help to not only define context but teach it and assess practitioners’ ability to understand and apply it in professional practice. As medical education has worked to improve the clinical skills of providers so too should medical interpreter education. This can happen by bringing interpreter practitioners incrementally closer to the medical contexts, that is to improve and assess their clinical skills.
What if we never agree on a common health information model?Koray Atalag
In this talk I will touch on some hard problems in health informatics around working with structured data and why we can’t link and reuse them with ease. The essence of the problem is that, while clinicians can perfectly understand each other, IT systems can’t. Traditional IT requires formally defined common terminology, meta-data, data and process definitions. While Medicine is mostly accepted as positive science, yet the great variation in the body of knowledge and practice is often seen as ‘Art’. Ignoring this bit, IT people tend to develop all-inclusive common information models (almost always too complex to implement) and expect everybody adhere to that. Clinicians love to do things a bit differently and of course don’t buy into that! Maybe they are right! Maybe we don’t have to agree on a uniform model at all. This is the basic assumption of the openEHR methodology which I will describe by giving clinical examples. The main premise of this approach is to effectively separate tasks of healthcare and technical professionals. Clinicians can easily define their information needs as they like using visual tools – called Archetypes which are essentially maximal data sets. These computable artefacts, built using a well defined set of technical building blocks, are then fed into the technical environment to integrate data or develop software. Lastly the free web based openEHR Clinical Knowledge Manager portal provides collaborative Archetype development and ensures semantic consistency among different models.
Citations & google my business for audiology marketingGeoffrey Cooling
One of the presentations we undertook at the audiology marketing master class events in the UK in 2015. This presentation focused on why citations and Google My Business profiles are imperative for your online audiology marketing strategy
Pay Per Click & social media in Audiology MarketingGeoffrey Cooling
One of the presentations we presented at the Digital Audiology Marketing Master Class in the UK in 2015. This presentation discusses the best manner in which to use AdWords to drive online leads and conversions in your online audiology marketing strategy. It outlined best practice to focus the targeting of adverts and customising landing pages to ensure high Advert Quality. It also briefly discusses social media and FaceBook marketing.
Recent content creation for Audiology presentation delivered at the Digital Audiology Marketing Master Class in the UK.
The presentation covers the need for content in an online audiology marketing strategy. The presentation covers why relevance is hugely important in a search engine ranking strategy and how Search engine optimisation has changed to reflect both semantic search and localisation. The presentation also covered the use of webpage design elements such as social proof and stand out Call To Action elements to increase conversion.
An article I undertook pertaining to on line marketing strategy for audiology practices. The article appeared in Audiology Practices, the official publication of The Academy of Doctors of Audiology
Social media & marketing for audiological PracticesGeoffrey Cooling
The article covers the case for engagement in online marketing channels for the Audiological profession. It also details the channels and channel strategies that may be followed. It was first published in ENT & Audiology News 2012
6. Decision-making…… Hearing aid choice Widex’ focus is on providing the best possible starting point for making the clinical decisions involved in helping the client. We follow evidence-based practice (EBP) that links best available evidence with patient choice and individual clinical judgment (ref: Thorne, P.R 2002) Hearing aid choice Decision - making
7. Traditional vs. EBP Differences To determine what treatment to use for a particular patient… Traditional approach: ……clinicians rely on their past experience or their knowledge of hearing disorders, check in a textbook, or ask an expert for advice. EBP approach: ....the choice of treatment for an individual should be based whenever possible on specifically relevant current data.
8. Do we have evidence to … …answer any of these questions: Is adaptive directional technology better than fixed polar pattern? Does digital noise reduction provide patient benefit? Can a hearing aid help tinnitus patients? Are low knee-points better than high? Is frequency transposition better than frequency compression?
12. Efficacy….. Evidence measured under laboratory or ideal conditions The efficacy of a treatment is how well it can work given the best possible scenario.
13. Efficacy….. Example: Comparison between an adaptive directional microphone system and an omnidirectional microphone in an anechoic room. Speech Noise
15. Effectiveness….. Example Comparison between an adaptive directional microphone and an omnidirectional microphone in real life situations. Questionnaire
16. Treatment efficacy vs. effectiveness Most important treatment A treatment with acceptable efficacy is not necessarily effective in the real world with real patients…… …….In the final analysis, treatment effectiveness is more important than treatment efficacy for evidence-based practice.
Welcome to this presentation on evidence-based practice. Evidence-based practice has its origin in Evidence Based Medicine, and has been a well-known approach in the pharmaceutical industry for many years. Evidence-based practice has been discussed in the audiological field for the last 5 years. Widex has carried out several dispenser focus group surveys in different countries – and the feedback was clear – all dispensers asked for more evidence to support their hearing aid choice. Evidence to support a hearing aid choice is the fundamental approach to evidence-based practice ....
After completing this presentation you will be able to : Explain the fundamental elements in evidence-based practice Identify the different steps of evidence-based practiceDescribe the difference between effectiveness and efficacy studies
This presentation is about decisions in the selection and fitting process. This is illustrated with the case of Ethel Tibbet, who is 75 years old. She lives alone. Ethel has bilateral moderate presbycusis. She has worn hearing aids for 10 years. She has a hard time following conversation, which is increasingly annoying for her family. Her family wants to know if the ”new” hearing aids will help Mrs. Tribett more….[click] The question is …..what should be the clinician’s recommendation and decision…..Evidence-based practice supports the clinician in the decision-making in the selection and fitting process……….
Widex’ focus is on providing the best possible starting point for making the clinical decisions involved in helping the client. We follow evidence-based practice. It’s important to understand three issues about evidence-based practice. First, “best available evidence”, which ideally refers to well-designed, patient-centred clinical research on the efficacy and effectiveness of rehabilitative treatments for hearing loss. This includes such matters as prescriptive fitting methods, technological innovations, audiological rehabilitation services, etc. Secondly, practitioners must use clinical acumen and rapport-building skills to describe and clarify each patient’s particular problems and circumstances, as well as their personal priorities and viewpoint. Thirdly, in EBP, these two types of knowledge (research results and patient specifics) are integrated in the optimal way for each individual. This means extracting the research evidence that is relevant to the patient’s situation and applying it prudently with consideration for what is likely to work in this unique set of circumstances.[click] According to Robin Cox ….Evidence-based practice (EBP) is the process by which audiologists make patient treatment decisions based on a careful study of the clinical evidence to make the right hearing aid choice
To determine what treatment to use for a particular patient, the clinician can call on their past experience or their knowledge of hearing disorders, check in a textbook, or ask an expert for advice. This traditional approach values expert opinion and standard approaches to care. EBP reflects a different mindset. It recognises that learning good clinical skills is essential for successful practice. However, the choice of treatment for an individual should be based, whenever possible, on specifically relevant current data. A fundamental tenet of the EBP approach is that clinicians can and should learn to evaluate the evidence from original research to answer their clinical questions and select optimal treatments for each patient.
Many questions arise when a clinician fits hearing aids and the perspective is ……do we have evidence to answer any of these questions. The questions could be [click] …………..are low knee-points better than high?……….. [click] Is frequency transposition better than frequency compression?……….. [click] Can a hearing aid help tinnitus patients ?Knowing the best current evidence on a topic provides justification for a clinician’s recommendations…….
The basic principle behind evidence-based practice is that ...it tackles one problem and one patient at a time
There is a widely accepted five-step agenda for tackling each problem
I will go through this five-step agenda shortly……[click] but please remember Mrs. Tribett who had a hard time following conversation. Her family wanted to know if the new hearing aid could help Mrs. Tribett more. This new hearing aid could for example be mind440….. The approach to evidence-based practice is….. [click] Formulate a focused and answerable question…. [click] Search for the best available evidence……[click] Evaluate evidence for validity and relevance……. [click] make recommendations by combining collected evidence, clinical expertise and user requirements……….. [click] evaluate the results and determine ways to improve……If we take a closer look at how to evaluate evidence……[click][click] an option is to categorise according to efficacy, which is evidence measured under ideal conditions …like laboratory conditions…….…. [click] or according to effectiveness, which is evidence measured in the real world.I will now explain the terminology efficacy and effectiveness in more details…….
The efficacy of a treatment is how well a feature or hearing aid CAN work given the best possible scenario………
This is an example of an efficacy set-up. We want to make a comparison between an adaptive directional microphone system and an omnidirectional microphone. [click] The hearing impaired person is placed in an anechoic room [click] with a speaker in front playing speech [click] and a speaker behind playing noise. The omnicirectional microphone will pick up noise and speech, whereas the directional microphone system will be able to zoom in on the speech from in front and dampen the noise.
The effectiveness of a treatment is how well a feature or hearing aid works in the real world.
In the effectiveness set-up, the hearing impaired is asked to try out both settings in real life situations. [click] The hearing impaired is in this case trying to follow a conversation from an actual speaker [click] in everyday sounds and noises [click]….[click] Finally he is asked to fill out a questionnaire to evaluate whether the adaptive directional michrophone helps when trying to follow a conversation in a noisy environment.
It’s important to remember that a treatment with acceptable efficacy is not necessarily effective in the real world with real patients…..and in the final analysis, treatment effectiveness is more important than treatment efficacy for evidence-based practice.
So - just to summarise the essentials of this presentation:The fundamental elements in evidence-based practice link best available evidence with patient choice and individual clinical judgment...The different steps of evidence-based practice is a five step agenda.Effectiveness is defined by how well a feature or hearing aid works in real life situations and efficacy by how well it can work under ideal conditions.